Applying for Long-Term Disability Benefits: Steps to Take: Call 24/7

Nine Critical Steps to Take Prior to Filing Your Claim

Deciding to purchase long-term disability insurance is a tough, but essential, choice. You want to protect yourself and your family without wasting money, and if you’re applying for long-term disability benefits, it’s critical to understand your policy and the steps you need to take before submitting your claim. As a Louisiana long-term disability lawyer, I can emphasize the importance of thoroughly knowing your rights and options under your policy.

Before you stop working and file your long-term disability application, it’s important to have a clear understanding of what your policy covers and how to successfully navigate the claims process.

In this step-by-step guide, we’ll walk you through the key actions you should take to prepare, ensuring you’re ready for the application process under your employer’s long-term disability plan.

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Nine Critical Steps to Take Before Filing Your Claim

When it comes to filing a claim, it’s often what you do before you file that will make the difference between success and denial. Our years of experience in the industry have taught us that your odds of success will be much greater if you take the following steps:

#1 Know Your Policy

Get a copy of your long-term disability benefits policy and a copy of the summary plan description as soon as possible. Do this before filing your claim. Your policy will contain unique terms and conditions that you must meet in order to get the benefits provided. The policy controls everything. Do not rely on assurances your employer may give you. Only the things promised to you under the long-term disability benefits will be covered by the policy.

It’s crucial to understand your long-term disability policy before filing a claim. Your policy dictates how your claim will be processed and your disability evaluated, so make sure to obtain a copy of both your policy and the summary plan description.

If your benefits are through your employer, request these documents in writing from your HR office. They have 30 days to provide them under ERISA, or face penalties. If you have a private plan, contact your agent or insurer to obtain a copy.

Your policy outlines the terms and conditions of your benefits. Don’t rely solely on verbal assurances from your employer—the policy controls everything. It defines how much of your earnings you’ll receive, how your disability is determined, the waiting period for benefits, and the maximum benefit duration.

Everyone’s policy is unique, so before you file a claim, remember: Know Your Policy!

#2 Make Sure Your Doctor Supports Your Claim

Until your doctor supports your long-term disability claim, you do not really have a claim. Winning long-term disability benefits even with a doctor is difficult. Without a doctor’s endorsement and supporting medical records, it’s impossible. You should also make sure you know what’s in your medical records so there are no surprises down the road.

Talk to your doctor. Make sure she knows that you are filing for long-term disability. Your doctor needs to support your disability. You should inform your doctor of the policy requirements (you know them right? – see “Know Your Policy”) for finding you disabled.

Your doctor should talk about your disability in terms of how your disability affects your ability to perform the substantial and material duties of your position. Your medical records need to show objective proof of disability. What does this mean? Appropriate tests should be performed, all results noted, and the doctor’s observations of your condition(s) need to be mentioned in your records.

When you file your claim for long-term disability benefits, the provider will request your medical records from your doctors. They will even request records from the other doctors mentioned in any of your records. Your chances of convincing the long-term disability company that you are truly disabled and entitled to the benefits paid for greatly increase with accurate and complete records.

How can you be sure that your medical records are accurate and complete? Request them from your current and past healthcare providers. Review the records carefully to make sure that everything you told your doctor (or nurse, physician’s assistant, etc.) ends up correctly noted in your medical records. Oftentimes “minor” details left off of your medical records can result in major problems later.

You should also review the medical records to ensure that they sufficiently document all of the objective reasons for your doctor’s diagnosis and opinion. Check to make sure that your doctor notes the correct date for the onset of your disability.

Do this before you file your first piece of paper with your long-term disability provider. If you notice problems or inconsistencies, get them cleared up before filing your claim. You can and need to make your file as strong as possible prior to filing your claim for long-term disability benefits.

If your healthcare providers do not understand the need for good reports, your file will likely contain a number of generic reports that could apply to any given person. This will not help you when you are trying to convince the long-term disability provider that you are disabled and entitled to long-term disability benefits.

A well-informed doctor and well-written medical reports that support your disability determination will go a long way in helping you get the long-term disability benefits you need. You and your doctor should be working as a team to build the best possible case for your long-term disability benefits. Discover the other 8 things you should know before filing your long-term disability claim.

#3 Get Your Finances in Order

You cannot depend on these benefits to completely replace your lost income. Most long-term disability policies only provide either 60 percent or two-thirds of your salary as a benefit. A long-term disability will force you to cut back on your expenses just to get by. Knowing what it will take financially to get you through this time and how much you will actually take home as a result of your disability will help you prepare your life accordingly.

I have not seen a long-term disability policy that provides 100% of your pre-disability wages during the period of disability. Most policies provide either 60% or 66-2/3% of your salary as a benefit. A long-term disability will force you to cut back on your expenses just to get by.

To make matters worse, you may not actually receive the percentage of pay from your long-term disability benefits provider you were insured for? Why is this? There are a couple of reasons. First, most policies have offset provisions that allow the disability company to reduce (offset) benefits for any amounts you receive from other sources. For example, Social Security Disability, worker’s compensation payments, early retirement benefits, etc. You will not be entitled to receive more from all sources of income than the percentage insured.

Another potential reason for obtaining less in long-term disability benefits than you would expect comes in the details of many policies It is this — many long-term disability policies do not factor in commissions, bonuses, supplemental pay, etc. as part of your income. So if half of your income is paid as salary and half is received as commissions, your long-term disability benefits may be paid only for that portion calculated as salary. Using the 50/50 numbers, your long-term disability benefit would then shrink to 30% or 33-1/3% of your actual income.

And just to twist the knife — unless you actually paid for your benefits yourself with after-tax money, you will generally owe income tax on your long-term disability benefits. Doesn’t the tax man always get his share?

Another often overlooked aspect – you will not receive benefits starting on the day you become disabled. There will be a waiting period. The length of this period is policy-specific. Under most policies, this “elimination period” ranges from 30 to 180 days. This means that you must be unable to work and without income (or with reduced income – see your policy for specifics) for the entire period in order to receive your long-term disability benefits.

This is a heavy cross to bear. Unfortunately, if you are truly disabled and unable to work, you must bear it. Knowing what it will take financially to get you through this time and how much you will actually take home as a result of your disability will help you prepare your life accordingly. Discover the other 8 things you should know before filing your long-term disability claim.

#4 Know What You Are Disabled From Doing

Take a detailed look at your job to understand what you do every day. Start with your official job description and supplement it with other tasks that you ordinarily do. You will need to know these duties to know if you are disabled. The long-term disability benefits provider will closely scrutinize your job duties and compare them to your abilities, so be prepared.

In order to be considered disabled under most long-term disability policies, you must not be able to perform (some, most, all, each, and every – depending on your policy) the substantial and material duties of your job/occupation.

Do you know them? All of them?

If not, find out and start keeping track. A good place to start is with a job description from your employer or human resources. If you don’t have a copy, request one. But don’t stop there. Another good place to find job and occupation descriptions is the United States Department of Labor’s Dictionary of Occupational Titles (use the keyword search to locate your occupational description).

Differences between what is actually done and the job description you receive are not unheard of. Take a detailed look at your job to understand what you do every day& — you know all those things that you just do without thinking (like, for example, sitting down for over 1/2 of the day) and don’t really consider part of your job description. It is part of the job.

You need to know these duties, to know if you are disabled. The long-term disability benefits provider will closely scrutinize your material and substantial job duties. Shouldn’t you?

More importantly, your doctor needs to know these things as well. As explained in an earlier post, your doctor’s opinion is very important in your fight for long-term disability benefits. If he knows and understands your job duties and what is required of you daily at work, he can tailor his opinions to your specific requirements. Get the full list of the 9 things you should know before filing your long-term disability claim.

#5 Start a Diary or Journal

In order to help your memory and strengthen your initial claim, a good idea is to keep a diary or journal to chronicle your daily struggles with life. When you go to file your initial claim, you will have your daily recollections recorded and can accurately depict your daily struggles for the claims examiner.

The battle against disabling illness or injury is often lonely and long. Your disability has left you unable to do little things like walking to your mailbox without losing your breath. And the pain you suffer from doing simple things like cooking dinner is hard to explain.

But the question is whether or not you will remember to note all of these things to the long-term disability benefits provider. In my experience, the answer is usually no. We tend to focus on the major difficulties we have and disregard or minimize the small details. These small details are important, however.

These little ones add up and count. Things like being winded by walking from your kitchen to your living room. Or how, after tying your shoes, it took you five minutes to straighten back up. And that’s every morning.

You can do this in a notebook or by creating a simple form on your computer. Whatever works best for you.

Not only may this help your disability claim, many authors feel that chronicling our problems and daily activities has therapeutic value. (I don’t know about the therapeutic value one way or the other, but I’m of the opinion that it can’t hurt.)

By truly understanding the impact your disability is having on your life, a more convincing initial long-term disability benefits application can be created. Start your journal today. Get the full list of the 9 things you should know before filing your long-term disability claim.

#6 Enlist Support

Let your friends and family members know that you are sick or injured and you may be filing a long-term disability claim.

You don’t have to feel like you are on an island. Your family and friends are there for you if you ask. While these understanding and caring individuals can help you through the emotional toll a disability brings to bear, they can also help your disability benefits claim.

They are always around you and have become accustomed to your personality and ticks. They may notice things about you that you don’t even notice yourself, things that may be caused by your ailment. But if they are unaware of what’s going on and that you are fighting a serious illness, they may not associate it with your disability.

How could they? Bring them on board. Let them know that you are sick or injured and that you may be filing a long-term disability claim.

Ask them to start keeping mental notes or write down any changes that they notice in you. You may need their support later in completing your application for benefits or in fighting a denial.

If they don’t remember, they can’t help.

Another good source of help is from your co-workers or employer. While I understand this is not always possible or advisable (for example, others have been fired when they got sick), your employer did pay for the long-term disability insurance that you will soon be trying to utilize.

They may help you get the evidence you need to support your disability application or appeal.

Your employer and co-workers can help you in defining your job duties. They can also make mental notes of your difficulties and/or inability to perform those duties.

The more people you have supporting you and your disability the better. And, it is better to know before taking a chance and hoping they will support you later. By then, it may be too late.

#7 Choose the Correct Date for Disability Onset

Generally speaking, you want the earliest disability onset date possible. But that’s appropriate only when you are absolutely certain that you have qualified for long-term disability coverage and are past any waiting period and preexisting condition period under your employer’s long-term disability policy.

The onset date of your disability is simply the date that your disability begins and you are no longer able to work. Simple, right? Wrong. Why?

The date your disability begins is important for a number of reasons, including:

* Starts the Elimination Period (EP);* Impacts the Pre-Existing Condition (PEC) determination;* Influences your Eligibility for benefits; and* May result in your benefits being delayed, or worse, denied.

Generally speaking, you want the earliest disability OD possible. But only in those circumstances where you are absolutely certain that you have long-term disability coverage and are past any waiting period and PEC period under your employer’s long-term disability policy.

The earlier your long-term disability onset date, the sooner your elimination period will expire. That means the quicker you are eligible for benefits.

However, the disability onset date can negatively impact your claim for long-term disability benefits sometimes.

For example, most policies contain some sort of pre-existing condition provision. Usually, PEC provisions are in effect for a certain period of time after you first become covered (for example, 12 months).

If you file a claim during that period, the long-term disability benefits provider will look back to your prior medical history for a certain period of time to see if you were treated for the disability prior to having coverage. They may also try to determine if you had the disability even if you didn’t get treated. A common look back period is 3 – 12 months.

If there is evidence of the condition during the look-back period, then you are denied benefits.

Let’s look at an example:

John is hired by CPI as a process tech on January 15, 2009. He is eligible for long-term disability benefits through CPI on day 1. When hired, John was being treated for depression. It was under control with medication and therapy. After he started, the stress of the job became too much and his depression got much worse. John was no longer able to function or complete the material and substantial tasks of his occupation. The long-term disability policy provided by CPI had a pre-existing condition clause that said if a claim is filed within 12 months of the date coverage began, you have a PEC if you sought treatment within the 6 months prior to the effective date.

If he gets worse within six months of taking his new job and files a long-term disability claim, the provider will easily determine that John had a pre-existing condition and deny benefits on that basis alone.

If however, John’s depression doesn’t disable him until 18 months after he starts, the pre-existing condition provision will not come into play. John’s claim will be reviewed for its merit.

Another example of where the disability onset date can negatively affect your claim for long-term disability benefits occurs if there is a waiting period in your policy. A waiting period is a certain amount of time that you must wait to be covered under the long-term disability policy.

Let’s look at John again. This time, his benefits do not start right away, but on the 1st day of the month following his hire date. As a result, his benefits start on February 1, 2009.

If John’s depression caused him to make a claim on January 16, 2010, he would have a pre-existing condition. Why? Because although his claim was made more than 12 months after his start date, it was less than 12 months after his long-term disability coverage went into effect.

Another reason why the onset date may be important comes from the policy’s definition of disability. Many policies have some combination of lack of ability to work and lack of ability to earn wages.

But what if your company allows you to work a reduced schedule for your full pay? Then the disability benefits provider would not consider you disabled until you met the lack of wages portion of the definition. Your onset date would be on that date.

These are merely examples of how the disability onset date can impact your claim for long-term disability benefits. There are probably many more examples of how this one date can affect a long-term disability claim. Each person’s policy and unique circumstance will be different and for specific advice, you should consult a disability attorney.

You must remember that you should never lie or conceal the truth about your disability, its impact, or when it began. However, understanding how this date impacts your claim before you file helps you make better decisions regarding your life.

You may be able to fight through the pain for that one more month (as long as your doctor approves) to get past the pre-existing condition exclusion and have your claim reviewed according to its merit.

No matter your disability onset date, it must be fully supported by your doctor and medical records.

When it comes to filing a claim, it’s often what you do before you file (like understanding your onset date) that will make the difference between success and a denial. Our years of experience in the industry have taught us that your odds of success will be much greater if you follow a step-by-step guide of what you should know before you even file your first piece of paper for long-term disability benefits under your employer’s benefits policy.

#8 Don’t Quit Work Too Soon

Most definitions of long-term disability will require that you can no longer work because of the disability. Unfortunately, some people stop working before their doctors diagnose a disabling condition. When that happens, the person will have no medical proof of a disability until after he stopped working. This can lead to a denial of his claim.

There are a few reasons why the date that you can no longer work due to disability is important. Two very specific reasons are:

It impacts coverage; and
You may not be disabled.

COVERAGE QUESTIONS

As we just discussed, pre-existing conditions, waiting periods, and effective dates of coverage are important topics to understand when you and your doctor are determining that you can no longer work.

Why?
Are you sure that you are covered under your employer’s long-term disability policy?
Did you fill out your election timely and has the waiting period passed?
Are you beyond the pre-existing condition exclusion?
These are just a few of the questions that impact whether or not you have coverage and are entitled to benefits at the time you can no longer work.

DISABILITY QUESTIONS

If you have been following along, you know the importance of having your doctor diagnose your disabling condition.

You also know that your policy contains a specific definition of disability. To get benefits under the policy, you must be disabled according to the definition. Most definitions will require that you can no longer work because of a disability.

Unfortunately, some people stop working BEFORE their doctor diagnoses a disabling condition. When that happens, the person will have no medical proof of a disability until AFTER they stop working. Sometimes, people file without any medical support.

The long-term disability provider will have an easy decision – that person decided to stop working (quit). The person cannot prove that a disability caused their inability to work. Why? Because they have no medical opinion saying so. The medical opinion only comes after the decision to stop working.

A good example here is the chicken and the egg. You know the one – which came first, the chicken or the egg?

While there is no clear answer on the chicken or the egg, in long-term disability settings there is. You must have a doctor’s opinion and medical proof of disability BEFORE stopping work and filing a claim.

[Just for the record – the chicken came first]

You should only stop working after you are certain that you are covered under the long-term disability policy, and you have adequate medical support and documentation. And not before.

#9 Understand Why Long-Term Disability Benefits Are Difficult to Get

You will be trying to get money from a long-term disability provider that wants to keep it. Your primary goal should be to make it difficult for the disability company to deny your legitimate claim by building a record of support for your disability claim so that even the most biased observer would say that benefits are due.

You will be trying to get money from a long-term disability provider that wants to keep it. They have employed and trained people to put you at ease and lull you into a sense of ease. The trained staff will appear to be helping you fill out the forms and gather information.

Do not fall for it.

The instances of long-term disability providers bad faith handling of claims are legion. Your long-term disability benefits provider may only be trying to get the information they need to deny your claim.

You have a right to the benefits paid for by you and your employer. The long-term disability provider must pay the benefits if it determines you are disabled under the policy. Even if it doesn’t want to.

Your primary goal should be to make it difficult for the disability company to deny your legitimate claim. How do you do this? By building a record of support for your disability claim so that even the most biased observer would say that benefits are due.

You do this from the outset by:

understanding your policy;
getting your doctor on board and understanding your medical records;
knowing your duties and making sure your medical records support an inability to do them;
getting your finances in order;
showing how your illness/injury impacts your daily life with a diary or journal;
getting your family, friends, and co-workers to help;
understanding the importance of the disability onset date;
making sure you do not stop working before you are disabled and have coverage; and
understanding the nature of the beast.

Simply understanding these 9 things in no way guarantees you will be successful with your long-term disability claim.

The long-term disability benefits process is long and difficult. Many claimants fall prey to the disability company tactics. Don’t be one of them.

While the law in this area is often not very favorable to you, rest assured that long-term disability claims are paid, and long-term disability cases are won in court.

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LJBLegal Is Here to Help

This list may seem overwhelming, but we want you to know that you do not have to go through this process alone. If you need help filing a claim, appealing a denial, or with litigation of a claim, call us today. We understand the process and will make sure you understand as well.

If you need help filing a disability claim or appealing a denial, we’re here to help. Give us a call at 985-240-9773.