FINALLY Get The Long-Term Disability You Deserve In 2018

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?

FINALLY Get The Long-Term Disability You Deserve In 2018

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.

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.


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 Long Do I Have To File For Long Term Disability?

Finding yourself disabled, even temporarily, can be a confusing haze of administrative work you may not be familiar with while you’re trying to heal. There are different types of disability classes, but long-term disability generally means that you are unable to go back to work in a short period of time. This type of policy provides income when you are unable to work, usually 60% of your previous income. The Herren Law Firm has been helping Houstonians through the disability process for over 20 years, and we can help you too.

How Long Do I Have To File For Long Term Disability?

What Does “Long-Term” Disability Mean?

A “disability” is a legal term that just means a medical condition that prevents you from working. Long-term disability means that you are unable to work an extended period. The average case lasts about 3 years. When you file for long-term disability and get it, you’re covered for things like car accidents, having a baby and serious illnesses and injuries, but it doesn’t always mean that you are permanently disabled.

You can only file your claim after a waiting or “elimination period,” when you have exhausted all paid time off (vacation, sick and any other PTO) and short-term disability has ended. Payments start after your claim is approved. Payments aren’t immediate, so it’s best to file as soon as possible so that there is overlap with the end of short-term disability.

Review Your Policy Before You Need It

When you receive your policy (whether through your employer, or on you own), review it carefully and take note of specific previsions. How does the policy define “disability?” What’s the waiting period (or “exclusion period”) on your policy? Will they pay if you’re unable to work the job you’re in, or if you’re unable to work any job, part time or full time? (There’s a difference.) How long will the policy pay you while you’re disabled—a year? Two or three years? Until you retire?

Review your exclusions. Most policies will not cover a disability for things like pre-existing conditions, acts of war, drug abuse, suicide attempts and any injuries sustained during the commission of a crime. There may be other exclusions in the policy—read carefully so you understand them before you prepare your claim.

Pay Attention To Deadlines

Find the deadline in your policy for submitting your claim. The policy will tell you when you’re required to file, and how long you have. Once the deadline is passed, most insurers will not allow you to file a claim.

Ensure That Your Claim File Is Complete

When you submit your claim, make sure that everything is included. Don’t assume that the insurance company has everything they need to process and approve your claim. Request a copy of your claim file for your own review. If anything is missing (X-rays, test results, etc.), request copies from the appropriate parties, forward them and ask the insurer to include them in your file. Complete medical records are a must, including a letter from your doctor explaining why you are disabled. If there are any errors, request that your doctor correct them.

Although he or she may charge you, asking your doctor for an additional detailed report about your current disabilities, limitations and medical history would be an advantage.

Long Term Disability Is Not Health Insurance

Disability payments replace your income when you are unable to work. Medical expenses are not covered under long-term disability. Health insurance, which is separate, only covers your related medical expenses.

Keep Copies Of Everything

It’s always important to know who you spoke to, when, what was mailed, to whom, and when. If you do find yourself fighting the denial of your claim, you’ll need copies of everything to file and appeal, and to take to your attorney. Keeping detailed records will help you fight denial and make it easier for an attorney to work on your case.

With over 4,000 successful disability claims under our belt, we’re ready to help you too. We work on a contingency fee basis—you only pay us a fee if we can win your case. Call us today at (713) 682-8194 or (800) 529-7707 to schedule your free consultation.

Do My Long Term Disability Payments Affect My Social Security Payments?

The short answer: Yes.

It’s called an “offset.” Payments from a long-term disability policy can (and very likely will) be reduced by the amount you receive from Social Security. This is true whether you receive SSI or SSDI. The Herren Law Firm understands the process and can help you manage your claim and get you the benefits you deserve.

Do My Long Term Disability Payments Affect My Social Security Payments?

What’s The Difference Between Disability Payments And Social Security Payments?

Long-term disability is private insurance that you either purchase yourself or receive as a benefit through your employer. Disability payments provide income while you are disabled and are unable to work for a long time. Long-term disability provides a portion of your income (usually 50% to 65%, depending on the policy) while you are disabled. This insurance starts when short-term disability ends, usually after three to six months.

SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income) are government-funded programs that provide income when you are unable to work due to a disability. You pay into the system with the Social Security deductions from your paycheck.

What Is “Disabled?”

Generally, it means that you are unable to work at your regular job; “long term” is more than 30 or 120 days. You must be able to prove that you are medically and physically unable to work for an extended period of time. Your policy may specify that you must be unable to work the job you were in, or if you are unable to work any job, full or part time. Review your individual policy to find out about disability payments and more.

Disability criteria differs for insurance companies and Social Security, which is much more stringent. The Herren Law Firm can help you apply for Social Security benefits, and increase your chances of approval.

The Offset

When you file your Social Security claim, your benefit payments will take a very long time. However, the date your first file is your date of disability. Individuals frequently receive a lump sum for the period before their regular benefits begin, called a “backpay.” The insurance company may require you to refund some of the payments they previously paid to you using the backpay, to offset the monies already paid.

How It Works

Some long-term disability policies will require you to apply for Social Security when your insurance payments begin. Once it’s approved, your disability plan will pay you the difference between your Social Security payment and your policy payment. That is, if your policy payment is $2,000 a month, and Social Security is $1,500, your policy payment will change to $500 instead of the entire $2,000. The “offset” is the $1,500 per month that Social Security pays you, and your total income remains the same.

Backpay Is Taxable

Even if you are required to make a large, lump-sum payment to refund your insurance company, the IRS will also collect taxes on the lump sum. Many individuals are shocked to receive a tax bill for that amount, and may be unable to pay it. If you expect to receive a lump sum from Social Security, consider saving a small monthly amount from your disability payments to protect yourself against an unpleasant surprise later.

Long-Term Disability or Social Security? Or Both?

It depends on the insurance policy you have, and how long you may be disabled. Individually purchased disability insurance may allow both without offsets, whereas group or employer policies may have more restrictions. Some policies may require you to apply for Social Security once the insurance payments start.

Reading and understanding your individual policy is essential before starting and submitting a claim, so that you understand what you can expect, and if there is an offset once you receive your benefits.

The Herren Law Firm Is Ready To Help

Applying for Social Security for disability is a long process, and most claims are denied at the outset, requiring appeals. This is where you may need an attorney to handle your claim so you can start receiving benefits. If your insurance company is denying your claim, an attorney can step in and get the process moving again.

We’ve helped over 4,000 Houstonians just like you get the disability benefits they need. Call us today at (713) 682-8194 or (800) 529-7707 to schedule your free consultation. Our contingency fee arrangement means you only pay us if we win your case.

Can You Be Fired While On Long-Term Disability?

Long-term disability can be confusing. The disability payments, insurance filings, doctor visits and everything that goes along with it. Eventually, you’ll be ready to go back to work.

But will your job still be there?

It Can Happen

getting fired while on long-term disability

Your employer can’t fire you just because you are on long-term disability, or because of your disability. But your employer can fire you while you’re out for reasons besides disability. There are laws to protect you in the event that you are disabled, and make sure you can go back to your job when you’re no longer disabled or recovered enough to return to work. The Herren Law Firm has helped over 4,000 Houstonians work through the maze of long-term disability. Let’s look at how the law protects you.

Family Medical Leave Act (FMLA)

The FMLA is a federal law that applies to companies with more than 50 employees (small businesses are generally exempted) and you must live within 75 miles of your company. Your company is required to give you 24 weeks of unpaid leave for things like physical or mental illness (yours or a family member), having a baby, etc. You must request FMLA leave according to your company’s policies, or you could be terminated for not notifying your employer that you need FMLA leave.

If you’ve properly requested FMLA leave, your employer must a) give you back the position you left, or b) give you a similar position, if you’re still able to do the same job you did before.

Americans with Disabilities Act (ADA)

The ADA is another federal law that applies to businesses with 15 or more employees. The ADA defines a disability as “a physical or mental impairment that substantially limits a major life activity.” If you meet this definition, you may be able to extend long-term disability after your FMLA time runs out. Your employer must offer reasonable accommodations after you notify them of your need. This can include flexible scheduling, wheelchair access, Braille signage, or even granting additional ADA leave.

Reasonable accommodation should not cause your employer an “undue hardship,” and your employer will determine if the accommodations will be enough for you to do your job. Negotiations may be necessary, and your employer may request that you try a number of different accommodations to see which ones work. If none are available, or they are unable to accommodate you to return to work, the company can legally fire you.

Business Changes

Your company may undergo a reorganization while you are out on disability. If this happens, and your job is eliminated, you can be terminated while you’re on leave. The company may not be able to keep your job open for an extended period of time due to business needs, and may be forced to hire someone else to do your job in your absence, whether temporarily or permanently.

You can be Fired at Any Time

Most employees are considered “at-will,” meaning that unless you have an employment contract/guarantee in writing and in place, you can be fired for nearly any reason at any time, or for no reason at all, unless that reason is illegal, i.e., discrimination, a medical condition, etc. It’s important to keep records of your requests for leave and accommodations under FMLA and ADA, as well as other important employment-related paperwork you may need later to prove your case. If you feel you’ve been wrongfully terminated, contact the Herren Law Firm for a free consultation.

If you were fired for poor performance, excessive absenteeism or another reason that an employer would normally fire someone for, then your employer can fire you legally. Under these circumstances, you can be fired during the long-term disability leave or when it ends.

Your employer can also legally fire you if:

• You do not return to work after using all of your sick/vacation time
• After FMLA leave, (or fail to declare it before leaving) after your employer has provided reasonable accommodations
• Can’t do the job despite the offered accommodations

Don’t Do It Alone!

We’ve helped over 4,000 Houstonians with disability related legal issues, and we’re ready to help you with yours. For a free consultation with attorney Bill Herren, call us today at (713) 682-8194 if you need legal help while you’re on long-term disability.

Don’t wait—it might be too late.

How to Establish a Service Connection to Your Disability

Filing a claim with the Veterans Affairs (VA) for disability compensation for an illness or disability that resulted from your military service? In an ideal world, Houston area Veterans would be able to receive benefits from the VA simply and painlessly; unfortunately, VA disability benefits are quite complicated, the process can take a fair amount of time, and there is a lot of preparation involved.

Establish a Service Connection to Your Disability | Houston VA Attorney

Nevertheless, when filing a claim, one of the cornerstone pieces of evidence that you need is a connection between your disability or illness and your time in the military. In other words, you need to show the VA that your disability resulted from an incident during your service with a branch of the U.S. military, whether Air Force, Marines, Army, Coast Guard, Navy, or others. By calling Houston veterans disability benefits attorney William Herren, we’ll diligently investigate the details of your claim and build evidence to support that claim. Furthermore, we’ll vigorously fight on your behalf to ensure timely and fair benefits. For a free consultation with our law firm, call our Houston office today at (800) 529-7707.

Five Ways to Establish a Service Connection for Disability, Disease, or Illness

The VA has fairly stringent regulations regarding the establishment of a service connection for disabilities, diseases, and illnesses. To be clear, however, it’s important to note that “service connection” means that the disability was either developed or aggravated during active duty. In general, there are five ways that you can establish a service connection for your VA disability benefits claim. These methods include:

  1. Direct Service Connection — A direct service connection occurs when there is clear evidence that the incident occurred while the veteran was in service. For instance, a Veteran is paralyzed from a back-breaking fall that occurred while he/she was in military parachute training. The Veteran’s disability is clearly connected to his/her military service. Sometimes, if your symptoms manifested before you were discharged, you may not need a medical opinion to establish a link between your service and your disability.
  2. Presumed Service Connection — There are some disabilities, illnesses, and diseases that are “presumed” to be service connected, and the VA has compiled a long list of conditions that are presumed to be service connected during a certain date range. For instance, Veterans who were exposed to Agent Orange during the Vietnam War, and who now have Parkinson’s Disease, are presumed to have a service connection. Some other presumptive conditions include chronic illnesses, tropical illnesses, tuberculosis, multiple sclerosis, and Hansen’s disease, among others. Certain forms of cancer are also presumed to be service-connected in cases where the Veteran was subjected to radiation.
  3. Pre-Existing Injury Aggravated by Military Service — For this service connection, the Veteran had a pre-existing injury that was made worse (aggravated) due to an event that occurred during his/her military service. The condition must have been reported in the Veteran’s entrance medical exam records, and there needs to be evidence that the condition worsened during his/her service connection.
  4. Secondary Service Connection — When one service-connected disability is the cause of another disability, you may have a secondary service connection. The secondary disability doesn’t have to be service-connected, but you do need to show that it wouldn’t have occurred without the service-connected disability. For example, the famous case regards a WWII Veteran who had tuberculosis and was treated with a medicine known for causing hearing loss. The hearing loss occurred because of the service-connected tuberculosis, and so the hearing loss may be considered as a secondary service connection.
  5. Service Connection due to Injury Caused by Treatment in the VA Health Care System — If your disability arose out of VA hospitalization, treatment, rehab, or therapy, then that disability is considered to be service connected.

Establishing a Service Connection for Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder can manifest after your service, and this condition isn’t so black-and-white when it comes to a singular event that occurred during service. For these reasons, the VA has special rules for disability benefit claims involving PTSD. To establish a service connection for PTSD, you’ll need to:

  • Provide a statement regarding the traumatic event(s) that occurred during service
  • Have a diagnosis of PTSD
  • Get an opinion from a VA psychologist or psychiatrist that the stressor (traumatic event) was sufficient to cause PTSD

Call Veterans Disability Lawyer William Herren Today

The disability benefits application process can be time-consuming and it requires a keen attention to detail, especially with regards to documentation and deadlines. By calling Houston VA disability benefits attorney William Herren of Herren Law, we can provide expert legal counsel, guidance, and representation regarding every stage of the application process and, if necessary, the appeal. We also work on a contingent basis, meaning you won’t pay a penny until you get your benefits.

For a free consultation with Herren Law in Houston, call us today at (800) 529-7707.

What is “Gainful Employment” for Long Term Disability?

When trying to better understand long-term disability, or when applying for disability benefits for your long-term disability, one term that you may come across is “gainful employment.” In short, this term refers to an LTD applicant’s ability to work, and if an individual is unable to engage in a substantial gainful activity (SGA), then he/she may be eligible to receive long-term disability benefits for his/her disability.

What Is "Gainful Employment" for Long Term Disability? - Herren Law

More specifically, if you are unable to hold any job where you would make 60-80% of your pre-disability earnings, then your long-term disability provider should pay benefits. Whether you are applying for LTD benefits, or the gainful employment aspect of your application is giving you troubles, then call Houston LTD attorney William Herren today. With decades of experience helping individuals like you, we fully understand the legal processes, what insurance companies are looking for, and how you can optimize your application.

We work on a contingency basis, and so you won’t pay a thing unless we win your case. For a free consultation with Houston attorney Bill Herren, call Herren Law today at (800) 529-7707.

What is a Gainful Occupation?

LTD policies often define “disability” in one of two ways, including:

  • Own Occupation: Your disability prevents you from the duties of your own occupation.
  • Any Occupation: Your disability prevents you from working in any gainful occupation for which you are reasonably suited, considering your education, training, and experience.

If you are able to work in any gainful employment, there is a higher possibility that your insurance company will deny your benefits. Furthermore, many LTD policies shift from “own occupation” to “any occupation” after a period of time (usually, it’s 24 months). This allows disabled individuals to find work outside of their own occupation.

Most LTD policies define “gainful employment,” however, as a job that is able to provide you with at least 60% of your pre-disability wages. Keep in mind that this 60% number is not universal, and so it’s important to refer to your specific LTD policy.

How Do You Know If You’re Reasonably Suited to Work?

In addition to understanding “gainful employment,” you also need to understand whether or not an LTD policy considers you as “reasonably suited” to work in your own occupation or any occupation. As you can imagine, the word “reasonably” is broad and open to interpretation, but in most cases, “reasonable suited” refers to an individual’s location, skills, education, and limitations.

An occupation would be considered “unreasonable” if some of the following factors apply:

  • There are few or no occupations available that are within a reasonable commute from your home.
  • The occupations available are beyond your skills or education level.
  • The occupation will interfere with your regular medical appointments, if applicable.
  • Your doctor has not provided a release that allows you to perform the tasks required of the occupation.

When submitting your application for LTD disability benefits, it’s very important to include as much evidence and information as you can. This information should include an opinion from your doctor that fully explains your working limitations, allowing the LTD provider to better assess your limitations as well as what types of jobs, if any, you’d be reasonably suitable to do.

Who Determines Whether You Work at Another Job?

Although you’ll be submitting your LTD benefits application to your insurance provider, your insurance provider will often work with vocational experts (VEs) to determine your employment possibilities and the compensation offered at various types of jobs available to you.

When making these assessments, the VE should be an expert in his/her field and rely on a number of sources, such as the Bureau of Labor Statistics, among others.

With the help of an LTD benefits attorney, your attorney should cross-examine the VE associated with your case, while making sure that the VE has all of the information he/she needs to know. A good attorney will also try to elicit a favorable response from the VE.

Call Houston LTD Attorney Bill Herren

Many insurance companies employ a long, complex rubric when determining whether an applicant has a disability that prevents him/her from working in his/her own occupation or any occupation. Showing your ability, or inability, for gainful employment will be an essential component for winning your LTD benefits case.

As such, you’ll need an experienced and capable attorney at the helm of your case, making sure that all of the necessary information is included in your application. For a free, no-obligation consultation with Houston attorney William Herren, call our law office today at (800) 529-7707.

The Key to Understanding Your Long Term Disability Policy

Understanding Long Term Disability Policy | Houston Attorney Herren Law

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.