Nurses and other healthcare professionals spend their days focused on other people’s health and wellness. However, when healthcare workers find themselves unable to work due to their own chronic health conditions, illnesses, or injuries, they often find themselves in unfamiliar territory, navigating the medical and disability insurance systems as a claimant and patient. It’s a lot to handle, but you don’t have to do it alone.
Bryant Legal Group has served Illinois’ nursing and medical professionals for decades, helping them get the long-term disability (LTD) benefits they deserve. In this article, we outline key issues that every nurse should know before they file an LTD claim.
Why Do Nurses Need Long-Term Disability Insurance?
Whether you’re an RN, LPN, nurse practitioner, or another nursing professional, you’ve spent a remarkable amount of time and effort building your expertise. Nurses play an essential role in healthcare organizations, performing work that poses both physical and emotional challenges. Sometimes this work comes at a cost: many nurses and other healthcare professionals struggle with high blood pressure, coronary artery disease, diabetes, depression, anxiety, and other chronic issues.
Nurses also face an increased risk of many occupational ailments:
- Musculoskeletal: Degenerative disc disease and degenerative joint disease are common in nurses due to the intense amount of physical work they perform (like transferring and positioning patients).
- Infectious diseases: Even before the COVID-19 pandemic, nurses and other healthcare professionals face an increased risk of contracting an illness. According to the CDC, more than 40% of all needlestick incidents involve nurses.
- Violence: Patients can become agitated or violent. In an American Nurses Association survey, 21% of nurses and nursing students reported being physically assaulted by patients.
- Emotional burnout: Serving the most vulnerable can take a toll on your mental health. An estimated 60% of all healthcare workers experience burnout and mental health issues during their careers.
When the unexpected happens, either due to an injury, chronic illness, or accident, you may have a lot to lose. According to the Bureau of Labor Statistics, the average RN made $73,300 in 2019. Social Security will only pay you a modest monthly benefit, and it probably won’t fully cover your lost income. (In 2019, the maximum Social Security benefit was $2,861 per month or $34,332 per year.) Long-term disability can fill in some of this gap.
Whether you have a privately funded or employer-sponsored LTD plan, you should receive a monthly benefit if you meet the policy’s disability definition. However, even the most sophisticated healthcare professionals are sometimes surprised to discover that their concept of “disability” doesn’t match the insurance company’s terms and conditions.
4 Things to Look Out for in Your Long-Term Disability Policy
1. Do You Have Private or Employer-Sponsored LTD Coverage?
Different rules and procedures will apply to your claim depending on whether your disability insurance policy is self-funded or employer-sponsored. Many nurses purchase their own LTD policies because they work as traveling nurses or independent contractors, and many nurses change jobs frequently. Individual disability insurance policies give nurses peace of mind since these policies are portable and aren’t dependent on their continued employment with a specific healthcare system or employer.
When you have long-term disability insurance through your employer, you don’t get to select the policy’s terms and conditions. Additionally, ERISA (Employee Retirement Income Security Act of 1974), a federal law, applies to your claim. Under ERISA, you must complete a two-stage insurance-level application and appeal process before you can file a lawsuit. The filing deadlines are also relatively short, so you need to act quickly and carefully monitor your LTD claim’s progress.
If you have an individual or self-funded LTD policy, you chose your policy’s terms and conditions, which may have impacted your monthly premium. Illinois law covers these long-term disability claims, and you can request a jury trial as soon as the insurance company denies your claim.
RELATED: What Is ERISA? We Answer Your Long-Term Disability Insurance Questions
2. How Does Your LTD Plan Define Disability?
Most LTD policies define “disability” in one of two ways:
- Own occupation: You are disabled if your medical conditions or injuries prevent you from doing your actual nursing job.
- Any occupation: The insurance company will pay your LTD benefits if you cannot perform any type of work, including jobs outside the nursing and healthcare fields.
While most employer-sponsored group LTD plans use the more stringent “any occupation” language, some private LTD policies contain an “own occupation” definition.
Your policy’s definition may significantly impact your right to ongoing long-term disability benefits. For example, suppose you work as a certified registered nurse anesthetist. You’re in a car accident and suffer severe shoulder and back injuries and mild TBI. These injuries make your job as a CRNA impossible due to both physical and mental limitations. However, you still can do simple tasks that don’t require a lot of physical exertion.
If you have an “own occupation” policy, the insurance company will probably approve your application for benefits. With an “any occupation” policy, you may receive a termination of benefits notice. However, under an “any occupation” policy, the insurance company may argue that you could do other work outside the nursing field and deny your claim.
3. Are There Exclusions or Limitations That Impact Your Claim?
Many LTD policies include specific limitations and exclusions. For example, if your disability claim is solely for mental health issues or addiction, your long-term disability policy may limit you to two years of benefits. Some individual policies also impose limitations or exclude pre-existing conditions.
Before you apply for LTD benefits, it’s a good idea to carefully review your Plan Document or Summary Plan Description (SPD). These documents will set out the specific terms, conditions, limitations, and exclusions that will apply to your claim. (If you need help understanding and interpreting your Plan Document or SPD’s dense, technical language, contact Bryant Legal Group.)
4. Do Waiting Periods Apply to Your Long-Term Disability Claim?
Most LTD policies have an elimination period, and you cannot receive long-term disability benefits until this period expires. Many LTD policies have a 90-day elimination period, although sometimes the period can be a year or more. You may be eligible for short-term disability benefits while you wait, so make sure you fully understand the scope of your disability insurance coverage.
When Should a Nursing Professional Consult a Disability Insurance Lawyer?
Don’t wait until you’re knee-deep in a long-term disability insurance appeal to call a lawyer. At Bryant Legal Group, we take a proactive approach. We can suggest ways to find the right policy, assess your eligibility for benefits, and guide you through both the application and appeal processes.
We know that disabled nurses have a lot of their minds, and you shouldn’t have to balance your medical conditions and a complex legal claim at the same time. Our lawyers can step in to manage your disability insurance matters, negotiate with adjusters, and adhere to your policy’s procedural requirements. This gives you the time you need to focus on what matters most: your recovery and your family’s needs.
Bryant Legal Group: Chicago’s Respected Disability Insurance Team
At Bryant Legal Group, we’ve earned a reputation for our practical, client-focused approach to disability insurance law. Whether you’re considering applying for LTD benefits or the insurance company terminated your monthly payments, our team can help you build a plan and educate you about your legal options. We assist people in Chicago and throughout Illinois with their disability insurance claims and appeals.
To schedule your free consultation, call us at 312-561-3010 or complete our online form.