Indiana Disability Insurance Claims
Long term disability insurance is vital to protecting your income. While health insurance will likely cover the cost of some of your medical treatment, it won’t help pay other bills like your mortgage, utilities, car payments, or other liabilities. If you become sick or injured and are forced to miss work, you’ll want to have long term disability coverage behind you. If you purchased a disability insurance policy or your employer provides coverage, you can file a claim for benefits.
Abell and Capitan Law has experience helping people just like you apply for disability benefits and appeal denied claims. Insurance companies use every resource at their disposal to prevent you from receiving the benefits you need. They might tell you your policy doesn’t cover your specific injury. They could also delay the claims process by requesting additional forms and documentation that results in you missing a deadline.
Most people feel intimidated by powerful insurance companies. They don’t understand their rights or what benefits they’re entitled to pursue. The critical thing to remember is you’re not alone. Abell and Capitan Law will be by your side and handle your claim for you. We believe in fighting for our clients to ensure their insurance company treats them fairly.
Disability Insurance: What it is and How it Works
Disability insurance is basically a replacement for your usual income. If you get injured or diagnosed with an illness and can’t return to work, your disability benefits can pay a percentage of your monthly income.
It’s important to note the difference between disability and workers’ compensation. Employers provide their employees with workers’ comp benefits for an injury or illness sustained on the job. With disability benefits, you receive monthly payments for a non-job related injury or illness from an employer-paid or individual policy.
Depending on the terms and conditions listed on your policy, you could potentially receive the following benefits:
- Monthly payments to replace your hourly wage or annual salary
- Employment rehabilitation to assist you in returning to work sooner
There are three types of disability insurance: short-term, long-term, and individual.
Short-Term Disability Insurance: Benefits paid to an injured or ill individual unable to return to work for less than one year.
Long-Term Disability Insurance: Benefits provided to someone whose injury or illness prevents them from returning to work for an extended period, usually around three to six months, when short-term disability benefits run out.
Individual Disability Insurance: A policy purchased by the injured or ill person because their employer doesn’t provide benefits, or they’re a contractor or freelancer.
Many states require, by law, for employers to provide disability insurance benefits to their workers. However, Indiana is not one of those states. Employers in Indiana can provide such insurance but can choose not to do so.
Fortunately, there are multiple options if you want to pursue benefits from a disability claim. The following plans provide disability insurance to those who can’t work:
- Employer Paid: An employer pays a monthly premium for a disability policy that covers an employee’s expenses if he or she becomes injured or sick.
- Employee Paid: An employer offers a plan as part of a benefits package but does not pay the monthly premium. The employee must pay for his or her coverage.
- Member Coverage: Benefits available at a group rate for members of a professional association.
- Individual Plan: Purchase a policy directly through an insurance carrier or broker if the injured party doesn’t receive coverage from their employer or belong to a professional organization.
After you file a claim for disability benefits, a decision will determine whether or not you can receive monthly payments. Whether you apply for short-term, long-term, or individual disability, the amount of money you receive will depend on your salary. The extent of your injury or illness and duration of time away from work is also an essential factor.
How ERISA Can Affect Disability Benefits
ERISA, the Employee Retirement Income Security Act is a law passed in 1974 to protect workers when they become injured or ill and can no longer work for some time. ERISA applies to both long-term and short-term disability insurance. It also regulates an employer’s plans, including the claims process, the timeline for processing claims, and the rights a worker has if their claim gets denied.
Any employee covered under their employer’s disability benefits policy should receive the details of the plan, including a summary of the benefits available. Additional information included explains how the policy works and if any out-of-pocket expenses exist for any of the coverage.
Coverage under an ERISA plan allows various protections for an injured worker seeking benefits. That includes notification of coverage and benefits and the process for filing a claim. There’s also information on how to file an appeal if the application gets denied. For denied appeals, the covered individual has the right to file a lawsuit against the insurance company or employer.
Short-Term Disability Benefits
In the state of Indiana, you cannot receive short-term disability payments for longer than five months. That includes a 30-day elimination period, which is a waiting period before your benefits begin. While you’re out of work, you must provide proof of your disability to the insurance representative handling your claim.
You can choose how you want to receive your monthly payments through a short-term policy.
- First option: 60% of your gross biweekly salary
- Second option: Increase payments to 80% by factoring in one day every week against your accrued leave days
- Third option: You can use ten days of leave every pay period to receive your full wages if there are enough leave days available
If you return to work but become disabled again because of the same condition within 90 days, you won’t have to go through another 30-day elimination period. Your benefits will start immediately and continue until you return to work or reach the six-month limit.
In situations where you can start working against but have to miss some time for medical care, you’re eligible to receive benefits for those periods. You could also choose to use your accrued leave time and receive your full compensation.
Long-Term Disability Benefits
Long-term disability benefits pay you for longer than one year if you can’t work due to your injury or illness. You receive a percentage of your gross wages for up to three years or extend the duration if your disability is permanent, and you’re unable to return to work indefinitely.
Filing for long-term disability requires sufficient evidence to support your claim. The documentation you provide demonstrates to the insurance representative that your disability is valid and covered under the terms of your policy. Submitting incomplete or incorrect information could lead to a delay in benefits or denial of the claim.
The most important information you should obtain for your claim includes:
- Information about your background, such as work, criminal record, home life, etc.
- Proof that you are partially or wholly unable to complete your job-related tasks
- Records from all medical providers treating you for your injury or illness
- A physician letter confirming your disability
- Document showing your current income
If you’re able to provide the information above, it will help your claim. However, the insurance rep may still deny your claim for any number of reasons. If that happens, you could file a lawsuit to pursue the benefits you deserve.
Reasons Disability Benefits Might Be Denied
When you receive a letter stating that the insurance carrier decided to deny your claim, you might not realize why. Even though they must include a specific reason for the denial, it can still be confusing for anyone unfamiliar with the process.
Claims get denied for various reasons depending on the type of claim and injury or illness reported. The top five reasons that are commonly provided include:
- Lack of medical evidence: You must prove you can’t work because of your disabling condition. To do that, you should submit all medical records showing the injury or illnesses that interfered with your ability to perform your job. You could seek care from your doctor for months, but if he or she doesn’t document how your condition prevents you from working, it’s insufficient evidence.
- Prior denials: If you previously applied for disability benefits that got denied and try to submit a new claim, you’ll likely receive another denial letter. It’s better to go through the appeals process rather than filing another claim.
- Failure to seek prescribed treatment: If your physician refers you to another doctor or to undergo additional testing, you must follow their orders. Refusing to follow a treatment plan makes it difficult for the insurance rep to determine if your disability prevented you from working.
- Failure to cooperate: Even if you don’t like the insurance representative or how they’re handling your claim, you need to work with them. That means submitting all requested documentation and forms during the application process, attending required medical exams, and promptly responding to correspondence.
- Undiagnosed condition: Any medical condition or symptoms with no known origin is difficult to predict necessary future treatment. Approving your claim isn’t possible until you provide records showing the status of your injury or illness or recover from it entirely.
Speak with a Disability Insurance Lawyer Today
For assistance getting the disability benefits you’re entitled to, call Abell and Capitan Law to schedule your free consultation. There’s no risk or obligation to speak with us about your case. Additionally, we work on contingency, so you won’t owe us any legal fees until we secure your benefits.
Contact us at (267) 419-7888 and let us seek justice for you. Our team of Indiana disability attorneys is waiting for your call.