Long Term Disability
GENERAL INFORMATION
If you have a disability policy through work or privately, you can file for short-term or long-term disability benefits. These are private insurance benefits, but if your company is large enough to fall under ERISA law, how the insurance company handles the case may be governed by federal law.
Short-term benefits typically last for up to six months, sometimes with your own company paying the benefits rather than the insurance company. If you continue to be unable to work, you may be eligible for long-term benefits after that. However, under many policies, long-term benefits are not automatic. You will likely need your doctor to complete forms giving you limitations that would prevent you from continuing to do your job. Some long-term policies require you to prove that you cannot do any job to be eligible for these benefits. And, some policies have limitations on the amount of benefits you can receive for certain types of conditions, most commonly psychological ones.
Benefits are typically calculated based on a percentage of the salary you were receiving before you had to stop working. Sometimes, the policy will also continue to pay for your health insurance. Because every policy can be different, both as to the requirements to qualify and as to the amount of benefits, it is important to know exactly what your policy involves.
I do not handle Long-Term Disability cases, but I would be happy to give you the name of a qualified attorney.
RELATIONSHIP TO SOCIAL SECURITY
Most long-term disability benefits policies require that persons who are receiving their benefits must file for and pursue a claim for Social Security Disability. This is because the policy says that if you get Social Security benefits, they get to offset what they owe you by the amount of your social security benefits. And they may want to be repaid past benefits that they have paid to you.
But not all long-term disability policies define “disability” the same way as the Social Security Administration defines disability. The long-term disability policy may agree that you are disabled if you cannot substantially do the work that you were doing. The Social Security Administration defines disability as the inability to do any type of work on a full-time basis. Therefore, the severity and limitations of your medical conditions may need to be documents differently for your social security case than for the long-term disability claim.
If the long-term disability policy does define disability the same way as the Social Security Administration, you may be running the risk of losing your long-term disability benefits if you lose the social security case. The insurance company may follow the findings by the social security judge as a way to say you are not longer disabled.
Under either scenario, your insurance company benefits with reduced amounts that are owed to you—which is why the policy requires you to file for and pursue a claim for Social Security Disability.
It is highly recommended, therefore, that you have an attorney for the social security case. A word of caution, though. It is now a trend for the long-term disability insurance companies to offer to send you at their expense to a company to handle your social security case. Some of these companies use non-attorneys to represent you. Most of them are located outside Florida. And, while it is true that it is free to you, remember that your representative is being paid by your insurance company, usually at a discounted rate in exchange for a volume of referrals. If you instead decide to hire a private attorney like myself, the fee that you pay is able to be deducted from any monies you owe back to the long-term disability insurance company.
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