Long-Term Disability ERISA FAQs
Here, we have answered some of the most commonly asked questions about long-term disability and ERISA. Find out more about your rights to fair insurance benefits if you face a long-term disability by browsing answers to our FAQs.
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When will my long-term disability benefits end?
You’ve jumped through all the hoops and you’ve done everything that was asked of you. Whether the insurance company relented and granted your request for long-term disability (LTD) benefits or you won benefits after a hard-fought appeal, you got the benefits that you deserved.
Now You Want to Know When LTD Benefits May End
There are a number of reasons that an insurance company can justifiably stop your long-term disability benefits. These reasons include:
- A change in the definition of disability after 24 months. Many employer-sponsored group long-term disability insurance contracts change the definition of disability after 24 months. For the first 24 months you may be considered to be disabled if you are unable to work in your “own occupation.” After 24 months you may only be considered disabled if you are unable to work in “any occupation.”
- Limited benefits for mental or psychological disabilities. Some group long-term disability contracts limit benefits for mental or psychological disabilities to 24 months. That means that if your claimed disability is for something like depression, anxiety, post-traumatic stress disorder, or obsessive-compulsive disorder then you likely have 24 months worth of benefits. In some cases, these benefits may be extended if you are hospitalized. Additionally, some disorders such as schizophrenia may be specifically excluded from the 24-month limitation.
- Medical improvement to the point where you are no longer disabled. If the medical evidence or video surveillance indicates that your health has improved to the point where you can return to work, then the insurance company may find that you are no longer disabled and it may terminate your benefits.
- Failure to apply for Social Security disability benefits. Most long-term disability plans will require you to apply for Social Security disability benefits and will offset your long-term disability benefits by the amount of Social Security disability benefits that you receive. The failure to apply for Social Security disability benefits may give the insurance company a reason to stop paying your long-term disability benefits.
- Failure to continue getting medical care. The terms of your long-term disability contract will likely require you to get continued medical care and to provide the insurance company with medical evidence of your continued disability at regular intervals. The failure to do so can jeopardize your benefits.
- Reaching retirement age. Retirement age should be defined in your contract. It is often found in the maximum benefit period section or chart. Once you reach that age, it is assumed that you would no longer be working and, therefore, your long-term disability benefits will end.
- Going back to work. Different long-term disability contracts address going back to work in different ways. Your contract may say that your benefits end if you do any work at all or only if you work a certain number of hours or if you earn a certain amount of money, for example.
If the language in your insurance contract supports ending benefits for any one of these reasons and the facts of your case support the termination of benefits then there may be little that you can do to keep receiving benefits.
But You Can Protect Yourself From Wrongful Termination of LTD Benefits
While there are legitimate reasons to end long-term disability benefits, insurance companies may try to end your benefits prematurely. If you have received notice of the insurance company’s intent to terminate your benefits or if you have any suspicion that your benefits may end, then it is important to familiarize yourself with the terms of your long-term disability contract and to contact an experienced long-term disability insurance lawyer today.
Our attorneys are committed to helping people with disabilities get the long-term disability benefits that they have earned through their employers. Please contact us today via this website or by phone if you would like to schedule a free, no-obligation consultation with an experienced disability lawyer to learn more about protecting your right to receive all of the long-term disability benefits you should pursuant to your insurance contract.
How long will it take to get long-term disability benefits after I become disabled?
Your disability is keeping you from working. Without an income, you are likely eager to start receiving the long-term disability benefits from the insurance policy that was part of your employment compensation package. Unfortunately, those benefits may not start immediately.
The Waiting Period for LTD ERISA Benefits
The majority of group long-term disability plans have something known as an “elimination period” or a waiting period. Typically, the elimination period lasts 90 or 180 days. During this time you may not receive long-term disability benefits.
However, you may still be receiving some kind of income. That income may include:
- Sick days. You may be eligible for sick time benefits and you may be able to take the sick days that you accrued.
- Short-term disability insurance benefits. Most long-term disability elimination periods are the same length as your short-term disability coverage. Therefore, you may be receiving short-term disability benefits while you wait for your long-term disability coverage to take effect.
Generally, long-term disability insurance plans are written to require you to exhaust your sick days and short-term disability insurance benefits before your long-term disability insurance benefits take effect.
Waiting for the benefits that you’ve earned can be frustrating. However, the wait is not unique to long-term disability plans. For example:
- Other programs that provide benefits to people with disabilities also have waiting periods. For example, Social Security disability benefits only start after you’ve been disabled for at least five months.
- Other types of insurance plans have deductibles. Your home and auto insurance likely have deductibles that you pay out of pocket. Your health insurance may also have a deductible, co-pays, or both. The wait for long-term disability benefits is similar to the concept of a deductible in that you are not compensated immediately and must wait until the elimination period is completed to receive benefits.
While the waiting period is required and may be expected, you can still take action to make sure that it is no longer than necessary and that you get your benefits as soon as possible.
How to Avoid Unnecessary Delays of Your Long-Term Disability Benefits
Insurance companies maximize their profits by paying out as little as possible in claims. One way an insurance policy may try to pay you as little as possible is to delay the approval of your claim. This may be happening to you if:
- The insurance company is repeatedly requesting small amounts of information from you. Each time the insurance company sends a letter requesting information, the clock stops on the insurance company’s deadline to decide your claim. Therefore, if you are repeatedly getting letters that ask for one or two non-critical pieces of information then the insurance company may be attempting to draw out the time that it has to make a decision.
- The insurance company denies getting the information that you sent. Make sure you keep copies of everything that you send so that you can quickly get a second copy to an insurance company that claims not to receive your mail, email, or faxes.
Insurance companies have a duty to act in good faith in deciding claims. Typically, the insurance company should make a decision about your claim within 45 days and your payments should begin within 90 or 180 days, as stated in your plan. While these deadlines may be extended in certain circumstances, they may not be extended because of unnecessary delays.
Our experienced ERISA attorneys are here to help you recover the long-term disability benefits that you’ve earned in a fair and timely manner. We will not let the insurance company violate the terms of your policy or violate ERISA law without facing legal consequences. To find out more about how we can help you get the benefits that you’ve earned, please contact us today for a free, no-obligation consultation.