Does My Long-Term Disability Insurance Policy Continue to Pay Benefits If I Am Fired?

Your employer fired you while you are on disability leave? The first thing going through your head is, “will my disability benefits continue even though I’ve been fired?”

The short answer is yes, BUT there are some things you need to know.

If you call us with this question, the first thing we will tell you is “look at your policy.” You would be surprised at how many questions can be answered by looking through your insurance policy.  If you have any trouble understanding your policy, then it is a great idea to reach out to an experienced ERISA disability law firm to get a better understanding of the language used in your policy.

My Policy Says That My Benefits Will Continue If I Am Fired – There Is Nothing Else I Need to Do, Right?

You may be thinking, “okay, I will continue receiving benefits, so I am all set.” Well no, it’s not that simple. Virtually all policies require that you continue to provide proof that you are disabled. How? You have to keep seeing your doctor, and your doctor has to continue to support your claim.

While receiving disability benefits, you must maintain your medical treatment. We cannot stress this enough. Regularly, claim examiners will look at your file to decide whether they think you still qualify for benefits. They will terminate your claim if they don’t have recent proof that “nothing has changed” and you remain disabled. So be sure that you continue to see your doctor as often as they recommend, and be sure your doctor completes the paperwork the insurance company continues to send them. There is no way around this – we have seen claims closed after many years of continued disability simply because the claimant and their doctor forgot to complete a form.

Your next question might be, “okay, I understand that I need to continue visiting my doctor, but my health insurance was provided by my employer. How can I afford my medical bills now?”

Medical Bills Are So Expensive – How Can I Afford Medical Bills With No Health Insurance?

We get it – this is a horrible situation to find yourself in. You can already see the medical bills beginning to pile up in the future, and you are worried that you will not be able to afford them with no health insurance. But the reality of the situation is, no medical treatment, no disability benefits.

The insurance company will not make an exception for you. They will follow the policy language, and if the language calls for “continued proof of disability,” that’s what you must provide. They simply will not take your word for it – you have to have a doctor fill out their forms and explain why you remain disabled.

Though far from perfect, you often do have options:

COBRA Health Insurance

Generally, employers with 20 or more full-time-equivalent employees are required to offer COBRA coverage for former employees, so make sure to check with HR to see if your former employer has it. If you worked for a large corporate company, then you are probably covered by COBRA.

You may be wondering, “what is COBRA!?”

COBRA is a health insurance program that allows eligible employees and their dependents the continued benefits of health insurance coverage when an employee loses their job or experiences a reduction of work hours. You must be given at least 60 days in which to choose whether to elect continuation coverage. Even if you waive coverage, you can change your mind if it is within the 60-day election period.

It is important to note that the cost of COBRA coverage is usually high because the newly unemployed individual (you) pays the entire cost of the insurance (including the share that your former employer paid).

Medicare

If you are receiving long term disability benefits through your employer, you are likely also receiving Social Security Disability Benefits (SSDI). After two years of SSDI, you are eligible for Medicare. Medicare is the federal health insurance program for people who are 65 and older and those with with disabilities. It covers:

• Hospital insurance
• Medical insurance
• Prescription drug coverage

These plans are offered by insurance companies and other private companies approved by Medicare.

The Affordable Care Act (ACA, also known as Obamacare)

The Affordable Care Act provides consumers with subsidies (“premium tax credits”) that lower costs for health insurance for households with incomes between 100% and 400% of the federal poverty level. Important for many individuals with disabilities, there is no “preexisting condition exclusion” for health insurance offered through the ACA marketplace. You can learn more at www.healthcare.gov.

Takeaway – How We Can Help

If you came across this article because you were recently fired while on disability leave, we understand that you are stressed and probably have a lot of questions.

First, check your policy. It will tell you whether “termination of employment” is a condition for “termination of benefits.” In most cases, it’s not.

Second, make a plan for providing continued proof of disability. Talk to your doctor about how important it will be to continue responding to the insurance company requests for information. Make sure you see your doctor as often as you need and they recommend.

Third, if you still have questions, call at (703) 584-7277. We can answer quick questions for free. If you’d like us to take a “deeper dive” into your policy and medical records to help you plan for the future, we offer a flat fee consultation (and if benefits are denied in the future and we handle your appeal, that consultation fee is credited to your appeal fee). No one plans to become disabled and lose their job. But we can help you plan for what comes next.