Long-term disability insurance can replace your missing wages when you are injured or sick and can no longer work. When everything goes well, this is a tremendous benefit. You can get the medical help you need, keep on paying your bills, and continue caring for your family.
Unfortunately, the application process can be confusing, and when you are dealing with health challenges, it can seem overwhelming. Insurance companies may even deny valid claims. A long-term disability lawyer handling claims in Pennsylvania can fight for the benefits you deserve.
At BenGlassLaw, we’ve helped recover over $100 million for injured workers, and we can be your advocates through this difficult time. Contact us today to schedule a free consultation and discuss your options.
What Is Long-Term Disability?
When you are unable to work because of a serious injury or illness that lasts for a long period, long-term disability (LTD) can provide income replacement to help you pay your bills. If your claim is approved, you may receive between 50% and 70% of your regular income.
LTD typically requires an elimination period after you have exhausted your short-term disability and sick leave. To qualify requires medical documentation of a serious condition, such as a major injury, chronic illness, or mental health disorder.
Although you can buy long-term disability insurance independently, many employers include it in their benefits packages. Examine your policy to make sure you understand elements like waiting periods, benefit duration, and exclusions.
Types of Long-Term Disability Insurance
Your long-term disability policy will reference two different types of coverage. These are:
- Own occupation: This coverage qualifies you for benefits when you are no longer able to perform the duties of your specific job title.
- Any occupation: This definition means you are not able to perform the work involved with any job for which you are reasonably qualified.
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Do You Need an Attorney to Apply for Long-Term Disability?
The help of a lawyer is not legally required to apply for long-term disability; however, it is always smart to consult with an attorney whenever you are dealing with something as serious as your health and financial benefits.
While we hope that insurance companies are there when we need them, the truth is that they are businesses with bottom lines. If they deny your claim and you choose to appeal, you’ll be facing teams of powerful lawyers. Don’t try to take on that fight by yourself.
If your claim has been denied, our team of long-term disability attorneys serving Pennsylvania can guide you through the appeals process. We regularly assist individuals in Pennsylvania and beyond, conducting in-depth interviews, consulting vocational experts, and building compelling narratives to challenge unfair denials.
Pennsylvania Long-Term Disability Lawyer Near Me (703) 591-9829
How Do You Qualify for Long-Term Disability?
Qualifying for long-term disability benefits requires that you meet the criteria stated by your insurance provider. If you need assistance reviewing the terms of your policy, our long-term disability lawyers can help you understand if you qualify for benefits.
Your insurance company will require medical documentation from your doctor to support your claim, and it may request independent medical evaluations. Your attorney can help ensure you provide the right support documents to avoid a delay in your benefits.
Conditions that typically qualify for long-term disability include spinal injuries, traumatic brain injuries, and other catastrophic injuries; chronic illnesses such as cancer; and mental health disorders such as post-traumatic stress disorder (PTSD).
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What if You Are Denied Long-Term Disability?
If your long-term disability application is denied, you have the right to appeal. The denial letter should clearly outline the reasons your claim was rejected. Some common excuses an insurance company may try to use to deny your claim include:
- Your medical records failed to show evidence to support a diagnosis that qualifies for long-term disability.
- You missed deadlines or submitted incomplete paperwork.
- You fail to meet your policy’s definition for Own Occupation or Any Occupation disability.
- Your injury or illness is caused by a pre-existing condition that extends to before the look-back period began.
- You have not seen a doctor for treatment regularly and therefore don’t have a serious condition.
- An investigator has uncovered evidence through video surveillance, social media, or otherwise that counters your disability claim.
- The insurance company’s independent medical examiner disagrees with your doctor on the severity of your condition.
Our long-term disability lawyers in Pennsylvania can review the reason for your denial and put together an evidence-based case that shows your condition and proves your need for LTD.
Employee Retirement Income Security Act
If your employer offers long-term disability coverage, you might be subject to the Employee Retirement Income Security Act (ERISA). This federal law sets regulations on the handling of benefit claims and appeals.
ERISA gives you important rights, such as:
- The right to a complete review of a denied claim
- The right to view your plan documents and claim file
- The right to file a lawsuit in federal court once you’ve exhausted your provider’s appeal process
However, ERISA restricts your legal options as well. For instance, you generally cannot present new evidence in court that was not part of the appeal process. And, there is no jury trial. A federal judge will adjudicate the case.
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Get Help From a Long-Term Disability Attorney Serving Pennsylvania
Nobody wants to get hurt or face an illness that keeps them away from work. You’ve worked hard your whole life, and you didn’t ask for this. Now, you have a long recovery ahead, your bills are mounting, and your family is feeling the strain.
Long-term disability insurance is supposed to help in times like this, but when insurers deny your claim with confusing or unjustified reasons, it can feel like they’ve turned against you.
Our experienced lawyers regularly assist individuals in Pennsylvania with long-term disability appeals, and we’re ready to fight for the benefits you deserve.
At BenGlassLaw, our team has over 100 years of combined experience, advocating for the rights of injured individuals. We leave no stone unturned. Contact us today to schedule a free consultation and find out how we can help you get the benefits you deserve.
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