If you’ve been out of work after a disabling accident, illness or injury, chances are you have a lot going on at once. Between doctor visits and other necessary outings, you’re taking care of yourself and trying to heal while dealing with insurance company requirements. But what about long-term disability?
Are you trying to get long-term disability, or headed in that direction? Here are a few things you need to know.
Disability Defined
The definition of your disability is whatever your policy says it is. But the policy definition, rules and exclusions define what they consider to be “disabled.” Your policy definition may look something like this:
Disability exists when, due to illness or accidental injury, you are not able to perform, for wage or profit, the material and substantial duties of your regular occupation.
This definition, known as “own occupation,” means that your illness or injury prevents you from performing your current job and/or occupation. However, an “any job” definition means that you may not be able to perform your current job/occupation, but you are well enough to perform another one, even if it pays less than your current salary. This assessment is also based on your training, education, and experience.
Some policies change from “own occupation” to “any occupation” after 24 months, and benefits may be terminated at that time, particularly if there has been significant medical improvement.
Are You Still Using Paid Time Off?
Long-term disability has a waiting or “elimination” period, generally three to six months, before you’re eligible. You’re required to exhaust all of your sick, vacation, personal and any other paid absence time before you can become eligible for LTO.
Short-Term Disability
The elimination period LTD also takes into account the short-term disability payments you may be receiving. This type of insurance typically lasts less than six months and is intended for a short-term illness that isn’t work-related.
Long-term disability starts when your short-term disability ends.
Short-term disability differs from worker’s compensation, which is for employees who have work-related injuries and/or are injured on the job.
The Length Of Long-Term Disability
LTD starts three to six months after your disability begins, and after you’ve exhausted all time off and short-term disability.
Some policies will pay you until the age of 65 when most people generally retire and will file for Social Security (retirement) and Medicare. If not, there is a limit to the number of years the policy will pay you. Most will pay between 50% and 80% of your former salary.
Social Security Disability Insurance
Most LTD policies will require you to apply for SSDI. If and when your SSDI application is approved, and you start receiving benefits, your LTD payments will be offset by that amount. For instance, if your monthly LTD payment is $2500, and you’re awarded $1800 in SSDI, your insurance company will reduce your LTD payments by that amount, to $700 per month. You’ll still receive $2500 a month, but not from one source.
Working While Collecting LTD
It is possible (although not necessarily recommended) to work while you’re collecting long-term disability. Your benefits could be cut or terminated, particularly if you make too much. Before you start sending out resumes for a new job, even for part-time work, it’s best to read your policy and make sure you understand it first. Speak to your claims administrator to answer any questions.
Some policies may discontinue your benefits even if you’re still technically disabled, especially if you make more than 80% of your previous income. If yours is an “own occupation” policy, you may be able to work in a different occupation and still collect LTD. Again, this is based on how the policy is written, so you’ll need to read it before you start.
Some policies have “return to work” incentives, limiting your benefits and income to 100% of your previous earnings. If your earnings and LTD payments exceed 100% of your previous income, your benefits will be reduced to your pre-disability earnings and will reduce further over time.
Denied Your LTD?
If your insurance company (or your employers) has unfairly denied your claim, stopped your benefits or you need help filing an appeal, The Herren Law Firm is ready to help. We’ve helped over 4.000 Houstonians with their long-term disability cases and can answer any questions. Call us at (713) 682-8194 or (800) 529-7707 for a free consultation. Our contingency fee arrangement means you won’t owe us anything unless we win your case.
