LTD Benefits: What You Need To Know erik berger According to a 2016 survey, approximately 40% of Americans have a privately purchased disability insurance policy or a disability policy offered through their employer. Since Social Security disability benefits, on average, provide approximately one third of the amount of the average disabled worker’s paycheck, and since many people live paycheck to paycheck without substantial savings, the successful presentation of a Long Term Disability benefits claim (LTD) is absolutely critical to maintaining the worker’s financial and personal stability. For instance, a 2017 study of bankruptcy court records demonstrated that over 40% of mortgage foreclosures are attributed, at least in part, to disability. LTD benefits obtained as a benefit of employment (and usually paid for by the employer), somewhat like Social Security benefits, are paid to beneficiaries whose disability is expected to last more than a few months; although the terms of the LTD contract control, generally speaking most workers may be entitled to LTD benefits for up to 2 years if they are unable to work at the job they were performing when they became disabled, and even permanently if the worker’s disability results in an inability to perform any gainful employment. In almost all cases involving a disability policy purchased by the company, the worker will be required, as a condition of receiving LTD benefits, that they also apply for Social Security disability. However, if the LTD policy is bought privately most of these policies provide disability benefits on the sole basis that the policyholder is unable to perform their past job. One way that claims for LTD benefits is vastly different from Social Security claims is that they are adversarial cases, where the employer and/or insurance company has claims adjusters, doctors,
vocational experts and other experts who provide evidence against the worker’s interest. So, even though the “HR person” at the company may be, in fact, a very nice person, this should not lull the worker into forgetting that, in the end, the employer/insurance company will always look out for itself first. Again, the terms of disability policies differ, but in most cases an LTD case can only be successfully filed after a claim for Short Term Disability (STD) has been successfully filed; the primary difference between LTD and STD benefits is that the latter only applies in cases where the disability is expected to last less than 6 months, i.e., is only temporary. In most cases the STD claim must be filed within 20-30 days of the date that disability is alleged. A claim for LTD benefits is then filed to coincide with the ending of the short term of disability that has already been awarded. The process for applying for LTD benefits requires strict adherence to the time frames established in the Department of Labor’s regulations, and all evidence and all medical and vocational opinions should be submitted with the application, if possible. If the LTD claim is denied, the claimant has 180 days to file an appeal; this may seem like a long time, but the last chance to submit evidence is when this appeal is filed. If the claim is again denied after the appeal, the worker’s last chance is an appeal to a federal district court. Because of the strict procedural deadlines, the need to submit evidence in a timely fashion, and the need to develop a persuasive narrative establishing that the worker is “disabled” based on the law and the evidence, it takes very careful, long term, strategic planning to anticipate the NADR NEWS | FOURTH QUARTER 2018
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