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.