Understanding Long-Term Disability Insurance (LTD)
LTD insurance and SSDI are similar to each other in many ways. Both disability plans require claimants to make a written application for benefits and, if denied, the insurance company, like the Social Security Administration, issues a written reason for the denial and explains the claimant’s appeal options.
While the claim evaluation processes may be similar, insurance policies or plans do not necessarily define “disability” the same way the Social Security Administration does. It is very important to refer to your insurance policy or plan to see just how disability is defined.
Even more important, unlike the Social Security Administration, an LTD insurance carrier may be financially motivated to deny your claim.
After all, the less benefits an insurance company pays out, the more money it can keep for itself. For this reason, it is often advisable to contact an experienced disability attorney before you make your claim.
Many LTD insurance policies provide two levels of coverage.
They will pay disability benefits for a limited period of time (often no more than one or two years) if a claimant can no longer perform the duties of his or her job. This is often called the “own occupation” period of disability. To receive benefits beyond the “own occupation” period of disability, a claimant must prove he or she cannot perform any work at all.
LTD insurance benefits can be part of an employer-sponsored fringe benefit plan or they can be purchased as an individual, private disability insurance policy.
If the LTD benefits are part of an employee fringe benefit plan (and the employer is not a government entity or church organization) then that insurance plan will be governed by the Employee Retirement Income Security Act (ERISA). This federal statute, unfortunately, stacks the deck in favor of the insurance companies.
For example, if a claimant is forced to sue his disability insurance company, the lawsuit must be filed in federal court, the claimant is not entitled to punitive damages and there is no guarantee his or her attorney’s fees will have to be paid by the insurance carrier.
Disability insurance policies which are purchased individually and are not part of employer-sponsored plan (or are part of a church or government employer sponsored plan) are governed by state law. In these cases there is the potential to win punitive damages and attorney’s fees in addition to obtaining the insurance payments themselves.
If you are a self-employed professional contemplating making a claim under your individual disability insurance (DI) policy, it is particularly important to contact an attorney before you make the application.
In addition to the usual tactics used by insurance companies to deny claims, when dealing with self-employed professionals, insurance companies are notorious for denying claims by asserting that their insured is not disabled so much as he or she is a bad business person.
In other words, your insurance company is not above accusing you of making a disability claim because business is bad and you’re not making as much money as you would like. In order to preempt the insurance company from using this tactic, contact an experienced disability attorney to make sure your claim application is in order before submitting it to the insurance company.