The Complete Guide To Disability Claims Insurance And Benefits
If you become disabled and can no longer work, disability insurance plans and government disability programs offer potential sources of replacement income in the form of disability benefit payments.
These sources of income can become a lifeline for you and your family should the unthinkable happen.
The Complete Guide to Disability Claims, Insurance and Benefits is your one-stop source for disability benefit information. Our easy-to-read guide explains:
- who is eligible for disability benefits
- what type of benefits are available to you
- how to apply for disability benefits
- how to make sure your disability claim is properly prepared
- tips that make the difference between claim approval and claim denial
- what to expect during the disability claims handling process
- how to handle difficult situations that may arise
- what to expect once benefits are granted
- why benefits are denied or terminated, and what to do about it
How To Survive While Waiting For Disability Benefits
July 6, 2018 by Robert Brand
Its no secret insurance companies and governments make disability benefits as difficult to receive as humanly possible. Not only do they bury you in complicated paperwork, but they also drag out the process for months or even years.
And since 44% of Americans recently said they couldnt cover an unexpected $400-dollar emergency expense, its often devastating for disabled people to go without any income for extended periods of time. Sadly, stories of disabled people going hungry and becoming homeless are all too common.
I found myself in a similar situation not too long ago. After years of suffering from increasing vertigo attacks due to Menieres disease, I finally reached the point where I couldnt work any longer. I applied for disability, armed with dozens of doctors reports, vestibular rehabilitation notes, and the support of numerous medical professionals. I was immediately denied.
I found myself with a newborn son, a wife on maternity leave, and absolutely no way to support my family. And the appeal process could potentially take years before I saw a single penny.
Thankfully, there were options, and below, Ive listed some of the best ways to survive while youre waiting for disability benefits to be approved.
Reduce Your Expenses
Use Your Existing Assets
Apply for Help
Move Up Your Decision
Final Word
Chapter : Is Your Ltd Policy Subject To Exclusions And Limitations
Make sure your policy covers your condition! No policy covers every condition, and those diseases, injuries and impairments that are not covered, or have limited coverage, may carry great weight regarding your claims success.
Get familiar with your policys exclusions and limitations. If the language is unclear, ask the insurance company. We describe common examples below but read your policy carefully to know exactly what you can expect.
Disabilities Caused by Preexisting Conditions
A pre-existing condition is an illness or injury that began or occurred before you were covered under the policy. Most policies exclude pre-existing conditions, which means you cannot receive benefits if those illnesses or injuries occurred in the past.
Pre-existing exclusions usually come into effect when a person has been eligible for benefits for less than a year Besides the preexisting condition exclusion time period of a year, there is also a look back period, usually the three months prior. This means if you were treated for the claimed condition during the three-months before the effective date of your policy, you are ineligible for benefits.
Basically, if you apply for LTD benefits less than a year after you sign up for the benefit, the insurer will review all your medical and pharmacy records for the entire year plus the look back period, looking for a pre-existing condition.
Mental or Nervous Condition Limitation
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Cons Of Disability Loans
There are a number of disadvantages to disability loans, starting with the terms that come with many disability loans.
If you no longer have a stable income and apply for a disability loan, certain lenders may reduce their risk by offering you short repayment terms. While you may receive the cash you need, you might have to pay it back far faster than you would if you took out a disability loan while you were working.
Lenders may offer personal loans with high interest rates to protect themselves when lending money to you while youre unemployed and they may charge expensive loan origination fees or other fees. Costly fees paired with high interest rates can make it easy to rack up debt in a hurry a dangerous scenario when youre not working.
Chapter 1: Why You Need To Appoint Your Own Ssd Attorney Representative
Review your policy to see if it contains language requiring you to apply for Social Security Disability Insurance . If it does, this provision also gives the insurance provider the right to offset any Social Security benefits from the LTD monthly payment. Your LTD benefits will be reduced by the amount of Social Security disability that you receive.
For instance: If the insurance company is supposed to pay you $3,500 per month, and you also win Social Security Disability that pays you $1,800 per month, the LTD insurance company now only has to pay you $1,700 per month. You will also be required to reimburse the insurance company from the back benefits of any social security disability award.
The Insurers Motive for Recommending Their Preferred Social Security Advocate
The insurance company may urge that you allow their recommended SSDI representative to help you obtain Social Security disability benefits. They will frame this recommendation so that it appears they have your best interest in mind.
In reality, the insurer has a financial motive to help you win Social Security Disability benefits. By putting your SSDI case in the hands of their chosen claims management company, the insurance company can control who represents you before the Social Security Administration.
In most cases, representatives or advocates who get referrals from LTD providers are not attorneys, meaning
Attorney-Client Privilege
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I Lost Everything Waiting For Disability Assistance And Im Not The Only One
Last week, ABC News reported that the backlog of Americans waiting to see if they qualify for disability assistance from Social Security has swollen to one million people and that thousands have died while waiting for the agency to deal with their cases. What they didnt report is that thousands have also lived while waiting for the agency to deal with our cases. And that can be just as bad.
I was born in 1968 in York, Pa. My birthparents were semitruck drivers, so we bounced around the country quite a bit growing up. As a child, I was placed in foster care, and by 21, after working for a time in a warehouse, I, too went into truck driving.
Driving, loading and unloading trucks is not an easy business on the body. But as a young person, feeling invincible, I didnt think much of it. I got married in 1997 and realized that being gone all the time wasnt a great thing. So I left truck driving and went into trade school to become a locksmith. I love working with my hands, tinkering with things and figuring out how they work, so the job was a natural fit for me. Of course, lifting and moving heavy safes without proper equipment, I wound up damaging my back even more than I had already damaged it driving trucks.
Chapter : Short Term Disability Insurance Vs Family Medical Leave Act
Both STD and Family Medical Leave are in place to help you if you become disabled and cannot work for a temporary time span. However, they are very different sources with different purposes. It is important not to confuse the two.
Family Medical Leave Protects Your Job
FMLA does not compensate for lost wages. If is a federal program that prevents employers from firing employees who miss weeks or months of work, because they are injured or very sick.
You may be eligible for up to 12 workweeks of leave per year under FMLA. The leave is unpaid: your employer is not required by law to pay you for missed time.
FMLA rules apply in all 50 states, and generally affect companies with 50 or more employees. FMLA also helps you be away from work due to a family members medical emergencies, and for maternity leave and adoption.
Short Term Disability Insurance Replaces Income
STD is a disability insurance plan that is totally financial in nature. It does not affect job security i.e., your employer is not required to hold your job. The insurance carrier that provides the coverage promises to pay on a legitimate disability claim, per policy limits. STD generally starts after any paid sick days are used up, and other policy conditions are met.
Whether purchased privately or provided by an employer, STD coverage is optional. STD only covers the named insured on the policy, and no other family members.
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How Do I Get Approved For Disability Benefits
To get approved for Disability benefits, you must past two tests. First, the Social Security Administration assesses your work history. Then, the SSA determines whether they consider you disabled. To be eligible, you must have worked long enough and recently enough and thus paid enough in relatively recent taxes.
What counts as long enough and recent enough? The basic rule for Social Security Disability Insurance is that you must have worked at least five years of the last 10. If you havent worked enough, you may be eligible for SSI, but you have to meet certain income requirements before your medical issues will be reviewed.
If you pass the work history test, the SSA will evaluate the severity of your injury. If they determine that the injury is serious enough, you will be eligible for benefits. Whether youre injured severely enough by SSA standards is based on how much you are capable of working. If you can engage in substantial gainful activity, meaning you earn more than about $1,300 a month, youre probably ineligible for benefits.
Tip: Disability benefits last for as long as you remain disabled, or until you hit 65.
Back Pay And Your Attorney Fees
Disability attorneys accept cases on a contingency fee basis, which means there is no upfront cost for assistance with your SSD application. The attorney will require a percentage of your back pay as the fee for service.
The SSA sets strict limits on attorney fees for individuals receiving disability benefits. Fees are capped at 25% of your back pay, with a maximum of $6,000. If an attorney wishes to charge more than this, he or she must get special approval from the SSAwhich is seldom permitted.
The SSA will pay your attorney directly from your back pay. All applicable legal fees will be deducted before you receive the lump sum payment.
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You Start To Give Up Hope And Worry About The Future
A lot of bad things can and did happen over the five years it took to start receiving benefits. Even when I was able to work full-time, it wasnt easy. I had to wake up earlier than normal just to be able to function because the stiffness in my joints was so bad first thing in the morning.
There were times when I got to work in the morning and had to rest for a few moments in my car before heading in because my fatigue was so bad.
But then there were days and weeks when I felt amazing and had no issues thats how it is sometimes with a disease like RA, which ebbs and flows, flares and subsides. These are the types of things I struggled to explain to SSA when applying and reapplying for disability benefits.
Those years of not receiving any assistance had to be the scariest ones of my life. I was approaching my mid-20s and had to depend on family members for literally everything. I began to have serious worries about my future. Would I need to stay on disability forever? How would I explain my medical and financial situation to prospective love interests? And if I ever got married, the amount of disability I receive could be reduced or stopped altogether. This is because a portion of a spouses income and assets counts as yours. Talk about soul-stripping.
Chapter : The Initial Application: How To File A Long Term Disability Claim
Caution: A Successful Claim Requires Building a Strong Case
The initial application process for long term disability benefits may seem as simple as filling out the forms sent by your insurer. Yet this is never the case.
A great amount of preparation and forethought is required on the claimants end to prepare a claim that does not end up delayed or denied.
There are many pieces of evidence you will need to collect, complete and submit. Numerous bits of information must be carefully worded and supported to build an ironclad case.
The remainder of this guide is designed to inform disability claimants how to put together and present a strong claim of disability to their insurance provider.
A qualified attorney can be a true asset in properly submitting a disability claim. He or she will work with your doctors and various medical experts to produce essential evidence, as well as anticipate the tactics insurers may resort to in efforts to deny paying a claim.
Consider consulting an attorney who has reviewed or appealed hundreds of LTD claims. A good lawyer will develop your case so that it is strong enough to prevent a denial based on allegations that you are not disabled under the terms of the policy, or for insufficient or partial information.
The Application Process
For a group / ERISA policy, claim forms and filing information will be available to the claimant from the Human Resources department of the employer.
The Review Process
Also Check: 512-437-8000
Chapter 1: Psychological & Cognitive Disabilities
Disability Compensation for Mental Disabilities Other Than PTSD
If your case concerns a mental disorder, various unique issues may be present during the claim process. First you must be sure to have your mental disability professionally diagnosed. Once diagnosed, you will need to identify which particular mental disorder you are seeking benefits for you will also need to show that the disability is service-connected in one of five different ways.
The 5 Ways to Service Connect a Mental Disorder in a VA Claim
Disability claims involving mental disorders can be extremely challenging, and more than one mental disorder can exist.
Note: if you have applied for the wrong mental disorder, that alone is not basis for denial. As long as some of the symptoms overlap, the claim can be applied to the correct disorder once it has been diagnosed. You may be required to provide new evidence in the case.
Glossary of Key Terms Used in Mental Disorder VA Claims
Common Places For Financial Help
Places you might consider contacting for financial help while you are waiting for your Social Security Disability to be approved include:
- Family. In many cases, family should be the first place you look for financial assistance. While no one wants to be a burden to his/her family, it can be somewhat humbling to ask for help and your family is often your best bet for financial assistance while you are seeking Social Security Disability benefits.
- Friends. Sometimes a nearby friend is better than a far away relative. You may be surprised how many friends are willing to help, especially if they are aware of the circumstances surrounding your pending disability claim.
- Church or other Religious Organization. If you have a regular place of worship, make them aware of your need. If you dont worship anywhere, you may consider contacting religious organizations, as many of them are actively involved in charitable outreach to their communities. The Salvation Army, in particular, is a good place to turn for help with food, basic necessities, and utility bills.
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Department Of Vocational Rehabilitation
You might also want to contact the Department of Vocational Rehabilitation in your state. If you qualify for VR assistance, this department can sometimes assist you in a variety of different ways, even to the extent of getting you examined by a physician to determine the extent of your limitations. The report of such an exam could be very useful in your disability case, and “voc rehab” counselors are generally willing to provide such information when asked by either the disability examiner at DDS or by a disability attorney or non-attorney representative, if you hire one.
You can find the contact information for your state’s Department of Vocational Rehabilitation in our state disability resource lists.
Plan For The Long Haul
Something else I generally tell claimants is this: the wait for disability benefits is typically very long. Analyze your personal finances and plan for the long haul. For some people, this may mean cutting back on expenses or even looking at pulling equity out of their homes to make sure they can keep their bills paid while they wait for the process to play itself through.
: Tim Moore, former Social Security disability claims examiner
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