Utah Long Term Disability Lawyers
You might qualify for long term disability benefits if you sustained a non-job-related injury or illness. Abell and Capitan Law represents clients and assists them in filing a claim or appealing a denied claim. We have the experience and resources to ensure you will receive the maximum payments the insurance company owes you.
We understand the importance of LTD insurance coverage. You need it to pay for your medical treatment and support yourself while you’re out of work. The financial burden you feel can seem overwhelming at times. Our Utah long term disability lawyers will take on the responsibility and handle every aspect of your case. You can depend on us to resolve your claim efficiently and favorably.
To find out more about the legal services we provide or schedule a free consultation, call Abell and Capitan Law today at (267) 419-7888.
How Long Term Disability Insurance Works
Long term disability (LTD) is an insurance plan that replaces a percentage of an injured worker’s wages for the disabling condition that prevents their ability to maintain employment. Employers will provide it as part of an employee’s benefits package. The coverage you receive will depend on the type of disability you have and other provisions listed on the policy.
Most LTD insurance plans define the following injuries and illnesses as disabilities:
Musculoskeletal disorders. Examples include:
Neurological disorders. Examples include:
- Alzheimer’s Disease
- Multiple sclerosis (MS)
- Parkinson’s Disease
- Traumatic brain injury
Immune system disorders. Examples include:
- Graves’ Disease
Mental disorders. Examples include:
- Anxiety disorders
Respiratory diseases. Examples include:
- Cystic fibrosis
Cardiovascular disorders. Examples include:
- Coronary heart disease
- Ischemic heart disease
Digestive disorders. Examples include:
- Crohn’s Disease
- Inflammatory bowel disease (IBD)
- Ulcerative colitis
- Wilson’s Disease
Genitourinary impairments. Examples include:
- Kidney failure
- Nephrotic disorder
- Urinary tract infections
Hematological disorders. Examples include:
- Chronic anemia
- Sickle Cell Disease
- Spleen diseases
Skin diseases. Examples include:
Cancers. Examples include:
- Acute Leukemia
- Hodgkin’s Disease
How ERISA Affects LTD Insurance Companies
A federal law that protects disabled individuals and sets standards for how insurance companies must treat policyholders is known as the Employee Retirement Income Security Act (ERISA). ERISA applies to any policy paid for by a business and provided to employees. Under this law, employers must provide their workers with information about the LTD plan, such as coverage details and deadlines for filing claims.
ERISA LTD policies provide wage replacement to those who suffer non-job-related injuries and illnesses. Every policy has a different definition of what qualifies as a disability and specific circumstances surrounding its occurrence. For example, an insurance company might allow benefits for employees with spinal cord injuries but don’t provide coverage if it happened due to a construction accident. You must obtain a copy of the policy so you can review the provisions and exclusions.
Your Utah long term disability lawyer will file the claim on your behalf and gather sufficient evidence that proves you have a disabling condition and deserve LTD benefits, such as:
- Physician letters stating the type of disability and how it interferes with your job
- Hospital records showing the initial injury or illness
- Physical therapy records, imaging results, or surgical reports proving ongoing medical treatment
- Statements from friends and family of the impact the disability has on daily life
- Job description and employment records to show that you’re unable to perform the tasks of your job
- Affidavits from medical experts
Steps to Take After Developing a Disability
If your doctor diagnoses you with a physical or mental disability and you can’t complete your job duties, you should take immediate action and file a claim for LTD benefits.
Notify your employer of the injury or illness and the exact date you’re no longer able to work. This should be done in writing, so there’s a record of it.
Complete an application for benefits. Your employer should provide it to you. You’ll need to fill out the employee section and give it back to your employer to fill out their section. They will submit it to the insurance company.
Seek medical treatment from someone who specializes in your particular injury or illness. If they refer you to follow up or make an appointment with other medical providers, follow their instructions.
Request a physician statement that mentions the type of disability you have and why it prevents you from returning to your job.
Obtain evidence of your disability, such as medical records.
Hire a Utah long term disability lawyer to assist you with your claim.
After we submit the application and evidence to the insurance company, they’ll review everything and perform an investigation of their own. They’ll likely look for evidence using their resources to determine if your injury or illness qualifies as a disability.
If the insurance company approves your claim, there’s an elimination period you must go through before you start receiving benefit payments. This is a waiting period from the date of your disabling condition to the first date of LTD coverage. Every policy differs, but the elimination period usually ranges from 30 days to one year.
You’ll continue receiving benefit payments until you return to work or reach a specific time limit. Some people can collect benefits for up to two years or until they turn 65 years old. Others might qualify for lifetime benefits depending on the injury and whether it’s permanent.
How to Appeal a Denied Insurance Claim
When an insurance company receives an application for long term disability benefits, they’ll have up to 45 days to review everything and decide. Sometimes they’re allowed to request a maximum of two 30-day extensions. During the claims process, they review all the documentation you submitted, evidence they find on their own, and expert witness statements.
If they determine that you don’t qualify for LTD coverage, they will issue a denial letter. The letter should include their reasoning for denying the claim and instructions on how to file an appeal. With most ERISA plans, you can file an administrative appeal within 180 days from the letter’s date. You must find additional evidence not included in the original claim that might help prove your disability.
The appeal gets filed with the insurance company you initially filed a claim with. If they approve your appeal, you’ll be able to collect benefit payments. If they continue to deny your application for LTD insurance, you can move forward with a lawsuit. The lawsuit gets filed within the civil court system. It’s an opportunity for you to take your case to court and convince a judge that you deserve benefits.
Why Do Insurance Companies Deny Long Term Disability Claims?
The most common reasons insurance companies will deny an applicant’s claim include:
- Missed deadline: You must follow the requirements listed on your LTD policy. That includes complying with all filing deadlines.
- Information discrepancies: You’ll need to fill out an application and provide evidence that supports your disability. The injury you claim to have and the information on your medical records must match.
- Incomplete forms: When you’re completing forms provided by the insurance company, ensure you fill out each section completely and accurately.
- Lack of evidence: Evidence that you have a disabling condition, and it directly affects your ability to work is necessary. Sufficient evidence includes medical records and expert witnesses.
- Failure to attend IME: Many insurance companies will require that you attend an independent medical examination. It’s an appointment with a doctor that they choose to evaluate your injuries and determine if they agree with your initial doctor’s diagnosis. This isn’t optional. You must attend.
- Incorrect definition of disability: Every LTD policy has slight variations in the definition of a disability. Your injury or illness must match the definition listed on your employer’s insurance policy.
- Preexisting medical condition: A list of exclusions typically include preexisting injuries and illnesses. If you received prior treatment for the same disabling condition you currently have, you might not be eligible for coverage.
Speak With a Dedicated Utah Long Term Disability Lawyer
At Abell and Capitan Law, we know the hardships you’re facing. When you get hurt or sick and can’t earn a living, it becomes stressful to keep up with medical bills and household expenses. You should receive the maximum benefits available from your employer’s long-term disability plan. We’ll help you with your claim and ensure the insurance company treats you fairly.
When you hire us, we’ll represent you on a contingency fee basis. That means there are no upfront fees or costs required. We don’t collect legal fees unless we recover LTD payments for our clients. If we don’t win, you won’t have to pay us anything.
Our Utah long-term disability lawyers care about the people who hire us. We’ll fight hard to protect your rights and help you move on from this difficult experience. We have the experience, skills, and resources to handle each step of the process, including filing an initial claim and appealing a denial by the insurance company. If you need help with your case, call us at (267) 419-7888.