FINALLY Get The Long-Term Disability You Deserve In 2018

January 31, 2018 by

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.

Filed Under: Long Term Disability, Uncategorized Tagged With: , , , ,

Can I Receive Long Term Disability While on FMLA Leave?

December 28, 2017 by

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.

Filed Under: Long Term Disability Tagged With: ,

The Key to Understanding Your Long Term Disability Policy

November 26, 2016 by

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.

Filed Under: Long Term Disability Tagged With: , ,
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