Most people expect that they will recover quickly after a surgery, unexpected illness, or injury. They file a claim for short-term disability assuming that they will soon be back to work. Unfortunately, sometimes things aren’t that simple.
Most short-term disability plans only pay monthly benefits for 6-12 months. If medical complications or other issues keep you away from work for longer, you will need to consider other options, like long-term disability insurance.
In this article, the experienced attorneys at Bryant Legal Group outline common next steps when your disability lasts longer than your short-term disability coverage.
Not All Disabilities Are Short-Lived
It can take a year to recover fully from a back surgery. At least 50% of stroke survivors experience life-changing limitations that affect their ability to do daily tasks. And depending on your profession, even seemingly “minor” issues with your hands, feet, or cognition can make work impossible.
It can be difficult to accept that you can no longer do the job you love — especially if you have invested much of your adult life to it. However, during these difficult times, long-term disability insurance can give you peace of mind and help you maintain your family’s lifestyle.
RELATED: How Do You Prove You Are Disabled Under a Disability Insurance Policy?
- Related Article: 5 FAQs About Private Disability Insurance Claims
4 Differences Between Short-Term Disability and Long-Term Disability Coverage
Your short-term and long-term disability insurance policies have different terms and conditions. You should not assume that just because the insurance company seamlessly approved your short-term disability benefits, they will do the same with your long-term disability.
Sometimes, you might encounter difficulties because the policy defines “disability” differently than your short-term plan or it excludes specific conditions. But you might also have a more broad array of benefit options, including residual benefits if you can return to another role or occupation.
LTD Policies Often Have a Different Definition of Disability
Most insurance policies define “disability” in one of two ways:
- Own occupation: you are disabled if you cannot perform the material responsibility of your current job.
- Any occupation: to be “disabled,” you must be unable to do any type of work
Most short-term disability insurance policies use the less rigid “own occupation” definition.
However, if you have a group long-term disability insurance plan, either through your employer or a professional organization, it likely is an “any occupation” plan. So, if your conditions prevent you from doing your most recent job, but you can do other, simpler work, the insurance company will likely deny your LTD claim.
Even if you have an individual or private disability insurance policy, make sure you look at the fine print. Some LTD policies use an “own occupation” definition of disability for a period (typically two years), then convert into “any occupation” policies.
Some LTD Policies Limit Benefits for Certain Health Conditions
When you purchased your private disability insurance policy, you agreed to specific terms and conditions. They might have included limiting or denying coverage of specific health conditions, such as:
- Denying coverage for pre-existing conditions
- Limiting mental health or addiction-related disability benefits to two years
- Excluding specific conditions, such as cancer
Before you apply for LTD benefits, you should carefully review your policy or Summary Plan Description. These documents will outline your policy’s exclusions and limitations.
If you need help determining your eligibility for long-term disability benefits, consult with an experienced disability insurance lawyer at Bryant Legal Group. We can help you understand your policy’s precise terms and suggest practical next steps.
Insurance Adjusters Are More Likely to Deny Your Long-Term Disability Claim (Even if You Received Short-Term Disability)
Paying out years or decades of long-term disability benefits is costly, and insurance companies do everything in their power to avoid this. Companies like UNUM have long histories of denying legitimate LTD claims for vague or improper reasons.
If your long-term disability claim is denied, consult with an experienced disability insurance lawyer who can review your medical records and policy language and assess your eligibility. Unlike an insurance adjuster or representative, an attorney will work on your behalf and advocate for your best interests.
Do not delay in making that initial phone call. Most disability insurance claims have strict filing and appeal deadlines — especially if you have an employer-sponsored plan that is covered by ERISA (Employee Retirement Income Security Act of 1974).
RELATED: Residual Benefits in Private Disability Policies
You Might Be Able to Return to Another Job Once You Qualify for LTD
Now that we have covered several of the more bleak issues that can pop up in a disability insurance claim, let’s look on the bright side.
Years ago, many professionals purchased LTD policies with very attractive terms. If you have a private “own occupation” policy, you should look carefully at its definition and whether residual benefits are available. Under some policies, if you cannot return to your “own occupation,” you can receive a monthly long-term disability benefit — even if you return to work with a different role.
For example, suppose you are a cardiothoracic surgeon who has an essential tremor. While you can no longer do precise surgeries, you might still be able to work as a hospital or medical practice administrator, teach medicine, or provide consulting services to other professionals. Many of these jobs are lucrative — although they might not offer as much compensation as your previous role.
Depending on your policy, you might be able to receive a full LTD benefit or a residual benefit. Residual benefits pay you a portion of your LTD based on your current earnings and how much you made in the past.
When Should I Talk To a Long-Term Disability Lawyer?
Navigating a long-term disability claim can seem impossible. You need to analyze your policy’s language, interpret state or federal laws, and calculate the full value of your claim — all while managing your illnesses or injuries. That is why so many people rely on guidance from a disability insurance attorney.
Too frequently, we speak with professionals who should have called us sooner. Sometimes, we can help them untangle their claims and get the benefits they deserve. Other times, it is too late.
If you have a question about your disability benefits, don’t wait to consult with a lawyer. We can help you understand all your options, help you avoid mistakes, and streamline your LTD claim. Initial consultations are free.
RELATED: 5 Essential Questions You Should Ask a Disability Insurance Lawyer
Bryant Legal Group: Fighting for Disabled Individuals Across Chicago and Illinois
At Bryant Legal Group, our practice focuses on disability insurance law. We have a long history of standing up to disability insurance companies and helping disabled professionals get the benefits they deserve. We have recovered millions in benefits for our clients, and we can help you understand your disability insurance options.
To schedule your free consultation with a member of our team, call us at 312-561-3010 or complete this online form.