Infectious Diseases and Disability Insurance: A Claimant’s Guide
Today, more than ever, we’re painfully aware of how infectious diseases can dramatically impact your life. Whether you’re dealing with coronavirus, influenza, MRSA, C. Diff, or another disease, you’ll likely need time to rest and recover before you return to work. And, due to some diseases’ severe symptoms and long-term effects, you may become permanently disabled.
At Bryant Legal Group, we want to help you regain control. Our disability insurance lawyers help people living with both acute and chronic diseases with their long-term and short-term disability claims. In this article, we’ll explain the basics of a disability claim involving an infectious disease.
Disability Insurance Should Step in When You Cannot Work Because of a Disease or Illness
Whether you have an employer-sponsored disability insurance plan or purchased a private disability insurance policy, your plan is supposed to provide benefit payments and peace of mind when you’re unable to work. However, unlike Social Security disability benefits, disability insurance plans are issued by for-profit insurance companies. Your right to short-term or long-term disability benefits will depend on the language in your policy. Here are some essentials.
Short-Term Disability Insurance Typically Covers Illnesses That Last 3 to 6 Months
While some short-term disability plans cover disabling illnesses that leave you unable to work for a year or more, most policies will only pay benefits for three to six months. You will typically have to show that you cannot perform your own occupation due to your illness or medical condition and provide medical records that support your claim.
You’ll Need to Reapply for Long-Term Disability Benefits, Even if Your Short-Term Disability Claim Was Approved
If you qualify for long-term disability benefits, which may provide financial support until you reach retirement age, you will need to submit another application to your insurance company. You also shouldn’t assume that because the adjuster approved your short-term disability benefits, you’ll sail through the process of applying for long-term benefits.
Most long-term disability plans define “disability” differently than short-term disability policies. Most of them use an “any occupation” definition, and you must convince the adjuster that you’re unable to do any work due to your illness or disease. Before you apply for LTD benefits, it’s a good idea to consult a disability insurance lawyer who can help you understand your policy’s precise language and strengthen your claim.
Look for Elimination Periods, Limitations, and Exclusions
Before you file a claim form with your disability insurance company, it’s important to read your policy’s fine print. You may be surprised to find a variety of deadlines, waiting periods, limitations, and exclusions buried in your Plan Document. We’ll explain these terms.
- Elimination periods: Most short-term and long-term disabilities include strict waiting periods. You cannot apply for benefits until a certain amount of time passes. For short-term disability plans, the elimination period is often a week or so. For LTD policies, it’s common to see a 90-day elimination period.
- Exclusions: Some disability insurance policies exclude specific medical conditions and illnesses from coverage. For example, you may find that your disability insurance policy excludes certain high-risk, pre-existing conditions.
- Limitations: Even if your disability insurance policy doesn’t completely exclude your illness, it may limit coverage. Your lawyer should determine whether your private long-term disability or short-term disability plan has a “lookback period” for pre-existing conditions or illnesses. For example, if your plan has a six-month lookback period, it won’t cover pre-existing conditions for the first six months you have your policy. Other common limitations involve mental health issues and substance use.
What Illnesses Qualify for Long-Term and Short-Term Disability Benefits?
Many infectious diseases can limit your ability to work, especially in the short-term. However, some illnesses are more likely to cause disability than others, such as:
- COVID-19 (coronavirus): A viral disease associated with shortness of breath, fever, fatigue, and other symptoms. While some people who contract COVID-19 show mild symptoms, others require intensive care. Additionally, the disease can damage your body’s organs, including the heart.
- Influenza: A respiratory illness that can cause difficulty breathing, fever, body aches, and fatigue. Between 3% and 11% of the U.S. population gets the flu symptoms each year. Influenza can also cause long-lasting damage to your heart, secondary infections, and muscle weakness.
- Pneumonia: An infection that inflames your lung’s air sacs, making it difficult to breathe. Viruses, bacteria, and fungi can cause pneumonia.
- Hepatitis: An inflammatory liver condition that is typically caused by a virus. Doctors categorize viral hepatitis into five categories: Hepatitis A, B, C, D, and E.
- HIV and AIDs: Human immunodeficiency virus (HIV) attacks your body’s immune system. HIV-positive individuals who develop opportunistic infections or illnesses have AIDS.
- MRSA (Methillicin-resistant staphylococcus aureus): This difficult-to-treat staph infection typically damages your skin and soft tissues, but it can impact any part of your body. While some people can fight off MRSA with antibiotics, others face a lifetime of flare-ups and medical care.
- Clostridium difficile (C. diff): These bacteria can cause colitis and diarrhea. Many people who get C. diff will catch it again. It is often a hospital-acquired infection.
- Shingles: A painful condition that occurs when the chickenpox virus reactivates in your body. Shingles typically causes nerve pain, a rash, and blisters.
Whether your condition will qualify for either long-term or short-term disability depends on a variety of factors, including the severity of your illness, how long it takes you to recover, and the specific terms and conditions of your disability insurance policy.
How Do I Get Disability Insurance Benefits for an Illness or Disease?
Before you file for long-term or short-term disability benefits for an illness, you should also review your Plan Document or Summary Plan Description. These documents should outline all of the terms and conditions of your disability insurance policy, such as:
- How the plan defines disability (whether you must show you are unable to perform your own occupation or all occupations)
- Any elimination or waiting periods that apply to your claim
- How long you can receive short-term disability benefits
- How much you’ll receive in weekly or monthly benefits
- Any exclusions or limitations that apply to your policy
Your disability lawyer can help you interpret your plan’s language and determine whether you meet the requirements for benefits.
Then, your legal team will begin to collect evidence, including medical records, employment data, insight from your doctors, and other information that supports your claim. They’ll use these documents to frame your claim for long-term or short-term disability, create a written application for benefits, and substantiate your claims.
Once the insurance company receives your application, an adjuster will investigate your claim. The adjuster may ask your lawyer for more information, including additional medical records, statements, and completed forms. Your disability attorney will guide you through this process, keeping you updated while you focus on your medical treatment and recovery.
Make sure you keep your ERISA lawyer up to date on your condition, treatment, and symptoms. Infectious diseases can evolve quickly, and your lawyer will need to understand your circumstances and collect all the related medical records. For example, if your MRSA or C. diff reoccurs, you need to call both your doctor and your attorney.
Don’t Give Up if the Insurance Company Denies Your Illness-Related Claim
Insurance adjusters deny more disability insurance claims than they approve, including many legitimate ones. If your long-term or short-term disability benefits get denied, you need to speak with a lawyer. An experienced disability lawyer can evaluate your claim, explain your legal options, and file an appeal or lawsuit on your behalf.
Bryant Legal Group: Helping Disabled Individuals Receive Benefits in Illinois
If you or a loved one is fighting a serious illness, you shouldn’t have to worry about your financial security or a disability insurance claim. At Bryant Legal Group, our team helps people in Chicago and across Illinois get the disability insurance benefits they deserve. If you need help applying for disability insurance benefits or appealing a denial of benefits, call us today.
Key facts about influenza. (2019, September 13). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/flu/about/keyfacts.htm
MacMillan, A. (2018, October 4). 5 ways the flu can affect your health even after you feel better. Health. Retrieved from https://www.health.com/condition/cold-flu-sinus/flu-long-term-effects
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.