Chapter 1: Get Help From An Accredited Va Attorney Claims Agent Or Representative
Filing a claim for veterans disability benefits should be a straightforward task that is met with respect and processed with urgency. Yet for the thousands of veterans in dire need of disability compensation, the process is burdened by unforgivable delays and denials.
A veteran may wait 4 months to 2 years to receive a decision of benefits. If the claim is denied, a disabled vet can spend years more fighting and waiting for benefits. The road to winning VA compensation claims cases can be immensely improved with the help of a qualified representative.
Who Can Assist a Veteran with a VA Claim for Benefits?
Federal law states that the only individuals with the authority to assist a veteran in the preparation, presentation, and prosecution of a claim for VA benefits are those who are accredited by VA as an attorney, agent, or representative of a VA-recognized veterans service organization.
Accredited by the VA means a person has gone through the VAs official training process and is recognized by the U.S. Department of Veterans Affairs as being capable of assisting claimants with their affairs before VA. Accreditation is required to ensure disabled veterans who seek help are receiving efficient and competent representation. The VA lawyer or agent must also comply with the power-of-attorney requirements and the fee agreement requirements as set forth by law.
How Can I Find an Accredited VA Attorney, Agent or Representative?
Difference Between Long Term And Short Term Policies
Not all insurance policies are created equal, and each type serves its own purpose. Thats why its important to know what kind of coverage you have through your employer or other providing entity. In essence, the coverage available through Hartford and other disability insurance companies comes through either a short-term or long-term policy. Each has its own little nuances, but they generally share similar qualities when it comes to making an application for the stated benefits.
A short-term disability insurance policy is, obviously, going to only cover you for a limited period of time. With Harford, that period usually covers about 90 days. More often than not, Hartford is merely doing whats known as administering the policy. This means they are informing your employer that the benefits should be paid but the payments themselves come from a salary continuation.
You have the potential ability to collect these benefits until reaching your own personal Social Security retirement age, unless the policy contains limitations for mental health conditions or certain physical conditions. But getting approved for the benefit doesnt mean that Hartford wont turn around and issue a denial at some point in the future.
Workers Comp Vs Disability Insurance
When employees are injured on the job, its often the employers responsibility to pay their medical bills and wages while they cant work. Employers often purchase workers compensation policies to cover this risk.
This is a big difference from disability insurance.
Disability insurance covers a percentage of your earnings if you cant work due to illness or injury. It doesnt matter whether an accident or degenerative disease caused your disability. Workers comp only pays if youre hurt in an accident, and only if the accident occurred on the job.
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Long Term Disability Insurance Takes A Weight Off Your Shoulders
If you experience a covered illness or disability that leaves you unable to work for an extended period of time, Unum Long Term Disability Insurance can pay a monthly benefit of up to 60% of your normal income. You can use this benefit however you need, whether its to pay out-of-pocket treatment costs or to cover personal bills and day-to-day expenses.
Our coverage includes treatment for serious forms of cancer, as well as recovery from severe injuries. The most common reasons our customers use this benefit are1:
- Cardiovascular disorders
- Joint disorders
A disability can drastically impact your financial situation if youre not prepared. If youre the primary income provider in your home, a disability can place a huge stress on your loved ones. Protect what youve worked so hard to build. Talk with your HR representative to see if Long Term Disability Insurance is available through your workplace.
Offsets And Integration Of Benefits
Its common for insurance companies to reduce your disability benefit if you get other payments. In other words, they offset their payment usually dollar-for-dollar. For example, lets say you get a CPP disability payment of $900 per month. In this case, your insurance company reduces their payment by $900 per month.
Other offsets include money you get from workers compensation, personal injury settlements, severance payments, or CERB payments, to name a few.
To read more about the steps you can take when your insurer has overpaid you, read our article: LTD Overpayment because of CPP Disability Retroactive Payment: What are my options?
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After Approval For Long
You still have to deal with the insurance company after they approve you for long-term disability. They will monitor your condition and treatment. They may ask you to see a doctor. Or, they might enroll you in a treatment program. But ultimately, its your responsibility to follow the rules of your plan.
So, to keep your benefits, you must carefully manage your relationship with the insurance company. You will need to do what they ask, even if you disagree with it. The following are common issues that happen after claim approval.
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The definition of disability will vary depending on your employer’s plan. Some policies consider you disabled when you’re unable to perform your job duties, while others pay only if you’re unable to perform in any job suitable for you based on your training, education and experience. Other policies require that you not be gainfully employed while you’re collecting benefits or that you are unable to earn a certain percentage of your pre-disability income because of injury or sickness.
There are some policies that will pay you a portion of your total disability monthly benefit amount if you have lost a part of your income due to a disability. Other policies and plans may include a rehabilitation provision that requires you to take part in a vocational rehabilitation program in order to continue to receive benefits.
Keep in mind that many policies and plans have exclusions and limitations and may not fully cover certain disabilities and pre-existing conditions. Benefits differ from company to company, so speak with your benefits administrator for your workplaces complete plan details.
Benefits may begin after you have met an elimination period a plan-defined period of time, starting with the date you are disabled from work and the number of days you must continue to be disabled until benefits may begin. Most group long term disability plans have an elimination period of 90 days or 180 days. Under most group plans, generally the employer selects the elimination period.
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What Is Short Term Disability Insurance
LTD isnt the only form of Disability Insurance!
As the name implies, Short Term Disability exists to replace a regular income for a short period, typically a maximum of 13 26 weeks. During this time, an employee can be off work while receiving a portion of their income. A very high percentage of employees will return to their job within the short term disability time frame.
Take a look at this infographic to understand how Short Term and Long Term Disability Insurance work to help protect the health, wealth, and wellbeing of employees.
What Is Considered A Long
A long-term disability is an injury, illness, or medical condition preventing someone from working their usual job, at their usual pace, or making their usual income.
You might be surprised to learn that approximately 90% of long-term disabilities today are the result of an illness, not an accident or injury. This puts disability in the realm of possibility for any of us, no matter how young, healthy, or seemingly safe.
Long-term disabilities could include cancer, neurological or joint disorders, and asthma, to name a few. They could also include injuries, like those due to a fall or even a car accident.
If you have long-term disability coverage, it can protect your income for years, though you will need to wait until the end of your elimination period to begin receiving funds. This is why some people also carry short-term disability insurance these policies can have waiting periods as short as zero days, helping bridge the gap for you and your bank account.
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Individual Vs Group Coverage
The main difference between individual long term disability and group long term disability is cost. Participating in a group plan is typically cheaper than buying an individual policy. This is especially true if the sponsor of the group plan offers to pay some or all of the policy cost.
Another key difference is that group disability plans are guaranteed issue. This means if you apply for coverage, you are automatically enrolled without having to go through the underwriting process. Insurance companies can do this because they spread their risk among a large group of policyholders.
On the other hand, buying individual long term disability insurance will require you to:
- Fill out an application
- Go through underwriting
- Be approved by the insurance carrier
And for good reason. With an individual policy, the insurance company has to assess the risk of a single applicant. If the company considers you high-risk, you will pay more in premium. Itâs possible for an insurer to consider somebody so risky that they deny coverage altogether.
Although this process may seem like a downside to individual coverage, it pales in comparison to the cons of group coverage.
The biggest downside of group policy is that itâs possible to lose coverage in two ways that are mostly out of your control.
When you buy an individual policy, you own it for as long as you pay the premium. You control your own destiny.
Eligibility To Collect Short
Most short-term disability insurance plans include certain specifications regarding the employee’s eligibility to receive benefits. For example, some plans indicate a minimum service requirement or the minimum length of time that a worker must have been employed for, and may require that the employee works full-time or has worked consecutively for a certain period of time.
In addition to these requirements, some employers specify that an employee must use all of their sick days before becoming eligible for short-term disability benefits. Employers may also require a doctors note to verify an employees affliction, commonly including illnesses such as arthritis or back pain, cancer, diabetes, or other non-work-related injuries.
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Getting Approved For Long Term Disability Pay
In essence, getting approved for long-term disability comes down to a persons ability to work. But does it only mean the disabled claimant must be unable for perform the duties of their current job or does approval for Hartford benefits require an inability to do any work in any occupation?
About 95 percent of the time, especially in the initial 24 months of long-term disability pay, the requirement is an inability to do your own job After that, continued disability insurance pay can become dependent on whether you are able to successfully perform the work of any occupation based on your training, education, experience and other pertinent factors.
A fair share of Hartford policies, depending on the specific employers choice of coverage and premium rates, require the disabled employee to prove an inability to do any type of work at all. Thats why its crucial to understand exactly what your policy says and what the implications can be. Thats what will set the tone and expectations as you move forward with the claim.
As you can see, deciphering how Hartford disability works is much more complex than it appears at first glance. At the Dell & Schaefer disability law firm, we represent claimants across the entire country and always provide a free initial consultation. Whatever questions you may have about Hartford disability insurance, whether for short-term or long-term disability coverage, just give us a call. We welcome the opportunity to speak with you.
Changes To Ltd Benefit Starting January 1 2022
For the 2022 plan year, all employees will be automatically enrolled in employee-paid LTD insurance with 60-percent coverage of predisability earnings and a 90-day benefit waiting period, unless they are already enrolled at that level. You will not need to provide evidence of insurability. Learn more about this change with FAQs, a fact sheet, and a brochure.
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Can You Be Kicked Off Ltd
Technically, an employee is entitled to stay on LTD so long as they remain totally disabled. However, sometimes after a few years, the insurer raises the argument that the insured is no longer totally disabled and is fit to return to work in the same or some other occupation. In this case, it is the employees responsibility to prove they are still totally disabled. If a disagreement still remains, it is advisable that the insured should contact a lawyer to challenge the insurance company.
For any more questions about long term disability in Ontario, or if you need help applying for LTD or appealing an LTD decision, contact Dutton Employment Law for a free consultation.
Do You Have Enough Work Credits For Ssd Benefits
You need to make sure that your application accurately shows that you have worked long enough to qualify for SSD benefits. In other words, you need to show you are insured.
This is determined by the number of work credits you have earned. Work credits are based on your earnings. For instance, in 2013, you earned one work credit for every $1,160 you earned. The most work credits you can earn in a single year are four. Your application must show that you pass two different types of earnings tests: Recent work test and duration of work test. The number of work credits you need to pass these tests will depend on how old you were when you became disabled.
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Own Occupation Vs Any Occupation
The most important distinction in any disability coverage is the policys definition of disability.
Own occupation disability policies pay benefits if youre unable to perform your own job. Any occupation disability policies pay benefits if youre unable to perform any job.
For example, brain surgeons should always carry own occupation disability policies. If theyre in an accident and lose functionality in their hand, their career as a brain surgeon would probably be over.
An own occupation policy would pay benefits in this circumstance. An any occupation policy would not, since the surgeon could still go work in another profession.
As you can guess, own occupation policies are more expensive than any occupation policies since theyre more comprehensive.
Chapter : Individual Disability Claims Are Regulated By State Insurance Law
Private LTD policies are contracts between you and the insurance provider. Claim disputes under these policies are governed by state contract and bad faith law. If an insurer denies your claim, you can appeal the decision. However, these appeals are often nothing more than an internal review with the same insurer that initially denied the claim.
When an acceptable settlement with an insurance company cannot be reached, bad faith insurance claim litigation becomes necessary. Litigation of private policies are held in state or federal court. The burden of proof is the same as a civil trial. You are allowed a jury trial, and may fully engage in evidence and discovery.
State Protections Available
Depending on the state, the protections and damages that are available to you in a dispute over a private disability claim include:
- Emotional distress
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Reviewing Your Return To Work Schedule
Your manager will review your situation to determine if your needs can be accommodated in his/her organization. They will consult with departmental human resources who will coordinate your return to work with your manager and caseworker, if you are receiving benefits through disability or long term disability.
Your manager will inform the Pay Centre of your return to work or rehabilitation schedule, once it has been approved by the employee, manager and human resources, if it differs from your pre-illness schedule. Your manager will also inform your departmental human resources, who in turn will advise the Pay Centre when you are no longer on a rehabilitation schedule. You will be required to provide the Pay Centre with a copy of the approved rehabilitation schedule from your insurer.
The Definition Of Disability
Your policy’s definition of “disability” can have a major impact on whether you qualify for benefits. LTD policies fall into two broad categories: “own occupation” and “any occupation.” The definition of disability found in an “own occupation” policy might look like the following:
Disability exists when, due to illness or accidental injury, you are not able to perform, for wage or profit, the material and substantial duties of your regular occupation.
Notice that you’re disabled under an “own occupation” policy if you’re unable to carry out the duties of your own job. If you’re a firefighter who is medically unable to handle the physical or mental requirements of that demanding job, you’re disabled, even if you would be able to perform another, less strenuous job.
The definition of disability in an “any occupation” policy is more strict, as you usually must demonstrate that you’re incapable of performing any job for which you are reasonably qualified based on your education, training, or experience. A firefighter who cannot lift heavy objects or climb ladders would not be disabled under an “any occupation” policy if he’s still capable of performing other jobs, such as a clerk or cashier.
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