Medical Conditions Must Be Connected To Psychological/physical Impairments
As the non-exhaustive list on this page shows, there are many different conditions that can potentially qualify an applicant for long-term disability benefits. In fact, there are so many that it would be almost impossible to list them all. Yet, unfortunately, people who have qualifying conditions sometimes struggle to get their long-term disability claim approved.
One of the issues that many applicants run into in the disability claims process is that the insurance company does not accept the link between their underlying condition which may qualify for benefits, at least in the abstract and the actual psychological/physical impairment that is preventing them from returning to work on a full-time basis.
We will help you establish this link. Our long-term disability attorney has the skills and experience required to make sure that these connections are supported by comprehensive medical evidence and connected with a strong, persuasive legal argument.
Long Term Disability Plan Details
Salary Replacement: Up to 70%
Maximum Monthly Benefit: Up to $25,000 per month
Benefit Waiting Periods: From zero days to two years
Definitions of Disability: Cover the employee’s own occupation, any occupation and zero-day partial disability
Coverage Options: One, two-, or five-year plan designs, or to age 65 own occupation periods
Physicians, Attorneys and Dentists: Own Specialty definition of disability
Reporting: Administrative claims reports service available
What Is The Appeals Process Like For Long
When you work with Sokolove Law, we may be able to handle appealing your denied disability claim on your behalf. This process usually involves your disability denial lawyer:
- Gathering evidence to build your case
- Filing your appeal with the insurance company
- Representing you in court if your case reaches a hearing or trial
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Mental Health & Psychological Illnesses
Suffering from a mental illness can often impact your ability to perform activities of daily living. Fortunately, most mental health and psychological illnesses can be managed so long as you are provided adequate treatment and support. For instance, long-term disability benefits, which aid those who are suffering from mental health and psychological illnesses by covering a portion of their monthly salary. That is as long as their mental illness impedes their ability to perform the regular duties of their job for an extended period of time.
Some of the most common mental health conditions covered under LTD are as follows:
- Mental Retardation
- Alcohol or Drug Disorders
- General Anxiety Disorders
Over the years, mental health and psychological illnesses have become increasingly common within Canada. In fact, according to the Canadian Mental Health Association, close to 50% of the Canadian population will have suffered from some sort of mental illness by the time theyre 40. Whats more, because mental health issues are often considered an invisible disabilities, employers often get suspicious when their employees seek out disabilities for conditions such as depression, anxiety, or PTSD.
NOTE: Nearly every LTD policy has an outlined pre-existing condition clause, which can cause problems for mental health claims. Since insurance companies often take a more relaxed approach when determining whether or not a mental health disorder is a pre-existing condition.
Benefits For Widows Or Widowers With Disabilities
If something happens to a worker, benefits may be payable to their widow, widower, or surviving divorced spouse with a disability if the following conditions are met:
- The widow, widower, or surviving divorced spouse is between ages 50 and 60.
- The widow, widower, or surviving divorced spouse has a medical condition that meets our definition of disability for adults and the disability started before or within seven years of the worker’s death.
Widows, widowers, and surviving divorced spouses cannot apply online for survivors benefits. If they want to apply for these benefits, they should contact Social Security immediately at 1-800-772-1213 to request an appointment
To speed up the application process, complete an Adult Disability Report and have it available at the time of your appointment.
We use the same definition of disability for widows and widowers as we do for workers.
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Get A Statement From Your Attending Doctor
In addition to statements from yourself and your employer, the insurance company or claim administrator will require your doctor to complete a statement. The insurer will usually request that your doctor provide information about diagnoses, signs and symptoms, objective findings, whether your injury or sickness is work related, dates of treatment, types of treatment , referrals, an estimate of your physical limitations and/or mental impairments, an estimate of when you may return to work, and additional remarks. I recommend taking this form directly to your treating physician and asking them to complete this statement in-person. That way, this form will not be misplaced and you can remind your doctor to complete this form in detail.
Requirements For Receiving Benefits
It is important for you not to let your coverage lapse for your long term disability insurance. It can do so if you fail to pay your premiums on a timely basis. If your policy is one that is provided by your employer, you may not have any required premium payments, however. If your employer does not pay for your plan, you should make certain to make your payments on time each month. If your plan is provided through your job, it likely requires that you are working full-time when you first become disabled. Full-time work may be defined under your policy as working a minimum of 30 to 35 hours each week. Your policy will contain the definition, so you can check it to make certain.
Most long term disability insurance policies have elimination periods. These are the times that last from the date of your disability and when you can start receiving your benefits. You are ineligible for disability benefits through your long term disability insurance policy until your elimination period is over. These periods often last as long as your short-term disability coverage lasts so that your long term coverage can kick in when your short-term benefits end. The insurance company is also likely to ask that you use up all of your accrued sick leave from your job before applying for short-term disability and then to use up your short-term benefits before applying for them under your long term disability policy.
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Medical Conditions That May Qualify For Long
Many people think long-term disability insurance is for people who have been physically injured in an accident and are unable to work as a result of their injury. While this may be true, its important to know there are many medical conditions that may also entitle you to receive disability payments.
Some of the medical conditions that may qualify for long-term disability benefits include:
- Bipolar disorder
- Multiple sclerosis
The above list of medical conditions is not exhaustive, and qualifying conditions vary from policy to policy. Before filing a long-term disability claim, its important to understand how your insurance company defines a disability. This information can be found by carefully reading your insurance policy.
The Importance Of Short And Long
Its important that employees have a plan in place. One in four people in their 20s will become disabled before they turn 67, according to the Social Security Administration.
Providing short-term and long-term disability insurance at your business is a great benefit. Dealing with an illness or injury for an extended period of time is stressful on its own before factoring in the loss of wages.
Keep track of employee benefits and deductions with Patriots online payroll software. We make it easy to run payroll with our simple 3-step process. Try it for free today!
This article has been updated from its original publication date of September 27, 2017.
This is not intended as legal advice for more information, please
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Activities Of Daily Living Form
The Long Term Disability carrier has asked you to complete an Activities of Daily Living form in which you are asked to document what you are physically capable of doing. In that form, or even in a statement, you might tell the Long Term Disability insurance company that you always use a cane or that you always limp. If surveillance shows that you are walking without a cane or without a limp you are in trouble! While walking without a cane or a limp doesnt mean you can work, it does destroy your credibility.
Eligibility For Plan Benefits
You must be unable to do your job or any other job for which you are reasonably suited by education, training, or experience. Your disability or impairment must be expected to last for a continuous period of at least 12 months from your last day of work. There is a special provision for practicing physicians for partial disability benefits.
Real Results For Return
- 64% of employees who participated in the program successfully returned to work.5
- The program helped avoid almost $40 million in direct claim costs and 330,000 lost workdays.5
A bicycle accident left Pilar paralyzed. Despite her spine injury, she wanted to return to her job as an accountant as soon as possible. Pilar’s employer contacted Kai, a Workplace Possibilities consultant, for help. To meet both her work and medical needs, Kai developed solutions tailored for Pilar.
Kai evaluated Pilar’s workspace with an ergonomics expert before coordinating with local equipment vendors to:
- Find the best office layout including desk height and computer monitor distance, plus keyboard, mouse and phone headset capabilities
- Install the right equipment
Kai also made sure the office layout and equipment worked with Pilar’s wheelchair and allowed her to recline to relieve pressure on her spine.
Kai followed up with Pilar often. He adjusted what wasn’t working, looked into alternative options, and upgraded equipment and software. After a few months, Pilar reached her goal of returning to work on a modified schedule.
* Example is for illustrative purposes only. Services depend on the facts of each individual claim.
Rico, a behavioral health case manager, reached out to Ben and supported him by:
Because depression left Ben overwhelmed and confused, Rico referred him to the Workplace Possibilities program to be sure he got the guidance and motivation he needed during the process.
What We Mean By Disability
The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.
We consider you to have a qualifying disability under Social Security rules if all the following are true:
- You cannot do work and engage in substantial gainful activity because of your medical condition.
- You cannot do work you did previously or adjust to other work because of your medical condition.
- Your condition has lasted or is expected to last for at least one year or to result in death.
This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers’ compensation, insurance, savings, and investments.
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Pera Defined Benefit Vested Employee & Unum Short
Employees with at least five years of PERA Defined Benefit Retirement Plan covered employment service may be eligible for PERA STD benefits. The Unum STD insurance coverage will always coordinate with an employees PERA STD coverage. The PERA STD benefits will always be the primary STD benefits and will be an offset to Unum STD benefits.
PLEASE NOTE: Paid leave supplements will offset PERA disability payments. Employees should stop paid leave supplements prior to the commencement of PERA disability benefits.
The Disability Application Process
Whether you apply online, by phone, or in person, the disability benefits application process follows these general steps:
- You gather the information and documents you need to apply. We recommend you print and review the . It will help you gather the information and documents you need to complete the application.
- You complete and submit your application.
- We review your application to make sure you meet our for disability benefits.
- We confirm you worked enough years to qualify.
- We evaluate any current work activities.
- We process your application and forward your case to the Disability Determination Services office in your state.
- This state agency makes the disability determination decision.
To learn more about who decides if you have a disability, read our publication .
Once You’ve Applied
Processing time for disability applications vary depending on the nature of the disability, necessary medical evidence or examinations, and applicable quality reviews.
Once we receive your application, well review it and contact you if we have questions. We might request additional documents from you before we can proceed.
Look For Our Response
When the state agency makes a determination on your case, youll receive a letter in the mail with our decision. It generally takes three to six months for an initial decision. If you included information about other family members when you applied, well let you know if they may be able to receive benefits on your record.
Check The Status
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A Guide To Maternity Leave Laws By State: Know Your Rights
While the United States has come a long way in terms of maternity leave, the country is still behind compared to other nations in laws requiring time off and lack of nationally mandated paid leave. The Family and Medical Leave Act dictates the rules in place for taking a leave from and returning to work amid pregnancy, birth, and postpartum stages. Unlike many other nations, in the U.S., there is no requirement for paid time off following a birth, though twelve weeks of unpaid leave are required by law for the majority of workplaces. And while you are away, you cannot be replaced or overlooked for pay raises and other promotions.
Despite the Pregnancy Discrimination Act, pregnant people still face a great amount of inequity in the workforce. It’s crucial to be aware of both national and local laws when planning to take leave from a job during pregnancy and after having a child. Having paid maternity leave gives you more time to bond with your new child and recover, though not all companies offer this. If you will have to take unpaid leave, it’s a good idea to plan and budget accordingly to be able to take time to bond with your newborn, but temporary disability is available in some places to help cover the loss of income.
Other Ways You Can Apply
Apply With Your Local Office
You can do most of your business with Social Security online. If you cannot use these online services, your local Social Security office can help you apply. You can find the phone number for your local office by using our Office Locator and looking under Social Security Office Information. The toll-free Office number is your local office.
Apply By Phone
If You Do Not Live in the U.S. Or One of Its Territories
Contact the if you live outside the U.S. or a U.S. territory and wish to apply for retirement benefits.
Mailing Your Documents
If you mail any documents to us, you must include the Social Security number so that we can match them with the correct application. Do not write anything on the original documents. Please write the Social Security number on a separate sheet of paper and include it in the mailing envelope along with the documents.
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The Pregnancy Discrimination Act
Passed in 1978, the Pregnancy Discrimination Act prohibits job discrimination and gives pregnant women the same rights as others with “medical conditions.” This law applies to companies employing 15 or more people. Stipulations include:
- Your employer cannot fire you because you are pregnant.
- Your employer cannot force you to take mandatory maternity leave.
- You must be granted the same health, disability, and sick-leave benefits as any other employee who has a medical condition.
- You must be given modified tasks, alternate assignments, disability leave, or leave without pay as needed .
- You are allowed to work as long as you can perform your job.
- During your leave, you are guaranteed job security.
- While on leave, you continue to accrue seniority and remain eligible for pay increases and benefits.
This discrimination law protects you from being treated differently than other employees due to pregnancy. While this is generally good, it also means that if your company doesn’t provide job security or benefits to other employees with disabilities, it doesn’t have to provide them to you either.
Which Do I Need: Need Short Term Disability Insurance Or Long Term Disability Insurance
There are a few things to keep in mind when choosing disability insurance. First of all, do you have an emergency savings fund that could cover your expenses for a few months if you lost your job or were unable to work? If not, short term disability insurance is an essential financial protection, even if you are disabled for only a short period of time. If you have significant emergency savings on hand, though, you may focus on how a long term disability could impact your financial wellbeing and your retirement plans. If you were permanently disabled, could you cover your expenses until retirement? If not, look into long term disability protection.
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S To Applying For Long Term Disability Benefits
Employee benefits encompass a wide variety of compensation and insurance policies. Along with health, life, dental, and vision insurance coverage, disability insurance is often offered to full-time employees. This includes both short term disability and long term disability benefits.
When an employee becomes disabled and stops working, they must carefully review their disability insurance options. Depending on the terms of the policy, short term disability benefits are usually available for a time period of 30 to 180 days. If an employee remains disabled after the maximum duration of the short term disability benefits, they should immediately apply for long term disability benefits. Some employees make the mistake of assuming that their short term disability benefits will automatically roll into long term disability benefits however, in most circumstances a separate application for long term disability benefits is required.