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Understanding Your Long-Term Disability Policy

If you suffer a debilitating injury that makes you unable to work, you may qualify for long-term disability (LTD) insurance coverage through your employer or a personal insurance plan. LTD coverage can help you pay the bills after an injury that permanently takes you out of work.

Unfortunately, disability insurance policies can be difficult to comprehend. Furthermore, carriers often try to avoid paying out claims through both justified and unjustified means. The more you understand about your long-term disability insurance policy, the more you can protect your rights as a claimant.

Find Your Policy’s Definition of Disability

First, learn the exact definition of disability per the language of your LTD policy. Contact the insurance company or your employer and request a copy of the actual long-term disability insurance policy. Read it carefully to understand the definition of disability, as this definition can have a major impact on whether or not you qualify for benefits.

In general, there are two main types of LTD policies: own occupation and any occupation. Own occupation policies typically define disability as an illness or injury that makes the claimant unable to perform the material and substantial duties of his or her own occupation.

An any occupation policy, on the other hand, defines disability as the inability to perform the necessary duties of any occupation that you qualify for based on your education, training and job experience. In general, it is more difficult to obtain benefits under an any occupation policy than an own occupation policy. In some cases, own occupation policies may switch to any occupation after 24 months, leading to difficulties such as the termination of benefits.

Learn Your Policy’s Limits and Exclusions

Continue to read the fine print of your LTD insurance policy to discover your policy’s limits and exclusions. You should find these in the descriptions and provisions of your disability insurance coverage. Many disability insurance policies have exclusions and limitations connected to the following features:

  • Pre-existing injuries and medical conditions
  • Disability claims based on a mental health condition
  • Disability claims based on a substance abuse disorder
  • Waiting periods before insurance coverage begins
  • Duration of LTD benefits
  • Taxability of LTD benefits
  • Social Security Disability claim requirements

Understanding the rules of your policy can help you know what type of benefits to expect from your insurer, as well as when the company is committing bad faith by failing to pay you according to the terms of your plan. If you have trouble understanding the legal jargon in your policy, an attorney can help.

File Your Long-Term Disability Claim the Correct Way

Next, understand exactly how the insurance company wants you to file a long-term disability claim. Missing even one step in the filing process could give the insurer a reason to deny benefits. Read the instructions and follow them carefully. Do not skip any steps or miss any information on the paperwork and forms required. Do your best to provide any evidence or documentation requested as soon as possible to avoid processing delays.

Appeal a Wrongful LTD Denial

If you believe your disability insurance company wrongfully denied your claim based on the language of your policy, you have the right to appeal the denial. Check for the rules and deadlines in your policy for filing an internal appeal. Then, work with an attorney for assistance appealing the decision using supplemental evidence and records.

Contact an Insurance Lawyer for Assistance

Finally, know when to contact a Phoenix disability insurance attorney for assistance with your long-term disability claim. You may need to hire a lawyer if the insurance company is not treating you fairly, such as by delaying your payment without a valid reason or wrongfully denying coverage.

An attorney can help you file an insurance bad faith claim, if applicable, for additional compensation from the insurer mishandling your claim. Speak to an attorney today for more information.