After an injury, illness, or other disabling incident, many people are not able to continue their regular employment. For individuals without disability insurance, this may mean seeking Social Security disability payments, which offers minimal benefits. However, for employees with long-term and short-term disability coverage, they may be able to receive benefits sufficient to provide for themselves and their family.
Employer-Provided Disability Insurance
Disability insurance generally provides benefits to individuals who are not able to work because of a disabling disease or illness. Benefits generally come in the form of payments as a percentage of the workers' salary or income before they filed a disability claim.
Disability insurance plans vary greatly depending on the type of plan, extent of coverage, and whether the coverage is provided by the employee or employer. Most employer-provided disability plans fall under ERISA, a federal law which protects individuals who receive private health, pension, and disability plans. ERISA regulations mandate certain protections, including detailing the application process.
Employers should review their company's Summary Plan Description (SPD) or Summary of Benefits and Coverage (SBC). This should provide specific information on how to apply for disability, including deadlines, and waiting periods. It should also include minimum and maximum benefits, and coverage periods. Disability benefits are generally categorized as short-term or long-term.
Applying for Short-Term Disability
Short-term disability coverage is more common that long-term disability insurance; however, some employers provide both. Short-term disability provides benefits for individuals who are temporarily ill or injured. These policies generally provide coverage for up to 3 to 6 months and may require a waiting period before benefits begin.
Before applying for short-term disability, review your plan policies to ensure your situation is covered. Some causes of short-term disability may be excluded from coverage, including recovery from cosmetic surgery, or self-inflicted injury.
Applications generally require submitting a paper or electronic form. These forms may have separate sections to be filled out by the employer, employee, and physician. The employer's part of the application may include information about the employer's insurance policy, as well as the employee's insurance coverage, earnings, and job status.
The employee's section of the claim form may include information about how the incident occurred, how the disability prevents them from working, and whether the disability may be work related. The employee may also have to indicate any other benefits they are receiving from Social Security, workers' compensation, or other disability or pension plans.
An attending physician may also be required to submit information about the employee's diagnosis, symptoms, medical history, treatment, prognosis, and level of functional impairment. These forms may also use the employee's signature to act as a release for medical records.
Applying for Long-Term Disability
Long-term disability generally applies to long-term injuries and debilitating illnesses that keep the individual from returning to work for months, years, or in some cases prevent them from ever returning to gainful employment. The waiting period for a long-term claim may take up to 90 days to process.
Similar to the application for short-term disability, long-term disability claim applications generally require submitting paper or electronic forms. However, long-term disability claims may undergo much more scrutiny than a short-term disability claim. The applicant should review their benefits plan description to ensure their disability is covered.
Long-term disability applications may require statements and forms to be filled out by the employee, the attending physician, and the employer. The claim forms may also require the employee to sign a release to obtain medical information, as well as information from a psychiatrist or psychologist.
The physician's statement generally includes information about the diagnosis, symptoms, and medical history. It may also include a summary of the doctor's assessment that the patient stop working or limit activities, planned course of treatment, and prognosis.
It is important for the applicant to understand the questions and terminology of these forms before filling them out. Entering incorrect information can result in a denial of the individual's disability claim, which may make it more difficult to obtain coverage even if the information was entered as a mistake. You may want to contact an attorney if you have any questions about filling out or signing these disability claim forms.
Possible Red Flags in Disability Applications
Many people who file a disability claim have never done so before and are unfamiliar with the process. They may believe that because they are disabled, simply filling out the form will ensure they receive the disability benefits they have earned. However, these applications go through a review process that may end up denying valid disability claims.
There are a number of reasons why a disability claim may be denied. The insurance company may believe another party is responsible and should pay damages for the injury. They may also dispute your doctor's findings and not consider the injury or illness disabling. Others may be denied based on an administrative error, leaving the disabled worker without benefits until they hire an attorney to clear up the mistake.
Before filing a disability claim, make sure you have all the information and evidence necessary to support your claim. Do not rely solely on the insurance disability application forms to support your claim. Make sure you document your disability and keep a personal record of supporting documentation.
Another problem that may compromise your disability claim is relying on the “advice” of others who may not fully understand the process. Some people rely on friends or family to help them fill out an application, claiming they know what the insurance company needs to see to grant the application. This could result in false or incorrect information that could result in the insurance company denying the claim.
Disability insurance is in place to protect you and your family in the event of an unexpected illness or injury. You should not rely on your insurance company or your employer to make sure your best interests are protected. Those businesses may end up only doing what is best for their bottom line. The only other advocate you may have to represent you and only you is an experienced ERISA disability benefits attorney.
ERISA Disability Benefits Attorney
Greg Paul has 16 years of experience fighting for short- and long-term disability benefits against the insurance companies. We represent individuals and families who have been denied benefits by their insurance company or plan administrator. You have a limited time to appeal your disability denial, so do not delay. If you have been denied short-term or long-term disability benefits, contact our office for a free consultation.