Social Security Disability FAQ
1. What is long term disability insurance?
Long term disability (LTD) insurance coverage can be secured either on an individual basis or through an employer. If you become disabled due to sickness or injury and are unable to work for an extended period of time, long term disability insurance benefits will provide you with a percentage of the income you earned through employment. Disability insurance most often replaces around 40 to 60 percent of an individual's gross income. The income is dispensed tax-free. Many disability insurance policies require a 90-day waiting period from the onset of the disability before the individual can apply for benefits. An individual can elect for a shorter waiting period. However, this increases the insurance premiums on the policy. Unlike workers' compensation, LTD supplements an individual's income even in cases in which the sickness or injury did not result from an on-the-job incident. return to top
2. What should I do if I was denied long term disability benefits?
Long term disability insurance companies often deny and/or delay eligible claims. Many companies rush to evaluate claims or make it difficult to secure benefits in hopes of forcing people to give up their hope of receiving the full benefit they deserve. Insurance carriers deny claims based on an assortment of pretenses including, but not limited to, the severity of the injury, lack of documentation, failure to provide documentation in a timely manner, and other related reasons. If you have been treated unfairly by your insurance company or denied long term disability benefits, you should consult an experienced personal injury attorney to assist you. return to top
3. Why should I hire a long term disability lawyer?
Long term disability insurance policies are complex and contain provisions designed to limit the amount of benefits you receive. An attorney familiar with the long term disability claims process can help you if your claim has been denied. Most LTD insurance policies include an administrative appeals process that makes it difficult for a lay person to secure benefits. Insurance companies often assume that making it difficult for claimants to pursue their benefits will lead entitled claimants to simply give up. If your claim cannot be resolved during this administrative process, a lawyer can file a law suit for your benefits in Federal Court for ERISA claims or state court for individually purchased coverage. return to top
4. When should I consider litigation regarding my claim?
When you have been denied long term disability benefits, or the insurance company delays or otherwise makes it difficult for you to recover your benefits, litigation should be your next step. return to top
5. If I am not currently employed, how can I pay a lawyer to represent me?
If you are disabled and the insurer refuses to help, our attorneys may be able to provide representation on a contingency basis. Attorney fees would be paid out of the proceeds of any eventual settlement. The lawyer would receive a percentage of the recovery from the insurance company. If you received nothing, we would be entitled to no fee. return to top
6. What are your lawyer fees?
Attorney fees depend upon the type of case involved. In most cases, it will be a percentage of the amount of money recovered on your behalf. Before we are retained, you will be given an attorney fee agreement fully outlining the fee structure for your specific case. return to top
7. Why do long term disability companies refuse to pay valid claims?
Profit is their sole motivation. Long term disability companies put profits over the needs of policyholders. In recent cases, insurance companies viewed high-income professionals to be safe risks for disability income insurance. The industry believed most policyholders fitting that description would never make claims. Unfortunately, as these "good risk" professionals aged, the number of injured and ailing policyholders also increased, defying estimations. The number of claims grew and insurance companies such as Unum Provident Group, Paul Revere and Guardian lost money on these policies. They searched aggressively for ways to not pay these policies, and in some cases crossed the line, illegally denying many professionals benefits they were owed.
To maximize profits, many of companies are determined to collect premiums from policyholders for as long as they possibly can; even when a policyholder is suffering from illness or injury, their claims are uniformly denied. Statistically, very few policyholders take legal action in order to fight back after an unfair denial. However, insurance companies also know that of those who fight back, many will win.
When possible, insurance companies will seek to deny your claim based on a technicality, even if you are severely disabled. Your opinion on whether you can continue working is irrelevant in the eyes of an insurance company. That determination is usually made by a claims examiner lacking formal medical training. The bottom line for these companies is money. return to top
8. What is ERISA?
ERISA is an acronym for the Employee Retirement Income Security Act. The act was passed by Congress in 1974 to combat pension plan corruption. Ironically, the ERISA was not originally designed to control medical or disability insurance plans, but the phrase in the act "employee welfare benefit plan," has been subsequently interpreted by federal courts to allow the ERISA control over nearly all private employee benefits, including health, disability, life and pension plans. Most long term disability insurance benefits secured by an employer are governed by the ERISA. return to top
9. Am I covered by the ERISA or a private plan?
The ERISA controls almost all employer-sponsored benefit plans, but it does not apply to private policies purchased by an individual. Public employees are also outside of ERISA. return to top
10. What ailments are common for disability claims?
Almost any injury or disease severe enough to keep you from performing regular work for the requisite period of time may qualify you for long term disability. Some of the most common we see are:
- Spinal disorders, including herniated cervical and lumbar discs, spinal stenosis, arthritis, osteoporosis, compression fractures;
- Rheumatoid arthritis, lupus, fybromyalgia, chronic fatigue syndrome, HIV, AIDS;
- Amputations, multiple fractures requiring surgery, reflex sympathetic dystrophy, chronic regional pain disorder;
- Decreased vision or hearing, vertigo, tinnitus, stuttering;
- Asthma, emphysema, asbestosis, sleep apnea, chronic obstructive pulmonary disease;
- Heart attacks, angina, bypass surgery, congestive heart failure, enlarged heart, aneurysm, valve disease, heart transplant;
- Chronic liver disease, cirrhosis, hepatitis, ascites, colitis, Crohn's disease, diverticulosis, pancreatitis;
- Kidney disease, anemia, leukemia, polychthemia, lymphoma, myeloma, sickle cell anemia;
- Sklerodema, burns, psoriasis, atopic dermatitis, melanoma, hydradenitis, and skin cancer.
11. What long term disability insurance companies do you frequently see denying benefits to claimants?
The most common that we see include the UnumProvident family of companies and any of the following:
* Standard Insurance
* Colonial Life & Accident
* Paul Revere Life Insurance
* Duncanson & Holt, Inc.
* BenefitAmerica
* GENEX Services, Inc.
* Options and Choices, Inc.
* Unum Branded Companies
* Provident Life & Accident
* Boston Compania Argentina
* Unum
* UnumProvident
* Unum Limited
* Unum Bermuda
* Unum International
* Aetna Insurance
* CNA Insurance
* Cigna Insurance
* DMS Insurance
* Equitable Insurance
* Guardian Insurance
* Hartford Insurance
* Life of Vermont Insurance
* New York Life Insurance
* Northwestern Insurance
* Royal Maccabees Insurance
* Standard Insurance
* Trustmark Insurance
Also these Life Insurers offering LTD benefits:
* Bershire Life Insurance Company
* Central Life Insurance Company
* Metropolitan Life Insurance Company
* Paul Revere Life Insurance Company
* Unum Life Insurance Company of America
* New England Life Insurance Company
* John Hancock Insurance Company
* Equitable Life Insurance Company
* Colonial Life Insurance Company
* Provident Life and Accident Insurance Company
12. How does long term disability insurance interact with social security disability and worker's compensation benefits?
If you became ill or injured as a result of work-related activity, worker's compensation benefits are available. However, those restrictions do not apply to long term disability benefits. In some instances it is possible for you to be entitled to all three types of benefits. For practical purposes, it may be important for you to pursue a Social Security disability or workers' compensation claim in addition to your long term disability claim. These benefits can help "offset" your LTD benefits and make it less likely that the insurance company will "target" your claim for a denial. In addition, the extra benefits may provide an alternate source of income while you fight an LTD denial. In some cases, LTD carriers will offer to assist you with your Social Security claim. Beware of such offers. They are likely to share information from your Social Security file with their own company in order to use any information they can to deny your claim. return to top
13. Do you handle cases in my geographic area?
Our firm takes on cases from across the nation. When necessary, we can receive permission from the court to handle your case if we do not have an office located in your area. In addition, we will employ local counsel, at our own expense, to ensure that you get the best outcome possible with respect to your claim. We work hard to make sure that your benefits are secured no matter where you live. return to top
14. Was I wrong to have bought a disability policy?
No! You took action to protect your family by forming a contract that you expected to be honored. You are being victimized by an insurance company's desire to increase profits and your trust in the company has been violated. It is not your fault! return to top
15. How long will the process take?
Each case has various circumstances and there is no definite answer to this question. However, we will work our hardest to get you the benefits you deserve as soon as possible. The process can take a few months; sometimes it takes longer. It depends on a variety of factors. But you can rest assured that we won't rest until a resolution is reached. return to top
If you or a loved one is unable to work and have questions about your condition or insurance, call VanDerGinst Law at 1-866-843-7367 or click here for a FREE online case evaluation. The initial consultation is free of charge. If we agree to handle your injury case, we will work on a contingency fee basis, which means we get paid for our services only if, and when, there is a money recovery for you. In many cases a lawsuit must be filed before an applicable expiration date, known as a statute of limitations. So please call right away to ensure that you do not waive your right to possible compensation.
