If you receive long-term disability (LTD) insurance as an employee benefit through work, it’s likely that your benefit is governed by the Employee Retirement Income Security Act, also known as ERISA. ERISA is a federal law that applies to all sorts of employee welfare benefits, including health insurance, life insurance, short-term disability insurance, and LTD insurance.
Very generally speaking, if you need to make a claim for LTD benefits, you will be required to go through a claim process with the insurance company. Here are five tips to help make sure you are providing the insurance company with the information it needs for your claim.
Explain why you can’t work. This may seem obvious, but you will need to provide specific information about why you are unable to continue working. While an off-work note from your doctor might be sufficient for an excused absence with your employer, the insurance company may need additional information about why you can’t work. Be sure to gather and submit medical records and results from any diagnostic tests. Also, many insurance companies will provide you with fillable forms for you and your doctors to use to explain the basis of your disability.
Make sure to get all your information submitted. It’s important to make sure you have provided the insurance company with all the information it needs to make a decision on your LTD claim. If your claim or appeal is denied, you may not be able to submit additional information after the decision is made. As a result, it is imperative to provide all medical and vocational records before the claim process is over.
Pay attention to deadlines in letters from the insurance company. ERISA and its regulations set forth certain time limits for both you and the insurance company to follow during your LTD claim. If an insurance company denies your claim, it is required to give you notice of the amount of time you have to submit an appeal. Be sure to get your information submitted before the deadline passes.
If the insurance company gives you an opportunity to submit information in response to a medical report it has obtained, take the opportunity to explain your claim. Insurance companies might hire their own doctors to either examine you or to perform a review of your medical records. If the insurance company provides you with a copy of the report before finalizing its decision on your claim, be sure to review the report and submit any additional information.
Send in statements from co-workers or family members. Your medical records most often will have information about your medical conditions and why you are unable to work. If you have a co-worker or family member who can explain through firsthand knowledge how your medical conditions are affecting your ability to work or to complete activities of daily living, you can submit statements from those individuals in addition to your medical proof.
If you have questions about your long-term disability claim, contact the attorneys at Mehr, Fairbanks & Peterson. Philip Fairbanks, Esq., one of the partners at Mehr, Fairbanks & Peterson, wrote this piece. We hope this was helpful, and please get in touch with our firm if you have questions.
Philip Fairbanks, Esq.
Mehr, Fairbanks & Peterson
23 June 2021