Archives for December 2017

Can I Receive Long Term Disability While on FMLA Leave?

If you find yourself needing to take time from your job for an illness, injury, pregnancy or other reason, there are a lot of things you’ll need to address. Replacing your income via disability insurance is one important factor to consider, particularly if your leave is unexpected. Here are some things to know when going on FMLA leave.

Can I Receive Long Term Disability While on FMLA Leave?

Long Term and Short Term Disability are two separate insurance policies that many people get through their employer. They’re used separately as well as in conjunction when you’re injured and can’t work.

To better answer this question, let’s examine the parts of it first.

FMLA

The Family Medical Leave Act of 1993 (FMLA) is a law that allows workers 12 weeks of unpaid leave for a variety of medial or family reasons. Your job is protected because your employer is required to hold your job for those 12 weeks. (Many states, localities and municipalities have also adopted their own supplemental “family leave” styled policies.) When you’re able to go back to work, you’ll return to that job or one that is “substantially similar,” assuming you are still able to do your job after your leave is over. You’ll have job reinstatement rights and continued health coverage during the 12-week period (but not after.)

FMLA leave is generally unpaid, although there are some employers who pay during the leave time. However, your health coverage and other benefits are still in place as if you’d never left (although you may be required to pay your portion if your employer covers most of it.)

The FMLA applies to companies with 50 or more employees who work within 75 miles of the company’s location. You must have worked for 12 months in the preview year, totaling at least 1,250 hours, part or full time.

Notification should be given to your company at least 30 days in advance, if possible. (This is for cases like pregnancy, scheduled surgery, etc.) FMLA leave can also be used intermittently, for medical treatments that can’t be done off-hours, physical therapy, etc. Your personnel department can advise you about the best way to schedule this leave and when to notify your supervisor that you’ll be using it.

Short Term Disability

Short Term Disability (STDI) is an income replacement insurance offered as a benefit by many companies, and isn’t available for purchase as an individual policy. STDI partially replaces your income (usually about 60% to 65%) for your immediate financial needs until you are able to return to work.

STDI lasts anywhere from 30 to 180 days, and doesn’t start until after you’ve used up all of your paid time off (sick time, vacation, etc.) Decisions are quick, and payments usually start within about 14 days. A lot of what and how long you’ll receive benefits depends on how your employer structures the benefit policy.

On-the-job injuries are covered under Worker’s Compensation.

Long Term Disability

Long Term Disability (LTD) is an income replacement insurance that begins when your short-term disability ends. LTD is both an employee benefit at many companies as well as a policy you can purchase yourself.

This type of coverage pays you a reduced amount of your salary (generally two-thirds) for the length of your disability. Most disabilities last anywhere from six months to three years, but some may be lifelong disabilities. Your policy will cover you according to how it’s structured. Depending on your disability, LTD could replace your income until you reach retirement age.

Generally, LTD policies require that you exhaust your STDI coverage before you can receive LTD payments, and there isn’t any “overlap.” The LTD elimination period is anywhere from one month to one year.

So To Answer The Question

It Depends.

FMLA leave only lasts 12 weeks (about 3 months) so most of it will depend on how long your STDI coverage lasts. If your STDI coverage is less than 120 days, you’ll have to apply for LTD after the STDI coverage ends, and you have no other “coverage” available (savings, lines of credit, etc.)

Should your STDI coverage last less than the 12 weeks, and you need to cover the rest of your leave with LTD, it is possible to use LTD during an FMLA period.

If You Need Help

Call The Herren Law Firm at 713-682-8194. We’ll be happy to help you with claims, appeals, and other insurance claim related issues that you’re having trouble with. We’ll give you a free consultation and offer a contingency fee arrangement to make payment easier.

How Can I Help My Elderly Family Member With SSDI?

Elderly individuals don’t always have the capacity, understanding or frame of reference to take care of their needed affairs in the face of everything online. Many seniors have gone online, taking care of their accounts and joining Facebook to keep up with faraway family members. But there are still many elderly people who just won’t go near technology.

How Can I Help My Elderly Family Member With SSDI?

When it comes to applying for SSDI (Social Security Disability Insurance), they may not know where to go or who to call or what to do. Fortunately, by becoming an advocate, there are some things you can do to help them.

What Is Disability?

Strictly speaking, the Social Security Administration considers a “disability” as a condition that prevents someone from doing “substantial gainful activity” for a period of 12 months or expected to keep them from such activity for the coming 12 months. For someone who’s working, that means they cannot earn more than $1170 per month (current 2017 guidelines.)

A disability decision will also depend heavily on medical records and an individual’s medical history. The records must contain evidence of a “functional limitations,” or the inability to work. An individual’s age may be a supporting factor in an SSDI case since the Social Security Administration’s system weighs toward individuals over 50. A disabled individual can be working part-time when they apply, so long as they don’t earn more than the current guidelines.

Gather Important Records

Before you start an application, you’ll need to find your family member’s important records. You’ll need this information to complete the application. You can go online to complete the application at SSA, by phone at 1-800-772-1213, make an appointment and visit the nearest SSA office in person.

You’ll need:

·         Their Birth Certificate

·         Social Security Number/Card

·         Marriage/divorce/dependent records

·         Employment records going back 15 years, the last date worked and accompanying W-2 forms

·         Any public assistance they are currently receiving (food stamps, etc.)

·         Medical records, particularly those documenting the disabling condition

·         Any current prescriptions taken by the family member

·         Names and contact information for doctors and/or hospitals prescribing the medications

Medical Evidence

To substantiate the disability claim, the individual must have current medical records that support the claim and explain exactly how the condition (physical or mental) prevents him or her from working (called “functional limitations.”)  If medical records meet all the requirements to a Social Security Impairment Listing, showing exactly why the individual is unable to work, they’ll be approved immediately for benefits. If not, Social Security will then determine what kind of work the individual is suited for.

Disability claims are based primarily on evidence in someone’s medical records. So if your family member hasn’t had a medical evaluation, make sure they get one as soon as possible to establish a “disability.”

How Age Affects The SSDI Application

If your family member is over 50, Social Security considers them to be “close to retirement.” Education and work history is also a consideration, including things like transferable work skills. Residual functional capacity, or what type of work an individual is suited for in their present condition, is also taken into consideration.

Social Security uses a “medical vocational grid” to establish an individual’s ability to work based on prior work and age. Individuals over 65 who are still working but are forced to retire because of a disability generally won’t be required to find other suitable work.

The Hearing

Applicants will be required to attend an in-person or phone interview for their SSDI application. These are primarily to discuss the facts of the case, and a determination won’t be made at that time. You’ll need to have all of your family member’s records available so he or she can answer questions without wasting time.

The hearing is simply a meeting with an administrative law judge whose job is to determine if your family member meets the criteria for “disability.” Answering questions clearly and succinctly are key in getting a determination. An SSDI attorney cases can help with “rehearsing” beforehand or offer a list of questions that may be asked in the hearing.

Patience Is Required

SSDI’s application process takes a long time, and acceptance is not guaranteed. An appeal is almost a necessity before an individual is approved for disability.

Denied for SSDI?

Herren Law has helped over 4,000 Houstonians get the disability benefits they deserve, and we’ll be happy to help you. Call us at (713) 682-8194 or (800) 529-7707 for a free consultation. We’ll talk with you about your case and let you know how we can help. Our contingency fee arrangement means you won’t owe us anything unless we win your case.

 

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