Long-term Disability

Birmingham, Alabama

Preparing for the Unexpected

No one is ever really prepared for the devastating impact of a disability, but you can take steps to obtain some peace of mind in a very stressful time.

What is long-term disability?
Long-term disability coverage provides income when you are unable to work for more than six months because of an injury, illness, or other medical condition. Unlike workers’ compensation, your disability does not need to be due to a work-related injury.

Long-term disability benefits can replace 50-80% of your salary, though some policies have maximum monthly pay outs. The length of benefit coverage will vary with the policy, ranging from a period of years you choose or, in some policies, until you are 65.

What you need to prove to obtain benefits also will vary with the policy:

• For “own occupation” policies, you must demonstrate an inability to perform the material and substantial duties of your existing job.
• For “any occupation” policies, you must show that you cannot perform, with reasonable continuity, the material duties of any job.

Long-term disability coverage differs from social security disability benefits, which can be obtained in addition to long-term disability pay outs. Some long-term disability policies will offset pay outs if social security benefits are being received.

Long-term disability insurance providers
Long-term disability insurance is often provided as part of an employee benefits package. Professional groups may also offer long-term disability coverage. Individuals who are self-employed or who wish to supplement a group plan can purchase individual plans through private insurance companies.

As noted, not all long-term disability insurance policies are created equal and the fine print can be hard to interpret. An insurance agent can help you determine which policy is right for you. Look for someone who has obtained a Disability Income Associate designation.

Long-term disability benefits denials
Unfortunately, having long-term disability coverage doesn’t necessarily mean you’ll get benefits right away. Long-term disability providers are interested in their bottom line and the challenges you face in getting your policy terms honored usually come at a time when you’re least able to handle the stress.

Under the Employee Retirement Income Security Act (ERISA), if your group long-term disability provider denies your claim, it must:

• Point to the policy reasons for denial
• Identify any criteria or guidelines used to deny your claim
• Outline procedures for appeal
• Identify any material or information you need to provide to obtain your benefits

You have a right to any reports that the insurance company has prepared or reviewed in denying your claim. It’s important in an appealing a long-term disability benefits denial to address each and every argument the insurance company has raised. An experienced long-term disability insurance attorney can help you set forth the most favorable arguments in support of your case and can answer questions about your disability insurance denial.

If you have questions about long-term disability insurance or would like to fight a long-term disability benefits denial in Alabama, Georgia, Tennessee, or Florida, contact the experienced long-term disability attorneys at Burke, Harvey & Frankowski, LLC for more information.

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