Long Term Disability Insurance Lawyers Serving Alabama Residents
If you suffered a non-work-related injury or illness and need help applying for disability insurance, contact the long term disability insurance lawyers at Abell and Capitan Law. We serve Alabama residents with LTD claims. We can help you file your claim and secure your full and fair benefits.
You might not be able to work when you sustain an injury or get diagnosed with an illness. Taking extended time off can jeopardize your financial standing and prevent you from supporting your family. You might wonder how you’re going to pay your medical bills or if it’s possible to return to work in the future despite your disability.
There are many questions disabled individuals have, and our long term disability insurance lawyers are ready to answer them. Applying for a long term disability claim is complicated and, unfortunately, insurance companies will often try to reduce or deny the benefits you’re owed.
Our skilled attorneys will assert your rights and gather the evidence needed to support your claim. We’ll fight skillfully and exhaustively for the benefits you need.
You can schedule a free consultation with Abell and Capitan Law to find out what your options are and how we can help you. Call us today at (267) 419-7888.
ERISA and Long Term Disability Insurance
The Employee Retirement Income Security Act of 1974 (ERISA) typically governs long term disability insurance plans provided by employers. That means if your employer pays for part or all of your disability coverage, you must follow the rules and procedures set forth by ERISA. The benefits that are provided by your LTD insurance policy will replace a portion of your income for an extended period, which is generally determined by your plan and the nature of your disability.
Each policy varies slightly in its definition of disability, but in general, to be eligible for benefits, the injured individual must be unable to perform the duties of their own job. After some time, eligibility for benefits may change, and may stipulate that the individual be unable to complete any amount of work at any job due to their disability.
Is There a Difference Between LTD Insurance and Workers’ Compensation Benefits?
The main difference between long term disability and workers’ compensation is that LTD benefits provide partial-wage replacement for someone who becomes injured while doing something unrelated to their work, while workers’ comp is for job-related injuries and illnesses.
Both insurance policies can come from your employer; however, not all businesses in Alabama have a legal obligation to provide long term disability to their employees. If your employer hasn’t purchased an LTD policy, you can apply for your own individual plan and pay a monthly premium. If you sustain an injury or get sick, you’ll be able to collect benefits based on the type of plan you bought.
What Disabilities Qualify for LTD Benefits?
A long term disability is the result of a medical condition or injury that prevents you from maintaining the work schedule you had before. Disabilities covered under most long term disability policies include, but are not limited to:
- Physical injury
- Autoimmune diseases
- Mental disorder
- Respiratory illness
- Brain injury
- Cardiovascular disease
- Musculoskeletal and connective tissue disorders
How Do I File a Claim for Long Term Disability Insurance?
If you’re unable to work and have coverage under an employer’s LTD policy, you can contact the benefits representative for information regarding the benefits you’re entitled to, how to apply, and other important information.
You should file a claim the second your injury or illness keeps you from your job. You would need to file a short term disability claim first, then when those benefits run out and it’s clear your disability will prevent you from working for longer, your LTD benefits will kick in. Sometimes a claim gets denied or delayed, and the sooner you apply, the sooner you can resolve any issues that arise.
Notify your employer of your condition and submit an application for benefits. You’ll need to provide medical evidence supporting your claim along with the form. Sufficient evidence can include reports from physicians, imaging and lab reports, prescriptions, and records from a rehabilitation center.
You also need a written statement from your doctor that your injury or illness restricts you from performing the tasks at your job. The insurance adjuster will review everything you send them to determine if they agree with your claim. If there are any issues or inconsistencies in the documentation, the adjuster will probably deny your claim.
When You Can Expect Payments to Begin
To qualify for LTD benefits, you need to be out of work because of your disability for a specified number of days, depending on the requirements listed on the policy. Coverage is typically for a disability that lasts more than six months. If you’re unable to return to your job for just two months, you would have to apply for short term disability benefits.
If you’re already receiving payments under your STD policy, you can expect payments from your LTD benefits once your short term coverage expires. However, you’ll have to go through another waiting period and eligibility review by the insurance adjuster before they accept your application.
Once the adjuster approves your claim, you’ll start receiving monthly payments based on a percentage of your average wages before the injury or illness occurred.
Common Reasons Insurance Companies Deny Long Term Disability Claims
Filing a claim for long term disability benefits is complex. When you file a claim, you must provide detailed medical records and other evidence of your injury or illness. One mistake can result in a denied claim and ruin your chance of receiving benefits through the policy.
The most common reasons that lead to a denial include:
The Definition of Disability
LTD policies define disability differently. Some require unique circumstances to occur for you to be eligible. There are also exclusions listed in the policies that prohibit you from collecting benefits for specific injuries or accidents. If you don’t understand how to review the coverages on your policy, you might not know whether you qualify for benefits.
Missing Medical Records
During the claims process, you’ll need to submit documentation to the insurance adjuster that proves you have an injury or illness. That documentation includes hospital records, physical therapy bills, diagnostic reports, letters from your doctors, and prescription medication receipts. If you don’t include detailed information about the type of injury you sustained and the treatment you need to recover, an adjuster won’t get a clear picture of your situation.
Errors in Procedure
There are procedures you must follow and strict deadlines to adhere to during an LTD claim. Even if you miss one step or submit medical records a day late, you could lose your rights to collect benefits.
Insurance adjusters review everything you send to them with a fine-toothed comb. If they find any discrepancies regarding your injury, treatment, or lost wages on the records you submit, that could be a good reason to deny your claim.
Insurance Bad Faith
Some adjusters will intentionally deny a claim that meets the requirements under a long term disability policy. Others will fail to perform an adequate investigation and deny the request before reviewing all the available evidence. That is an act of bad faith.
Rare Medical Conditions
Even though insurance adjusters are familiar with LTD claims, they might not understand all the details of some medical conditions. That could cause them to deny your claim because they don’t think the policy covers your particular injury or illness.
You Can File an Appeal for a Denied Claim
If your claim gets denied, that’s not the end of the road for you. You’re allowed to file an appeal as long as it’s within 180 days from the date you received the denial letter. If you are fighting a LTD claim in Alabama, the process will be much easier if you enlist the help of an experienced long term disability insurance lawyer from Abell and Capitan Law. We understand the complexities of the appeals process and the necessary steps to take.
First, we will review your denial letter and all the documentation the adjuster sent you with it. The denial should include a specific reason for the denial and instructions for how to appeal the decision. Next, we will gather any missing evidence that was missing from the original claim or that the denial letter mentioned they need to send to the adjuster.
Once we collect sufficient evidence and understand why the insurance adjuster denied your claim so we can come up with a valid argument, we’ll file an administrative appeal. The appeal will outline our arguments and copies of additional documentation we believe is necessary to overturn the denial. If the insurance company agrees with our assessment of the denial and approves your updated LTD application, you’ll start receiving benefits.
Speak to a Dedicated Long Term Disability Insurance Lawyer
At Abell and Capitan Law, we understand the importance of receiving LTD benefits as soon as possible. When you’re hurt and out of work, it’s difficult to pay for treatment to recover from the injury or illness that disabled you in the first place. We want to ensure that there are no unnecessary delays in your benefits and that the insurance adjuster doesn’t deny your claim.
You can depend on us to work hard to protect your rights and ensure the insurance company treats you fairly during the claims process. If you receive a denial, we’ll file an appeal on your behalf and handle each step of the appeal process, so you don’t have to worry about doing anything yourself. We’ll be by your side from beginning to end to provide you with the support you need during this difficult time in your life.
If an injury or illness is keeping you from your job in Alabama, call (267) 419-7888 to find out how our long term disability insurance lawyers can help you file for benefits.