Know about your insurance coverage…before you need it

A crucial piece of advice that we regularly impart on the long term disability community is, “know your policy!” As we have said many times before, if you don’t understand your policy, you don’t understand the rules…as well as the benefits to which you are entitled. Understanding the terms of your plan can help you to (1) prevent insurance denials, and (2) advocate for your long term disability benefits if your claim has been denied.

Our firm recently represented a client who submitted a long term disability claim for a routine procedure. After failing to heal in the appropriate amount of time, as well as developing joint pain and headaches, she went to visit her physician for further testing. When the results came back normal, she decided that it was necessary to try a less demanding job, with a different employer. Shortly thereafter, she decided to visit a different physician for a second opinion. To her surprise, she learned that she had been diagnosed with several different < a href = "http://www.webmd.com/rheumatoid-arthritis/an-overview-of-rheumatic-diseases">rheumatic diseases! However, the physician’s office had never informed her of the results of her testing.

Unfortunately, after only 3 weeks of her to return to work, our client found she was simply unable to perform her job duties. Her physician again advised her to go on disability. Our client attempted to re-open her long term disability claim, but was advised that she was no longer eligible for long term disability benefits. The insurance company did not dispute our client was disabled. Rather, the insurer relied on a policy provision that terminated coverage once the insured returned to work for a new employer.

Two lessons can be learned from this case:

One, be sure to communicate honestly and openly with your physician, and insist on explanations of your doctor’s tests and examinations. If you feel that he/she is not helping you get to the bottom of your symptoms, seek out a second opinion. Find a knowledgeable physician that you feel confident working with until you find a diagnosis, and in the meantime, document everything! Keep a journal of your daily activities, symptoms, medication side effects, and descriptions of how your illness impacts your everyday life. If your physician understands the full picture of your illness, it will be much easier for him/her to provide support if it becomes necessary to make a claim for long term disability benefits. Unfortunately, our client was unable to get the support and expertise necessary for discovering her conditions in a timely manner. If she had known of the severity of her condition, she would have known she could not consistently perform job duties—even in the less demanding job.

Two, if you are considering applying for long term disability benefits, review your policy before you make your claim. If our client had known of the prohibition on continuing coverage in the event that she attempted to work for another employer, she would not have returned to work until she was sure that she could perform the job. Furthermore, if you are considering returning to work on a part time basis, you should know that many long term disability policies reduce the disability benefit by your current income. Therefore, the net income received between your part time job and your disability benefits may be less than the total disability benefit. It is critical to read the relevant provisions in your LTD Policy in order to understand how “partial” or residual” disability works.

If you have questions about the language of your long term disability policy, your long term disability claim, or your long term disability insurance denial, please do not hesitate to contact our office for a no-cost consultation.

We understand, and we can help.

www.kantorlaw.net (800) 446-7529

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