Washington Long Term Disability Insurance Attorneys
If you got hurt or sick and can’t work for an extended period, you might be wondering if you qualify for long term disability benefits. Contact Abell and Capitan Law, and we’ll advise you on your options and how you can apply for long term disability insurance. Taking time off from work because of an injury or illness can result in severe financial strain. You don’t have to face your disability and loss of income by yourself.
Our Washington long term disability insurance attorneys know you have a lot of questions, and we’re ready to answer them. Long-term disability insurance benefits can supplement your income while you’re out of work, trying to recover from your injury. If your situation becomes permanent, you might qualify for lifelong benefits.
You should be able to trust that you’ll receive your full benefits from your insurance provider, but the truth is that insurance companies are for-profit businesses who will try to cut corners and reduce your benefits, if they can. We’ll do our best to prevent that from happening.
We understand disability law through and through. We’ll work hard and skillfully to negotiate your LTD benefits or settlement, to appeal your denied claim, or to fight for your rights in court, if necessary, so that you receive the LTD payments you deserve. To find out how we can help you secure your LTD benefits, call (267) 419-7888 and schedule a free initial consultation.
Long Term Disability and Workers’ Compensation Are Not the Same
Some people will use the terms workers’ comp and long term disability interchangeably. However, they’re different types of insurance benefits. LTD replaces partial wages for someone who gets hurt off the job, while workers’ compensation provides insurance benefits for a job-related illness or injury.
Employers might offer both types of insurance; however, some might not, and then you would have to apply for benefits through a self-insured plan. When you’re applying for LTD benefits, you’ll need to contact your insurance company’s representative to file a claim and submit the necessary documentation.
How ERISA Affects Long Term Disability Claims
There are rules to ensure employees remain protected and have certain rights under the Employee Retirement Income Security Act (ERISA). The procedures and regulations set and enforced by ERISA become effective if your employer pays for your LTD insurance plan. Even if they only pay for part of the monthly premium, ERISA still covers it.
Every policy has variations in terms of its definition of disability, but typically a disability is a physical or mental impairment that prevents a person from performing their job-related duties. To receive benefits, you must have a qualifying illness or injury that keeps you from maintaining regular employment over an extended period. The benefits you’re entitled to replace a portion of your average income.
Injuries and Illness That Qualify for Long Term Disability
A long term disability develops because of a medical condition or injury that inhibits your ability to perform the same job you previously had or maintain an adequate work schedule.
Most Washington state LTD policies cover the following diseases and injuries:
- Musculoskeletal disorders, such as a back injury
- Cardiovascular conditions, such as coronary artery disease
- Various cancers
- Loss of hearing or vision
- Hematological disorders
- Digestive tract conditions, such as inflammatory bowel disease
- Neurological disorders, such as Parkinson’s disease and multiple sclerosis
- Immune system disorders, such as HIV/AIDS or lupus
- Marfan Syndrome, Sjogren’s Syndrom, and other similar syndromes
- Respiratory illnesses, such as asthma and COPD
- Skin disorders like dermatitis
- Mental issues, such as anxiety and depression
- Kidney disease
Steps for Filing an LTD Claim
If your employer provides long term disability insurance and you suddenly can’t work because of a qualifying medical condition, you need to contact the insurance representative. Under ERISA, you have rights to all LTD information, including policy details, coverage information, and instructions on filing a claim.
When you get hurt or sick and know you’ll be out of work for a while, you should notify your employer immediately. They will provide you with an application you’ll need to fill out and submit to the insurance company. If your employer doesn’t give you an application, you can print one out yourself.
Follow the instructions on the claim packet carefully and send all required documentation along with the form. If you don’t follow the instructions exactly, that could result in a delayed or denied claim.
Relevant evidence you’ll need to submit to the insurer along with the completed form includes:
- Physician notes
- Lab and imaging reports
- Operative reports
- Medical bills
- Physical therapy records
- Lost wage reports
Your doctor should also provide you with a written statement that includes the specific medical problem you have and how it interferes with your job. If none of your medical records mention that you got hurt or sick and can’t return to work, you won’t be able to collect benefits. The insurance adjuster won’t believe you have a qualifying issue because there’s no evidence of it.
When Will My LTD Payments Start?
When you’re applying for LTD benefits, it’s important to understand when LTD payments will actually begin. You must be out of work for a specific number of days to qualify for benefit payments. The period will depend on your policy, but typically LTD plans consider a disability lasting more than six months as eligible for long term disability payments.
Usually, the payments won’t begin immediately. You’ll have to go through a 90-day waiting period from the date you became disabled. During that time, the insurance representative will review your application and submitted evidence of your injury. This 90-day period may be covered by sick leave or short term disability insurance.
If the long term disability insurer decides to accept your claim, you’ll start receiving benefit payments. You’ll receive monthly payments at a percentage of your pre-disability average wages. Whether your employer is paying for your plan or you pay for a self-insured plan, you will only receive a portion of your wages. There are no LTD policies that reimburse you for your total wages.
Why Did the Insurance Company Deny My LTD Claim?
The process for applying for long term disability benefits is complicated. It requires filling out paperwork and submitting evidence to the insurer. If you make a mistake, you could end up with a denied claim.
The most common reasons insurance companies will deny a claim for LTD insurance include:
Long term disability policies from different insurers contain different definitions. What constitutes a disability on one policy might not constitute a disability on another policy. It’s crucial that you understand what a disability is on the plan you have and whether your medical condition qualifies for benefits.
Your Washington long term disability insurance attorney from Abell and Capitan Law will review your policy to determine your eligibility. Sometimes some exclusions prohibit coverage for injuries resulting from specific accidents. Other exclusions will prevent benefits for certain diseases or injuries.
You have to follow steps when you’re applying for LTD benefits. If you skip a step or complete a form incorrectly, your claim will probably get denied. There are also strict deadlines you must adhere to throughout the process. You might think submitting your medical records a day late isn’t a big deal, but it could cause a denied claim.
Incomplete or Missing Medical Records
The insurance company will require copies of your medical records to prove you have a disease or injury that prevents you from working. The records you provide must clearly state your qualifying medical issue and why it creates physical or mental limitations. Your doctor should also explain that you’re unable to complete your job’s duties because of the disability and list treatment you’ll need to undergo to recover or manage your symptoms.
Some insurance adjusters will act in bad faith when handling an insurance claim. Examples of bad faith include:
- Denying a claim without providing a reason
- Failing to perform an adequate investigation
- Offering a settlement amount lower than the claim’s value
- Refusing to pay a valid claim
- Misrepresenting policy coverage or language
- Making threatening statements to the disabled individual
- Unreasonably delaying a claim
- Withholding payments to increase the insurance company’s profits
- Refusing to comply with documentation requests, such as a letter explaining the reason for a denied claim
Discrepancies in Information
The information you submit to the insurer needs to be consistent and accurate. If the insurance adjuster finds any discrepancies in the documentation that discusses your injury, medical treatment, loss of income, or other information, they will have a valid reason to deny it.
You Have the Right to File an Appeal
If the insurance company denies your claim for LTD benefits, you can file an appeal. You must appeal the decision within 180 days from the date on the denial letter. The appeals process is complex, so hiring a Washington long term disability insurance attorney from Abell and Capitan Law could benefit you.
When you hire us, we will:
- Review your denial letter and documents the adjuster sent with it to determine if the reason for denying your claim was valid.
- Obtain all records missing from your original claim to submit to the adjuster.
- File an administrative appeal that will outline our reason for filing and why we believe you deserve LTD benefits.
- Ensure prompt payment of benefits if the insurance company approves the request.
Choose Abell and Capitan Law to Help You with Your LTD Claim
If you need help filing a claim for long term disability benefits, negotiating a settlement, or appealing a denial, you should contact the Washington long term disability insurance attorneys from Abell and Capitan Law immediately. We understand the importance of receiving benefit payments promptly. You can’t work and might be struggling to pay for your treatment. We’ll work hard to ensure the insurance company pays you the money they owe you.
We understand ERISA laws and the rights afforded to you as a disabled worker. We’ll ensure the insurance company treats you fairly, and your rights stay protected throughout the legal process.
Schedule a free consultation with one of our Washington long term disability insurance attorneys. We’ll review your case and determine if you qualify for LTD benefits through your employer’s policy. Call us at (267) 419-7888 today.