Send The Application And Supporting Documents To The Insurer
Ideally, you want to send your application in one package with all supporting documents. This package should include the following:
- Your application form, completed and signed
- Sheet attached to the application form with any additional information that wouldnt fit on the form
- Medical form, completed and signed
- Employers form, completed and signed
- Cover letter
You might not be able to send everything at once. For example, some doctors and employers will insist on sending their forms directly to the insurance company. Or, if someone is taking a long time to do the form, you should send your application and supporting documents in as soon as possible. That way, you will at least start the process so the insurance company can assign a claim representative to your claim. Sometimes, the claim representatives can help you get the doctor or employer to get their form in.
Cooperate With Reasonable Requests From The Insurer When Applying For Long
You should have a mindset of cooperation when applying for long-term disability. You should act in good faith with any reasonable requests from the insurance company. The following are some common requests:
- Speak with them by phone to answer questions
- Provide copies of your medical records
- Ask your doctor to give more information
Some people have the instinct to provide the insurance company with as little information as possible, or to object to requests for information or documents. We have seen people make excessive or unfounded complaints about privacy violations and other petty problems.
Please resist the urge to do this. When you act unreasonably with the insurance company, it hurts your credibility. Credibility is the key issue in most long-term disability claims. If people see you as credible, then your claim will have a much greater chance of being approved. If you arent credible, then there is little chance of you being approved, even if you are legitimately disabled and should qualify.
A denied claim will ultimately end up in court. You want the judge to conclude that you went above and beyond to be helpful and that you acted reasonably at all times. If the judge sees you being unreasonable or petty and sees the insurance company acting reasonably, then you are sure to lose your claim.
What Is The Elimination Period
The elimination period is a term that the insurance industry uses to refer to the period of time between the onset of your disability and the time you receive long-term disability benefits. It is a waiting period from the time youre illness or disability begins. The elimination period is also sometimes known as the qualifying period. Elimination periods could vary in length, however the most common elimination period is 90 days or 120 days. Typically, disability insurance premiums are cheaper if the elimination periods is longer.
During the elimination period, a claimant would apply for short-term disability, or in the alternative, unemployment insurance sickness benefits if their employer does not offer short-term disability coverage. Once the elimination period is expired, you would then apply for long-term disability monthly benefits. In order to do so, you must speak to your HR department or plan sponsor. If you have an individual plan, you would contact your broker directly.
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How Do I Apply For Long
Typically for most insurance companies, the application procedure for long-term disability benefits is quite similar:
Plan Member or Employee Statement The plan member or employee statement begins the claim submission process. You would provide to the insurance company a Plan Member Statement or Employee Statement which confirms and explains your condition, and how it developped or progressed. The statement provides a general overall medical history and an explanation as to any income or sources of income or benefits that you would receive well on medical leave.
The statement would also require you to describe when youre symptoms first appeared so that a date of onset of disability could be determined. You would also be required to provide information as to whether or not you ever suffered the same illness or disability. This is particularly important if you are new plan member. The statement would also require you to document a summary of treatments you are receiving, medications you are taking, any rehabilitation that you are participating in, a summary all doctors youve seen, hospitals you have attended and whether or not you suffer an injury that occurred in the workplace.
Some Plan Member Statements or Employee Statements require you to provide direct deposit authorization.
What If You Are Denied Long Term Disability
If you are denied there is almost always an internal mechanism of appeal, usually with a deadline. The appeal can be requested by a simple written request and the application is then reassessed sometimes by a different claims handler.
Why might you be denied? Usually, it is a lack of medical records which fully describe the nature and extent of disability that gets claims denied. A simple report describing a persons medical diagnosis is often not enough to qualify for disability if it does not explain how that diagnosis is so significant that it prevents a person from not being able to fulfill their work place duties.
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When Do I Need To Contact A Disability Lawyer
If your insurance company refuses to pay your disability claim, or cuts off your monthly benefits because they decide you can go back to work, you have the right to internal appeals. Typically internal appeals will require you to submit additional medical documentation to help prove your entitlement to disability benefits. Often times however, the final decision makers in the appeal process will not reverse the original adjudicators decision to deny long-term disability benefits.
You have the full right at any time after the original letter of denial to contact a disability lawyer. We always recommend that you start the disability claims process with a lawyer, rather than appealing your claim with your insurance company internally .
Get Legal Advice And Help
Filing a claim for LTD can be a difficult, confusing and lengthy process. Each policy is different. Submitting an incomplete or inaccurate application can lead to a claim being denied. A personal injury or disability insurance lawyer can help you understand your policy, notify you of any deadlines, guide you through the claim process, review your forms and documents and deal with the insurance company. This will help ensure that you will get the benefits you deserve in a timely manner.
Even when an individual has a legitimate cause for claiming their long-term disability benefits, often insurance companies will initially deny the claim, or offer an amount much lower than asked for.
If you or someone you care about suffers from a long-term disability and has disability insurance, contact our preferred experts. They can help you get the LTD benefits you are entitled to, even if your claim was denied. They offer a free consultation and do not charge up-front fees:
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Other Ways You Can Apply
Apply With Your Local Office
You can do most of your business with Social Security online. If you cannot use these online services, your local Social Security office can help you apply. Although our offices are closed to the public, employees from those offices are assisting people by telephone. You can find the phone number for your local office by using our Office Locator and looking under Social Security Office Information. The toll-free Office number is your local office.
Apply By Phone
If You Do Not Live in the U.S. Or One of Its Territories
Contact the if you live outside the U.S. or a U.S. territory and wish to apply for retirement benefits.
Mailing Your Documents
If you mail any documents to us, you must include the Social Security number so that we can match them with the correct application. Do not write anything on the original documents. Please write the Social Security number on a separate sheet of paper and include it in the mailing envelope along with the documents.
Use Of Leave Accumulations
During the six-month period, you must use all legacy sick time and PTO before going into an unpaid status. In cases of a delayed application for LTDI benefits, the approval may happen after the six-month waiting period ends. Because of this, part of the LTDI payment may be made retroactively given the following considerations:
- If the LTDI payment is approved and PTO accumulations have been used, no LTDI payments will be made for the period covered by the PTO time.
- If no PTO time was available following the six-month leave of absence, the approved LTDI payment will be paid once the six-month elimination period has been satisfied.
- If the LTDI company denies the claim and you have not been out beyond six months , and remain under the care of a physician, you can continue the leave for the balance of the six months.
- If the LTDI company denies the claim and you have been out beyond six months, you may be either returned to work or terminated.
NOTE: If an application has been submitted to MetLife for LTDI payments, but the approval takes longer than six months, the staff member who has PTO time available may continue to remain in a paid status until one of two things occurs: approval/denial is given for the benefit or accruals are exhausted. This is an exception to the use of legacy sick time accruals and the maximum leave time available under the Family and Medical Leave Act and Tennessee Maternity Leave Act policy.
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Apply For Benefits Online
You should apply for disability benefits as soon as you become disabled. Follow these easy steps to apply online for disability:
- To start your application, go to our Apply for Benefits page, and read and agree to the Terms of Service. Click Next.
- On that page, review the Getting Ready section to make sure you have the information you need to apply.
- Select Start A New Application.
- We will ask a few questions about who is filling out the application.
- You will then sign into your mySocial Security account, or you will be prompted to create one.
- Complete the application.
You can use the online application to apply for disability benefits if you:
- Are age 18 or older.
- Are not currently receiving benefits on your own Social Security record.
- Are unable to work because of a medical condition that is expected to last at least 12 months or result in death and
- Have not been denied for disability in the last 60 days.
Note: If your application was recently denied, our application is a starting point to request a review of the determination we made.
You may be able to file online for SSI at the same time that you file for SSDI benefits. Once you complete the online process above, a Social Security representative will contact you if we need additional information.
The Facts On Long Term Disability
Long-term disability may become available to people who have exhausted either or all the following: short-term disability insurance, sick leave benefits from your employer, or EI sickness benefits. If you qualify for long term disability, the insurance provider will pay a lower percentage of your salary, which can range anywhere from 60 to 80% of gross earnings before the onset of the disability. These policies usually last until age 65, the standard retirement age.
Note that being permanently disabled does not mean you will receive benefits forever. The term permanent refers to the nature of the disability. Insurance companies vary on the definition of what disabled means, so its always worthwhile to ask your HR or plan administrator to investigate the exact terms and what they cover.
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What Are The Elimination Periods For Long
The most common elimination period for long-term disability is 90 days, but the exact terms of the elimination period will be specified in the policy. If short-term disability coverage is available, the effective waiting period before receiving benefits will be relatively short. When a short-term policy is not available, however, employees may have to wait several months with no income before qualifying for long-term benefits. Due to the longer elimination periods, many employees opt for a combination of short-term and long-term disability coverage.
What Happens Next After Applying
After the application and the supporting documentation has been sent in claims managers at the insurance company will review the application. Often they will use their own internal medical experts, nurses, doctors, or other specialists, to review the evidence and advise on whether the application should be accepted or not.
Sometimes, but rarely at the application stage, an insured maybe asked to submit to an in-person or virtual medical assessment by the insurers medical experts.
Then a decision is made to accept or deny and is communicated to the insured.
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How Your Application Is Assessed
If you have made enough contributions to the Canada Pension Plan, we pass your file to our medical specialists for a medical assessment.
Applications are not assessed on the basis of a medical diagnosis alone, or on the basis of which disability or disease you have. Several factors are considered, including:
- the nature and severity of your medical condition
- the impact of the medical condition and treatment on your capacity to work
- the likely course of your condition
- your age, education and work history
- the number of hours worked, your ability to attend work regularly, and earnings
Service Canada does not consider the availability of suitable employment in the applicant’s region when determining eligibility.
Things You Need To Know About Long
Our team of long-term disability lawyers at Samfiru Tumarkin LLP gets a lot of questions about the difference between long-term disability benefits and Canada Pension Plan disability benefits.
Many LTD insurers tell claimants to apply for CPPD. But claimants then wonder whether they have to apply and what happens if they do not.
Here are five things you should know about the relationship between LTD claims and CPPD in Canada.
1. LTD is not the same thing as CPPD
A long-term disability claim is the benefit from income replacement insurance purchased privately by an individual. This insurance might also be included as part of an employees group benefits plan at work.
Canada Pension Plan disability benefits are a government pension provided to individuals. To qualify for CPPD, you must satisfy the government that the disability that prevents you from working is both severe and prolonged.
2. Getting CPPD may change the amount an LTD insurer pays
Long-term disability insurance companies often ask claimants to apply for CPPD because most LTD policies have provisions that say insurers get a credit for any CPPD that claimants receive.
For example, a disabled employee might receive $2,000 per month from their LTD insurer and then get approved for $1,000 per month in CPPD. That person would not receive a total of $3,000 in benefits per month.
3. If you want to claim LTD, you should also apply for CPPD
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What Is A Medically Determinable Impairment
In order to qualify for Social Security disability benefits, you have to prove you have a physical or mental medically determinable impairment that prevents you from working. The SSA defines it as an impairment that results from anatomical, physiological, or psychological abnormalities, which can be shown by medically acceptable clinical and laboratory diagnostic techniques.
For people who have or had COVID-19, there are three options to do this:
All can establish a medically determinable impairment, Stacy Cloyd, JD, the director of policy and administrative advocacy at the National Organization of Social Security Claimants Representatives, told Verywell. So, that indicates that a PCR test is not the only path towards establishing a medically determinable impairment.
At-home rapid antigen tests would not establish a medically determinable impairment on its own. Its questionable whether a self-administered test qualifies as objective medical evidence, since its not evaluated in a lab.
People living with long COVID may have very different experiences applying for disability benefits because the virus affects peoples bodies in different ways.
If You Run Out Of Paid Leave
Depending on your circumstances, you may request that sick leave credits be advanced to you to cover the period of your absence. This type of leave request is covered to the limit prescribed in your collective agreement or terms and conditions of employment.
You may also request leave without pay for illness or injury. Refer to Appendix B of the Directive on Leave and Special Working Arrangements for additional information.
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Determine When The Waiting Period Ends
All long-term disability plans have something called a waiting period. You can only qualify for long-term disability benefits if you are off work for an extended time. The waiting period is simply the length of time you must be off work for your disability to be considered long term. This is in contrast to a short-term or temporary disability.
There is no standard length for a waiting period. It can be different from plan to plan and can range from 12 weeks to 52 weeks. The majority of long-term disability plans fall in the 17- to 22-week range. Your waiting period will be set out in your insurance policy or group benefits booklet.
You can start your application before the waiting period ends. You want to apply early so your benefits can be approved and start immediately once the waiting period ends. The benefits administrator needs time to process your application. This can take 4 weeks or more. If you wait until the waiting period ends, then there could be a delay until your payments actually start. The delay may be a month or more. So, we recommend starting your application at least 4 weeks before the waiting period is over.