Practice Area:
Long Term Disability (LTD)

While SSDI claims are filed with the government, long-term disability claims are filed under a group policy obtained by your employer. Whether you are filing an initial claim for benefits under your disability insurance plan or filing an appeal, the following information should be helpful to you. The information is provided to help you understand the disability claim process, and to give you some basic tips on how the process works and how to protect yourself in the early stages of your disability claim.

  • Get an updated copy of your group disability insurance plan. If you cannot find it, contact your HR administrator. If your plan falls under ERISA law, your employer must provide certain information to participants within 30 days upon request, or face a fine for failure to do so.
  • Review your plan and determine your eligibility. You and your physician will need to demonstrate that your condition makes you disabled according to the definition in your plan. Different plans have different definitions, so read your plan carefully. You may also be required to fit certain criteria, such as length of employment or full-time status. Some illnesses even fall under policy exclusions; pre-existing conditions and self-inflicted injuries are common exclusions. It is also important to follow the appropriate procedure outlined in your plan; this is the most common area where people can make mistakes. Policies often have requirements about filing for short term disability, coordinating benefits with the state or federal government, medical treatment procedures, filing deadlines, and so forth. It is vital that you understand you are familiar with your policy. Once you begin your claim, the insurance company begins an administrative record, and all of your actions and statements are included.
  • Start a disability claim journal. A written journal of your actions and statements can help you keep a clear legal record for future reference. This is private, however, and should not be shared with anyone except your attorney. Record dates of requests for information, communications you receive from your employer or your insurance company. Track the course of your disability, including all symptoms that impact your ability to perform your job. Request a copy of your medical records and record all dates of medical visits, tests, and test results.
  • Consult with your physician. The strongest disability case will be supported by a physician who believes that you are truly disabled, is highly credible to the insurance copmany and is willing to serve as your advocate. If you are at the “any occupation” stage of your policy, you will also have to review how your illness limits you from functioning in a broader range of jobs. Make sure you ask your physician to explain any aspects of your medical condition that can grow to become a bigger obstacle to work in the future. If the two of you agree on the nature of your disability, you have a good starting point for your claim. If you sense that your physician is reluctant to get involved with a disability claim, it is perfectly appropriate to look for a second opinion from another physician that you think is more willing to be your advocate. It is also helpful if your physician has strong medical credentials, as indicated by their education and training.
  • File your disability claim. In most cases, you begin by filing a claim for Short Term Disability benefits. It is recommended that you add to the claim any information that reasonably supports your case: medical records; excerpts from your claim journal; written statements from co-workers, family and friends; anything else you think will help your administrator understand the nature of your disability.
  • Wait for the decision. If your plan falls under ERISA law, your insurance company must approve or deny your claim within six months after filing. If they haven't made a decision within 60 to 90 days, they are typically required to notify you that they need more time to consider your claim, based upon "special circumstances." They must explain those circumstances and provide you with an estimated date of their determination. Under ERISA law, you will usually be notified in writing of the insurance company's decision.

Practice Areas:

Social Security Disability Insurance
(SSDI)

Long Term Disability
(LTD)

 

 

7169 Germantown Avenue | Philadelphia, PA 19119
215.242.1160 | email