Minnesota Long-term Disability Lawyers
Did you suffer an injury that prevents you from returning to your job? Do you need help filing a claim for long-term disability benefits or appealing a denied claim? If so, contact Abell and Capitan Law. We have the experience and resources to ensure you receive the benefit payments you need while you’re out of work.
We know it’s stressful when an injury or illness keeps you from earning an income. You have bills to pay and a family to support. You should be able to collect benefits through your long-term disability policy, but insurance companies make the process difficult. Our Minnesota long-term disability lawyers will handle the claim on your behalf and make sure the insurance company pays you what they owe you. Call us today at (267) 419-7888 to schedule a free consultation.
What is ERISA?
If your employer provides long-term disability insurance, they have to follow standards set by the Employee Retirement Income Security Act (ERISA). Under this Act, there are guidelines for filing a claim and instructions for an appeal. It’s also supposed to protect an employee’s rights to benefits. Unfortunately, many insurance companies violate those rights by unfairly denying eligible applicants.
LTD plans offer wage replacement benefits to workers who suffer a non-job-related injury or illness that keeps them out of work for a specified period. Every policy has variations for what qualifies as a disability. Typically, most people who can’t return to work are eligible to receive benefit payments. Some policies even allow those who can return to work but at limited functional capacity to apply for coverage.
Long-term disability policies differ from workers’ compensation because WC benefits replace lost wages due to an injury or illness sustained at work. LTD benefits replace lost wages for an employee who gets hurt or sick due to anything other than their job duties.
Employers can provide both insurance benefits to their employees but it’s not a legal requirement to purchase an LTD policy. If you don’t have coverage through your employer’s policy, you can purchase an individual plan and pay a monthly premium.
Eligibility for Long-term Disability Benefits
Every LTD policy has its own definition of disability and what situations qualify someone for coverage. If you have an injury or illness that’s keeping you from your job, you can request a copy of your employer’s policy to check if you’re eligible. You should also review the exclusions list for conditions that might prevent you from receiving wage replacement payments. Some policies might state that a back injury makes you eligible, but the circumstances surrounding how it happened might not.
Common injuries and illnesses covered by LTD insurance include:
Musculoskeletal disorders, such as:
- Carpal tunnel syndrome
- Herniated disc
- Lumbar stenosis
- Rheumatoid arthritis
Neurological disorders, such as:
- Cerebral palsy
- Multiple sclerosis (MS)
- Parkinson’s disease
- Traumatic brain injury
Immune system disorders, such as:
- Severe allergic reactions
- Graves disease
- Immune deficiency disorders
- Joint pain
Mental disorders, such as:
- Asperger’s syndrome
- Anxiety disorder
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
Respiratory disorders, such as:
- Chronic obstructive pulmonary disease (COPD)
- Cystic fibrosis
- Sleep-related breathing disorders
Cardiovascular and circulatory disorders, such as:
- Coronary heart disease
- Congestive heart failure
- Heart attack
- Orthostatic hypertension or hypotension
- Recurrent arrhythmia
Digestive disorders, such as:
- Crohn’s disease
- Inflammatory bowel disease (IBD)
- Kidney failure
- Necrotizing colitis
- Ulcerative colitis
- Wilson’s disease
This isn’t a comprehensive list of all qualifying medical conditions, so you should check with your employer’s LTD insurance company if they cover your injury or illness.
Filing a Claim for Long-term Disability Benefits
There are specific steps you must follow to receive LTD benefits through your employer. Request a copy of the policy to determine the deadlines for filing, the documentation you need to submit, and whether your injury or illness qualifies for coverage.
Notify your employer. Let your employer know that you suffered an injury or illness that prevents you from performing your job’s regular duties.
Complete LTD application. Fill out an application from your employer’s insurance company. Be sure the information is accurate and complete. Any mistakes you make could delay the process or result in a denied claim.
Seek medical treatment. Go to a doctor for an evaluation of your injury or illness. They will provide a diagnosis and treatment plan. You must show up regularly for appointments. LTD insurers will deny a claim if there isn’t sufficient medical evidence of a disability.
Obtain physician statements. You might have to request that your doctor provides a written statement to submit with the application. It should include the type of injury or illness, the date it occurred, how it happened, and the mental or physical limitations.
Maintain records. Keep copies of every document related to your disabling injury or illness, such as medical records. You’ll need to submit it to the insurance company along with your application. The more evidence you can provide, the better.
Return application to your employer. Your employer will also have to fill out a section of the application. When completed, they will send it to their insurance company for review.
How LTD Benefit Payments Work
You’ll have to go through an elimination period before you receive your first payment. This is the amount of time between the date of your disability and when coverage will begin. It’s a requirement insurance companies use to ensure your medical condition affects you long-term. Every policy is different, but most require an elimination period of 30 days up to one year.
After you submit your application for LTD benefits, the insurance company will have up to 45 days to review it and make a decision. They might enlist the help of a medical expert to determine if your condition qualifies as a disability. They can also request a copy of your job description from your employer to confirm you’re unable to complete necessary tasks.
One they finish reviewing your application and performing their own investigation, they’ll send you a letter with their decision. If they approve the claim, you’ll start receiving benefits once the elimination period ends. Payments are at a percentage of the income you earned before the disabling injury or illness. The duration will depend on the type of LTD policy, but coverage typically lasts a few years up to a lifetime. Some insurance companies will also provide benefits to individuals who can work but with limitations that decrease usual wages.
Why Was My Claim Denied?
Applying for long-term disability is a tedious process. You have to comply with strict deadlines, provide sufficient evidence of your disability, and prove that you’re unable to work. Various reasons could cause the insurance company to deny your claim. The most common reasons include:
- The application contains incomplete or incorrect information.
- Your injury or illness doesn’t fall under the policy’s definition of a disability.
- You have a preexisting medical condition excluding you from collecting benefits.
- You didn’t provide adequate evidence of a disability, such as detailed medical records.
- The insurance company’s medical experts disagree with your doctor that you have a disability.
- You missed the filing deadline.
- There are gaps in medical treatment or missed appointments with your doctors.
- An investigator hired by the insurance company catches you participating in activities you shouldn’t be able to do.
- The person processing the claim made an error.
Filing an Appeal for LTD Benefits
Even if the insurance company denies your claim, there are legal options available to recover benefits. When you hire Abell and Capitan Law, we’ll take care of each step of the appeals process.
Read the denial letter. We’ll review the letter the insurance company sent you to determine why they denied the claim. The letter should include the deadline for filing an appeal and additional documents to submit. Under most ERISA plans, the deadline is 180 days from the date on the denial letter.
Request a copy of the claim file. We’ll contact the insurance company for a copy of your file. They’ll send us the application you completed, medical records, and documentation they found during their investigation.
Gather evidence. Depending on the reason for your denied claim, we’ll obtain additional documents that prove your disability, such as:
- Letters from medical experts confirming your disabling medical condition
- Medical records missing from the original claim
- Employment information detailing how your injury or illness affects your ability to work
- Statements from friends and family that your disability impacts your daily life
- Objective medical evidence, such as x-ray results and MRI reports
File appeal. We’ll file an appeal with the insurance company along with all evidence we collected.
File a lawsuit. If the insurance company denies the appeal, we can move forward with a civil lawsuit.
Abell and Capitan Law Will Fight for Your Rights
Under ERISA law, there are certain rights afforded to you. When you hire one of our Minnesota long-term disability lawyers, we’ll ensure the insurance company treats you fairly throughout the claims process.
We have the experience and resources to assist our clients with filing an initial claim or appealing a denial. We’ll work hard to recover the benefit payments you deserve. To find out more about our legal services, call us at (267) 419-7888 and schedule a free consultation.