If you paid your LTD premiums with after-tax dollars, the benefits are generally tax-free. ERISA provides that LTD insurance companies themselves decide whether you're approved for benefits, a process that frequently results in good cases being denied.
Be sure to follow your insurance company's instructions for filing your initial claim to avoid having your claim denied unnecessarily. Read your policy for rules about filing an internal appeal, and take special note of all deadlines. You must exhaust your insurer's internal appeals process before taking your case to federal court. Under ERISA, federal court judges are generally limited to reviewing the "administrative record" and will not consider any evidence that wasn't presented during your internal appeals.
Thus, when you file an internal appeal, it is critical that you supplement the administrative record with favorable medical evidence, especially supporting statements from your treating physicians. You should consider hiring an experienced long-term disability attorney to help you navigate the administrative appeals process and "stack the administrative record" in your favor.
Most disability attorneys charge a fee only if you win your case. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site.
The attorney listings on this site are paid attorney advertising. In some states, the information on this website may be considered a lawyer referral service. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Grow Your Legal Practice. Meet the Editors. There are a few key areas of your LTD policy that you need to read and understand. The Definition of Disability Your policy's definition of "disability" can have a major impact on whether you qualify for benefits.
Exclusions and Limitations Mental conditions. Who Decides Whether I'm Disabled? Appealing an LTD Denial Read your policy for rules about filing an internal appeal, and take special note of all deadlines. Talk to a Lawyer Need a lawyer? This article describes that sometimes it's not much fun trying to get answers out of your insurance company.
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Specific definitions of disability will vary by Insurer, however, LTD generally provides coverage for injuries or illnesses that prevent someone from performing the duties of their own occupation.
LTD offers supplementary income for two years in their own occupation or up to age 65 if they are unable to work in any occupation. As the name implies, Short Term Disability STD exists to replace a regular income for a short period, typically a maximum of 13 — 26 weeks. During this time, an employee can be off work while receiving a portion of their income. A very high percentage of employees will return to their job within the short term disability time frame.
Short Term vs. Long Term Disability Insurance. Take a look at this infographic to understand how Short Term and Long Term Disability Insurance work to help protect the health, wealth, and wellbeing of employees. While driving to work one day, John experiences a minor stroke and crashes his car. He is taken immediately to the hospital, where his initial injuries are assessed — broken arm, concussion, and whiplash.
Over the next few days, it becomes apparent that he has lost the use of his entire right side due to his stroke, and is unable to continue working until he regains his mobility and speech.
He is set to begin physiotherapy in an attempt to restore his motor skills, but his doctors warn him and his family that the process could take several weeks, months or even years, and he will be unable to continue working during recovery. After his crash, John is taken to the hospital immediately. Since his STD Insurance includes 1st-day hospital coverage1, his coverage period begins on day one.
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