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Have Your Long-Term Disability (LTD) Benefits Been Denied?

The intersection between short-term disability (STD) benefits, long-term disability (LTD) benefits and employment law issues is common. Goldstein Law has experience representing employees in claims against long-term disability insurers that have denied or terminated your application for long-term disability benefits.

If you are an employee covered by a group benefits plan, including long-term disability insurance coverage, you may be entitled to receive LTD benefits as a form of income replacement if you are unable to return to work for a period of time due to an illness or injury.  Most LTD policies have a ‘waiting period’ (i.e., 6 months) that have to be satisfied in order for the insured to be eligible for benefits.  Once the waiting period is satisfied, if the requisite forms are submitted to the insurer along with supportive medical documentation from your treating practitioners that indicate your inability to engage in competitive employment, you may be approved for LTD benefits.

LTD policies are a great way for employees to obtain compensation while they rehabilitate in an attempt to eventually return to work. Disability benefits are typically calculated as a percentage of an employees pre-disability salary (i.e., 66.6{a739806ea1ec03325fdb6a8791d85aad1201ada6e9f0c1ac6e9348733b242bdc} of your pre-disability weekly salary is paid out to the insured that is approved for LTD).  Under many LTD policies, to qualify for long-term disability benefits, the employee must provide evidence to substantiate the fact that he or she is unable to continue working at his or her own occupation; in other words, the employees’ illness or injury prevents that person from performing the essential duties of their own job.

After 24 months’ of receiving LTD benefits, the insurance policies typically contain a ‘change of definition,’ at which time employees’ benefits are often cut-off. The change of definition makes the threshold for eligibility to receive LTD benefits more strenuous than during the initial 24-months of coverage.  This period is considered the ‘any occupation’ period; in other words, an employee will only be eligible to receive LTD benefits after the initial 24-month period if their disability prevents them from performing the essential duties of any occupation commensurate with their education, skills, and training.  The insurance company will often find jobs that are seemingly unrelated to your own occupation as the basis for terminated benefits.

If your application for long-term disability benefits have been denied or if your benefits have been terminated at the change-of-definition, or otherwise, please contact Goldstein Law for a free consultation.