LONG TERM/SHORT TERM DISABILITY CLAIMS
Long term disability claims are based on an insurance contract between an insurance company and an employee. Under the typical plan there will usually be a short term disability plan, sometimes called accident and sickness pay. These benefits run for a period of 26 weeks (6 months) to allow time to recover from injury or illness. The employee is paid a portion of their normal wages while they are unable to do their normal work. If the disability continues beyond the 26 weeks of benefits, then the employee may be eligible for long term disability.
Most long term disability policies break down coverage into two different categories: (a) specific occupation, and (b) any occupation. Under the specific occupation coverage, an employee will receive benefits for months 7 through 24 (after the first 6 months of short term have expired) if that employee is unable to do their regular occupation.
After the 24 month period the usual policy then converts to an “any occupation” policy. This means the disability of the employee is re-evaluated to determine if they are disabled from not only their own occupation, but ANY occupation in the open labor market. Most Long Term Disability policies require the employee to file for Social Security Disability to reduce the payments from the Long Term
At each of these points in the process, the insurance company may deny payments. If a claim is denied, it is important to build a strong case by building the claim file in your favor. This will increase your chances of winning an appeal of the denial. Read any letters of denial carefully for time limitations on appeals. It is crucial to provide as much medical evidence as is possible to support the claim.
Thomas and Brown attorneys have over 40 years combined experience in pursuing long term disability actions on behalf of workers. If you are unable to work due to injury or illness, please call or email today for a free case evaluation.