Answers to Frequently Asked Questions About LTD

I was fired, but can I still file for long-term disability benefits?

Yes. If your employer’s benefits package included short-term or long-term disability benefits, you can always apply.

Is it possible to file an LTD claim for working stress or burnout?

You can apply for long-term disability payments if you have developed anxiety or depression as a result of workplace stress/burnout to the extent that you are unable to work.

What are some conditions for which people file a long-term disability claim?

People file disability claims for a variety of reasons, including:

  • Depression, anxiety, and bipolar disorder are examples of mental illnesses.
  • Fibromyalgia and Chronic Fatigue Syndrome are examples of chronic conditions.
  • Fractures and spinal cord injuries are examples of physical injuries.
  • Diseases of the Cardiovascular System
  • Parkinson’s disease, Multiple Sclerosis, Stroke, and Traumatic Brain Injuries are all neurological diseases.
  • Osteoarthritis, Lupus, Psoriatic Arthritis, Fibromyalgia, Gout, Rheumatoid Arthritis, and Scleroderma are all types of arthritis.
  • Irritable Bowel Syndrome, Colitis, Crohn’s Disease, Diverticulitis, and Diverticulosis are all gastrointestinal problems.
  • Endometriosis and other gynecological problems
  • Retinopathy, peripheral neuropathy, Charcot fractures, and osteomyelitis are all complications of diabetes.
  • Cancers and treatments for cancer
  • Pain, exhaustion, lymphedema, despair, and anxiety are all side effects of cancer treatment.

Do you have to file a new claim if you return to work after receiving LTD benefits and become disabled again?

Many long-term disability (LTD) policies include a “recurrence” clause, which means you won’t have to reapply if you return to work but cannot continue working due to the same disability. You can instead make a’recurrent claim. The time restriction for filing a claim for recurrent disability is six months under some insurance.

What happens to your extended health care benefits if you’re on long-term disability or in the middle of a legal battle?

Suppose you have extended health care benefits that are generally paid for by your employer. In that case, your benefits should still be available to you if you are still an employee during a claim for long-term disability benefits (or if your benefits have been denied during the lawsuit).

What am I suing for if I file a lawsuit against my LTD insurer?

If your claim for long-term disability payments has been denied, you can file a lawsuit against your insurance provider by engaging a disability lawyer.

You’re suing for a declaration of coverage (that you’re entitled to benefits) and a benefit reinstatement (also referred to as getting back on the claim).

When your lawsuit is settled, you have the option of obtaining a lump-sum payment or having your benefits reinstated. In many cases, a lump-sum settlement is reached. Contact a disability lawyer now if you have any questions about the legal process or how a lawsuit works.

In a long-term disability claim, what does “complete disability” mean?

Each long-term disability policy is different, but a person must meet the criterion of totally disabled to be eligible for payments.

A total disability occurs when you are unable to perform the essential functions of your work. It doesn’t mean you have to be physically unable of doing any portion of your job; rather, your injury or illness is severe enough that you should cease working so you may focus on getting better. You cannot perform the fundamental functions of your own occupation due to your injuries or illness.

Your insurer will use this definition during the “own occupation” stage of your disability. You are deemed fully incapacitated if you are unable to perform any occupation for which you are fairly suited or could become suited after your existing occupation has ended.

To find out what your LTD policy covers, read the definitions section of your policy or have it reviewed by a lawyer.

I didn’t receive full STD benefits, thus may I qualify for LTD benefits?

If you are eligible for STD benefits but do not receive payments for the entire period, you are not necessarily no longer disabled from working. Benefits for STDs are paid for a set amount of time. This normally covers the “qualifying time” for LTD benefits.

During the waiting period, you must meet the disability standards in order to receive and qualify for LTD benefits.

Suppose you are still unable to work and your doctors continue to support your condition. In that case, you should file for long-term disability benefits even if your insurance company did not pay you the entire amount of short-term disability benefits or does not believe you satisfy the qualifying period.

What are the differences between “Own Occupation” and “Any Occupation”?

You are evaluated in a long-term disability claim to see if you can perform the fundamental functions of a) your own occupation and b) any occupation. The own occupation time is usually two years in most policies, however it varies by policy.

Own occupation refers to your pre-disability occupation or your work when you became disabled.

Any occupation is one for which you are reasonably competent or may become qualified due to your education, training, or experience.

Test Your Own Occupation

This test is only valid for the first 24 months of a person’s impairment (or the period set out in your policy). During this time, total impairment means you are unable to work at your own occupation and perform the essential functions of your job.

Test for Any Occupation

The inability to work in any occupation is referred to as total disability. Your ongoing eligibility for long-term disability payments will be determined by whether you are unable to perform the essential functions of any occupation for which you are fairly qualified after the 24-month period. This includes jobs for which you might be qualified by education, training, or experience.

It’s critical to read your own policy to determine which tests are appropriate and when they’re appropriate.

Is it necessary for me to take part in a gradual return to work program? What if it aggravates my symptoms?

Your insurer may try to work with your employer to create a gradual return to work program. A progressive return to work schedule is one in which the number of hours and days you work gradually increases until you achieve full-time hours and days. If you are unable to resume your usual duties, you may be assigned modified assignments.

To receive approval for the gradual return to work plan and to identify your restrictions and limitations, your insurer will usually write to your treating physician and therapy providers.

You must give supportive medical documentation to your insurer if the gradual return to work plan and returning to work worsens your symptoms and you are unable to continue working. If you are unable to fully participate in the program, you must also submit supporting medical evidence that your symptoms would be worse if you did so.

Is it necessary for me to take part in a work hardening program? What if it aggravates my symptoms?

If your insurer believes you would benefit from a rehabilitation program that prepares you for a return to work, they may arrange for a “work hardening program” for you. For example, physiotherapy sessions, chronic pain education, and cognitive behavioral therapy sessions may be used to prepare you for a return to work if you have chronic pain.

Suppose the program aggravates your symptoms or prevents you from participating. In that case, you must produce medical documentation to support your medical condition and/or inability to engage in or complete the program.

Is it necessary for me to attend an independent medical examination?

An independent medical examination is a face-to-face checkup with a doctor of the insurance company’s choosing. It is critical to attend planned appointments set by your insurance carrier during your disability claim or during a lawsuit against your insurer to demonstrate that you are a willing participant in the legal process.

Your insurance company may require that you be seen for an evaluation during your disability claim so that they can get an opinion on your condition. Therefore, it’s critical that you show up for this appointment and answer all of the assessor’s questions honestly.

What is a premium waiver?

Suppose you are liable for paying a premium for LTD benefits. In that case, the insurer will usually approve you for a premium waiver for long-term disability and optional life benefits if you are responsible for paying a premium for LTD benefits when your benefits are authorized. This implies you won’t have to pay any premiums as long as you pass the total disability exam. If your claim is refused, you must continue to pay insurance premiums to keep your coverage.

What does it mean to have a no-evidence limit?

Some policies include a “no evidence maximum,” which means you can only receive a certain amount of benefit without submitting proof of medical evidence. Even if the policy has a formula, you can only be paid up to the no-evidence limit, which may be less than what you are entitled to. For instance, the policy may have a $1,000 maximum payout, but your monthly earnings are $5,000. Because the benefit calculation is based on the lesser of 50% of monthly wages or the no-evidence maximum, you would only be eligible for $1,000.

What do you mean by “basic earnings”?

The term “basic earnings” refers to your normal wage from your employer, excluding any overtime, bonus money, or incentive payments.

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