South Carolina Long-Term Disability Insurance Lawyers
If a non-work-related injury or illness has kept you from earning a living, contact Abell and Capitan Law for help filing a claim for long-term disability benefits. We represent clients like you with claims, appeals, and lawsuits. We have the experience, resources, and knowledge to protect your rights to the maximum payments you deserve. We’ll fight hard to ensure the insurance company pays what they owe you.
We know the financial strain of not working for an extended period. You have medical bills, household expenses, and a family to take care of. You need LTD benefits immediately so you can afford to pay for everything. Our dedicated South Carolina long-term disability insurance lawyers will work efficiently to resolve your claim so you can move forward with your life.
To find out more about how we can help, call Abell and Capitan Law at (267) 419-7888.
Medical Conditions Eligible for Long Term Disability Coverage
A disability is a physical or mental impairment that prohibits an individual from performing at least one major activity, such as working. LTD insurance provides an injured worker with replacement wages when they’re unable to maintain employment. Employers typically offer this type of insurance to their employees, but it’s also available to workers as an individual plan. The monthly benefit payments you receive will depend on the policy’s provisions and the type of disability you have.
Most insurance companies consider the following injuries and illnesses as qualifying medical conditions:
Immune system disorders, such as:
- Grave’s disease
- Rheumatoid arthritis
Mental illnesses, such as:
- Anxiety disorder
Neurological disorders, such as:
- Parkinson’s disease
- Multiple sclerosis
- Traumatic brain injury
- Alzheimer’s disease
Digestive disorders, such as:
- Ulcerative colitis
- Crohn’s disease
- Inflammatory bowel disease
- Wilson’s disease
Skin disorders, such as:
Musculoskeletal disorders, such as:
Genitourinary disorders, such as:
- Kidney failure
- Urinary tract infection
- Polycystic kidney disease
Respiratory illnesses, such as:
- Cystic fibrosis
Cancer, such as:
- Hodgkin’s disease
- Acute leukemia
Cardiovascular diseases, such as:
- Pulmonary embolism
- Coronary heart disease
The Impact of ERISA on LTD Insurance
The Employee Retirement Income Security Act (ERISA) regulates long-term disability plans and protects policyholders’ rights. ERISA law applies to all insurance policies provided to workers by their employers. Upon request, the insurance company must provide information, such as coverage details, filing deadlines, qualifying disabilities, and other policy documents.
ERISA long-term disability insurance replaces a percentage of a disabled individual’s wages while they’re unable to work. Most policies allow between 50% and 80% of pre-disability average monthly wages. It’s vital that you review your policy to determine your eligibility. Every policy has a list of provisions and exclusions that state who can collect benefits and who’s prohibited. Your South Carolina long-term disability insurance lawyer has experience reading through coverage information. We’ll help you determine whether you qualify through your employer’s insurance.
When you hire us, we can file the claim on your behalf and obtain sufficient evidence that proves you have a disabling condition that prevents you from returning to your job. Examples of this evidence include:d
- Records from ongoing medical treatment
- Letters from physicians explaining your condition and its physical or mental limitations
- Statements from family and friends about the impact of the injury on your daily life
- Hospital records showing the initial diagnosis of a disability
- Job description and list of duties proving your inability to complete the tasks
- Affidavits from medical experts and vocational experts
Take Immediate Action After Suffering a Disability
There are specific steps you should take after suffering a disabling injury or illness to protect your right to long-term disability insurance:
Notify your employer of the injury or illness you sustained. Don’t wait too long. The deadline for filing a claim will depend on your specific policy. You should begin the process as soon as possible, so you don’t run out of time to recover benefits.
Complete the application for benefits that your employer provides. If they don’t give you a form, you can directly contact their insurance company for a copy. You must fill out everything completely and accurately. Include an employee statement that describes your disability, how it happened, and why it prevents you from working.
Request a copy of the insurance policy. Your South Carolina long-term disability insurance lawyer will look it over to ensure it covers your medical condition.
Seek a medical evaluation of your injury or illness. The doctor might refer you to undergo imaging tests, physical therapy, or follow-ups with a specialty provider. Follow their instructions and continue treating until you’re released from care.
Ask your doctor to provide a statement that describes their diagnosis of your disability and how it impairs your ability to perform your job duties.
Collect evidence of your disabling injury or illness. This may include medical records, physician notes, and billing statements, for example.
Hire a lawyer from Abell and Capitan Law to help you pursue LTD benefits.
Once we file your claim with the application and evidence we find, the insurance company will review everything and perform its own investigation. They’ll attempt to locate additional evidence to determine if you have a disability and deserve benefit payments.
There’s an elimination period you must go through if the insurance company approves your claim. It’s a waiting period between the first date of your disability and the date you receive your first payment. You’re ineligible for coverage during this time. Every policy has a different elimination period, but most require 90 days.
Once your benefits begin, you’ll continue to receive monthly payments at a percentage of your prior average wages for up to two years. Some policies allow you to collect benefits until you turn 65 years old as long as you can’t maintain employment during that time. Depending on the extent of the injury or illness, you could potentially receive monthly benefits for the rest of your life.
Common Reasons for Long-Term Disability Claim Denials
Following are some of the most common reasons that LTD claims are denied:
Missed deadline – You have to follow all deadlines listed on the policy, or the insurance company will deny your claim, and you’ll lose your right to benefits.
Lack of evidence – You have to provide the insurance company with proof that you have a disability and can’t complete the required tasks at work. Without evidence, they can’t confirm your eligibility to receive benefit payments.
Failure to attend IME – Sometimes, the insurance company will request that you attend an independent medical examination. During this appointment, a doctor they choose will evaluate your injuries to determine if they agree with your original doctor’s diagnosis. It’s a mandatory appointment and could ruin your chance of LTD coverage if you miss it.
Discrepancies in information – The forms and records you submit must include complete and accurate information. If any of the details, such as the type of injury you sustained, differ from one document to another, you could end up with a denied claim.
Incomplete forms – You must complete every section of the application for benefits. If you send the insurance company an incomplete form, that could delay the process or result in a denial.
Preexisting medical condition – Injuries and illnesses from prior events are typically excluded from coverage. For instance, if you suffered a back injury from a car accident five years ago but recently hurt your back from a fall, that could make you ineligible for benefits.
Disability definition – All insurance policies include a definition of disability and list qualifying conditions. If your disability doesn’t match the definition, the insurance company will likely deny the claim.
Legal Options for Denied LTD Claims
Just because the insurance company denied your claim doesn’t mean you can’t collect benefits. You have the option to appeal their decision. Under ERISA law, you must file an administrative appeal within 180 days from the date on the denial letter.
Your South Carolina long-term disability insurance lawyer will review the letter to determine why they denied the claim. We’ll prepare an adequate appeal and provide additional evidence that proves you deserve benefits. The insurance company will investigate and decide if they agree with our request or their initial decision. The average amount of time it takes is 45 days, but they can ask for two 30-day extensions if they need more time.
If they continue to deny your application for benefits, the next option would be to file a lawsuit. The standard statute of limitations is three years. It’s a strict deadline that requires you to file suit within three years from the disability date. If the statute passes, you’ll lose your right to LTD benefits. Some policies have different requirements, so be sure to check yours for the statute of limitations.
Schedule Your Free Consultation Today
At Abell and Capitan Law, our South Carolina long-term disability insurance lawyers understand the stress you’re feeling. It’s an overwhelming experience becoming disabled and attempting to seek treatment while pursuing insurance benefits. We’ll relieve your burden by handling every step of the process from start to finish. You won’t have to go through this alone. We’ll remain by your side to provide support and guidance.
If your disabling injury or illness affected your ability to work, call us today at (267) 419-7888. We’ll help you file your claim or appeal a denied claim and recover the maximum benefits you deserve.