Q & A with Kantor & Kantor
Written by Kantor and Kantor insurance Matters on December 1, 2013
Question: How do I get started if and when I decide I need to? I'm working part time, but it's become more difficult each day.
Answer: We understand how complicated this decision can be. Filling for disability benefits can mean a loss of career, a loss of income, and even a loss of identity. However, when your illness becomes disabling in a way that you can no longer work, it is often the only option. Here is how you can get started when you are ready.
- Request a copy of your Long Term Disability Policy from your employer or your insurance company. You can refer to it for the specific claims submission procedures you must follow.
- The steps for submitting a claim can vary depending on your employer. However, the process usually begins when you contact your employer, or insurer, to tell them that you need to submit a disability claim. You will then be provided with a number of forms to complete and sign for your claim. Make sure that you complete ALL required forms…failure to do so will most likely result in a denial for “failure of proof.”
Keep an eye out for:
- Disability Claim Form: state the reasons that you are disabled and identify your treating physicians.
- Attending Physician Statement: this will be completed by your treating physician. He/she will state your restrictions and limitations, which prevent you from performing the material duties of your occupation (and the expected duration of your condition).
- Employer’s Statement: this will be completed by your employer, identifying your rate of pay and job responsibilities at the time of your ceased employment.
- Authorization of Release of Medical Information: this form will allow the Claims Administrator to obtain your medical records.
- Additional Information: take advantage of this opportunity to submit additional documentation in support of your claim. For example, records from your treating physician that support your diagnosis and disability, a detailed job description which describes your work duties (including the physical and mental demands and the working hours required), a letter from you describing the symptoms of your disability and how this impacts your functional capacity for work and daily living, and letters from family, co-workers, or friends describing their personal observations of your symptoms and how this has adversely impacted you at work and home. DON’T JUST RELY ON THE FORMS THEY PROVIDE! SUPPLEMENT WITH AS MUCH DETAIL AS POSSIBLE!
Unfortunately, it is not uncommon for insurance companies to deny a Long Term Disability Claim. Under the Employee Retirement Income Security Act (ERISA), you have a legal right to appeal the denial of disability benefits. If you encounter a long term disability denial, contact our office. We offer free consultations, and work on a contingency fee basis. This means that we do not collect a fee from you unless we get your claim paid.
Question: I have been on full disability for years now and have an opportunity to work a few days a week. Will this have a negative effect on my status? I need the money as I cannot live on disability alone but do not want to jeopardize my Long Term Disability benefits. What should I do?
Answer: You should know that if you begin working again, your disability carrier will likely deduct all or part of whatever you earn from your Long Term Disability Benefits. So, your net income will probably remain the same or close. It is critical to read the relevant provisions in your LTD Policy in order to understand how “partial” or residual” disability works.
If you decide to return to ANY type of work, this will open up the door for the disability carrier to argue that you have work capacity, and while you may claim it is limited, the carrier will likely claim it is not, and may try to deny your claim in total.
If you have questions about your Long Term Disability Insurance claim, please contact us for a free consultation at (800) 446-7529. Please note that we do not handle Social Security Disability Insurance (SSDI) claims, but can refer you to a reputable attorney that does.