When severely injured or suffering from a grave, debilitating illness, working for an income can become considerably difficult. For some conditions, working and gainful activity are impossible. Unfortunately, not being able to work doesn’t change the fact that you have bills to pay, stomachs to feed, and other financial obligations. For these reasons, a long-term disability (LTD) insurance policy can be a life-saver. Whether you have LTD insurance through a private policy or an employer’s group policy, filing for LTD disability benefits can help ensure that you have an income even though you’re unable to work.
At Herren Law, Houston LTD disability attorney William Herren has worked on hundreds of disability insurance cases, successfully helping residents in the Greater Houston area achieve essential benefits for their disabilities. We boast an extensive network of legal resources and in-depth knowledge of various LTD insurance policies, how they work, and how you can continue fighting for benefits even after you receive your first LTD benefits claim denial. To speak with attorney Herren regarding your disability and your LTD insurance policy, call our Houston office today at (713) 682-8194.
We work on a contingency basis, and you will not be charged a fee unless you win a case with us at your side.
Basics of an LTD Insurance Policy
If you’re covered by an LTD insurance policy and you’re unable to work, you are entitled to monthly disability benefits of between 50% and 80% of your prior earnings. The first step in filing a disability claim, however, is to obtain a copy of your LTD policy. If you have an employer group policy, you should also obtain the summary plan description from your employer’s human resources department. If you have an individual plan, you can get the plan documents by sending a written request directly to your insurance provider.
Definitions of Disability in an LTD Policy
In most cases, LTD insurance policies fall into two categories, including 1) an inability to perform your current (“own”) occupation and 2) an inability to perform any occupation. Furthermore, the definition of disability in most plans includes phrasing such as, “a disability that prevents an individual from performing, for wage or profit, the material or substantial duties of the individual’s regular occupation.”
In this case, if you receive a mental or physical disability and are unable to perform the duties of your job (although you could technically perform the duties of another job), you may still be entitled to disability benefits. The definition of disability in “any occupation” is definitely more strict, requiring stronger evidence proving your inability to work in any capacity.
It is also important to note that many LTD policies switch from “own occupation” to “any occupation” after 24 months, meaning that after 24 months of receiving disability benefits, your policy may become more strict and you may lose coverage if the insurance company concludes that you can perform a job, even if it’s not your current occupation.
The Exclusions and Limitations of an LTC Policy
Another key to understanding an LTD policy is knowing the various limitations and exclusions found in many LTD insurance policies. Once again, it is always essential to thoroughly examine the details of your policy. For example, some common exclusions and limitations among many LTD policies include:
- Mental disorders and conditions— In many cases, benefits for mental conditions are capped at 24 months, though there are exceptions for conditions such as schizophrenia and organic brain diseases.
- Pre-existing conditions — Nearly all policies have exclusions for pre-existing conditions.
- Waiting period — Many LTD policies also contain an “elimination period,” which is essentially a period of time where you’re qualified for disability but unable to receive benefits. Often, the limitation period lasts for about six months.
- Duration of benefits — Many LTD policies pay benefits until the claimant reaches 65 years of age, though some only pay for a certain number of years.
- Social Security disability — If you’re filing for LTD benefits, you may be required to also file for Social Security Disability Insurance (SSDI) benefits. The insurance company may offset the SSDI benefits against the LTD amount.
- Taxability of benefits — Whether LTD benefits are taxed may depend on whether your premiums are paid with before-tax or after-tax dollars.
Appealing a Denial for a Long Term Disability Claim
Benefit claims denials are fairly common, and if you receive a denial, your best option to continue fighting for benefits is to submit an appeal. Often, the denial notice will also contain any deadlines or other information regarding the appeals process. If you want to take the case to federal courts, however, you need to exhaust all possible options with your insurance company, including internal appeals.
Call Houston Disability Attorney William Herren
From the beginning of your LTD claim to pursuing a case in federal courts, it’s always essential to have a prominent and experienced LTD benefits attorney at your side. With the help of Houston attorney William Herren, you are assured a leading expert who has helped hundreds of individuals successfully win their benefits, whether at the negotiating table or in state or federal courts. If you’re applying for LTD benefits, make sure to call our Houston law firm today at (713) 682-8194. Free consultations are always available, and we work on a contingency basis, meaning that you don’t pay any fees unless you win your case with us by your side.
