If an injury or illness leaves you unable to work for an extended period of time, your long-term disability insurance can provide a crucial lifeline and make up for some of your lost income.
However, monthly benefits probably won’t last forever. Every policy has its own rules about when benefits begin and how long they can last. They also come with their own definition of disability and set of exclusions, meaning your benefits could be terminated under certain conditions.
In this article, the team at Bryant Legal Group discusses factors that may impact the duration of your long-term disability benefits. We’ll also outline steps you can take if your benefits are cut off prematurely.
If You’re Applying for (or Receiving) Long-Term Disability Benefits, It’s Time to Review Your Policy
Your policy documents are full of information about when your long-term disability coverage can begin, and how long benefits can last, under a variety of circumstances.
During the early days of your disability insurance claim, it’s smart to carefully review your Plan Document or Summary Plan Description, since these documents outline all of the essential terms of your policy. As you do, here are a few big things to watch out for:
Elimination Period
Before your long-term disability benefits can begin, you will need to complete the elimination period, sometimes also known as a qualifying period or waiting period. A typical elimination period for an LTD policy is 180 days, although shorter and longer waiting periods are also common.
If you are already receiving short-term disability insurance benefits from the same provider, it’s likely that your short-term benefits will cover the gap before long-term disability kicks in. However, don’t assume that you will automatically qualify for long-term benefits. LTD policies may have different requirements and exclusions or different definitions of disability.
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Benefit Period
The benefit period is the maximum length of time that you can receive benefits. This does not mean that your benefits won’t necessarily be terminated at some point. But once your benefit period ends, your monthly checks stop coming—even if you’re still unable to work.
Some LTD policies have benefit periods as short as two years. Five- and ten-year plans are also fairly common options for group policies. The most robust plans can provide coverage until you reach Social Security normal retirement age (SSNRA), no matter when you become disabled.
Definition of Disability
No matter how long your benefit period, you will still need to convince the insurance company (or a judge) that you meet and then continue to meet your insurance policy’s definition of disability. Broadly speaking, there are two main definitions used by insurance providers:
- Own occupation: You are considered disabled if you cannot perform your actual job.
- Any occupation: You must show that you are unable to perform any type of work to which you are reasonably suited, regardless of whether it is in your current profession or provides a similar salary.
It is common for LTD policies to start out as an “own occupation” plan, then transition to “any occupation” after a set period of time (often two years). This can result in a sudden loss of coverage at the two-year mark, even if the benefit period is much longer.
Limitations
Many LTD policies limit benefits for claims involving certain conditions. For example, mental health disorders, conditions caused by substance abuse, and conditions with “self-reported” symptoms might be limited to only two years of coverage, regardless of how long the benefit period is for other conditions. Additionally, many policies won’t cover pre-existing conditions if your disability income insurance claim occurs within a certain period of time (often one year) after you purchase coverage.
Exclusions
In addition to navigating your policy’s definition of disability, benefit, and waiting periods, you will also need to look out for exclusions. Many policies will not cover self-inflicted injuries, workers’ compensation claims, and conditions you suffer during civil unrest or due to criminal conduct. Additionally, many individual disability policies will exclude specific conditions — such as cancer, cardiovascular disease, or certain pre-existing conditions.
Residual or Partial Benefits
If your long-term disability insurance provides partial disability benefits, you may be able to return to part-time or lower-paying work without losing your entire monthly benefit amount. Instead, your benefits will cover part of the difference between your pre-injury income and your current income.
RELATED POST: Can You Work Part-Time and Collect Disability Insurance?
Social Security Disability Offset
Many long-term disability policies contain language stating that you are required to apply for Social Security Disability Insurance, and that the disability insurance provider can offset your monthly benefits by the same amount.
Because monthly SSDI benefits are calculated using a completely separate formula, it’s possible that your monthly long-term disability benefits will be significantly reduced or even eliminated if you are later approved for SSDI.
Other Reasons Why Your Benefits Might Be Terminated
Long-term disability claims are expensive for insurance companies to pay out. They have a financial incentive to look for any reason to terminate benefits.
The insurance company will periodically review your claim in the years after you’ve been approved. They may require you to send them new documents, participate in a “field interview” with an insurance adjuster, or submit to an independent medical examination. The insurance company may even hire someone to conduct surveillance if they suspect you are being dishonest about the severity of your disability.
These reviews can be extremely stressful for claimants, and it’s important to be as prepared as possible. Working with a long-term disability lawyer can help you preserve your benefits or appeal a wrongful termination of them.
RELATED POST: How to Talk to Insurance Claims Adjusters About Your Long-Term Disability Case
What Should I Do if the Insurance Company Terminates My Benefits?
If you receive a written notice terminating your long-term disability benefits in the mail, you must act quickly. Disability insurance companies sometimes improperly close out claims, hoping that you won’t read your long-term disability insurance policy’s fine print or consult with an experienced LTD attorney.
Depending on your circumstances, you may be able to file a lawsuit or an appeal demanding ongoing coverage. However, strict filing deadlines often apply to long-term disability claims. If you have an employer-sponsored LTD plan, you may have as little as 180 days to file an appeal.
For this reason, we encourage you to contact our office as soon as you get a notice of termination. Our team of experienced disability insurance lawyers can review your Plan Document and Summary Plan Description, advise you about your legal rights, and suggest ways to either enforce or challenge your policy’s terms and conditions.
In the meantime, we also encourage you to download a copy of our free ebook, “How to Appeal a Long-Term Disability Termination.” This short, informative guide is packed with information about why insurance companies deny legitimate claims, legal options that are available, and the steps you need to take to make a successful appeal.
FREE EBOOK: How to Appeal a Long-Term Disability Termination
Bryant Legal Group: Chicago’s Trusted Disability Insurance Firm
Our team has helped people across Illinois and Chicago get the disability insurance benefits they deserve. We take a practical, client-centered approach, helping our clients make smart decisions about their long-term disability claims and appeal.
If you are ready to speak to an experienced Chicago insurance attorney about your claims, please call us today at 312-561-3010 or complete our simple online form.