BRYANT LEGAL GROUP

Long-Term Disability Benefits

Chicago Long-Term Disability Insurance Attorneys

If you become disabled and are unable to work for an extended period, your long-term disability (LTD) insurance is supposed to replace a portion of your lost income and protect the standard of living you worked so hard to build. But in practice, that’s not always how it works.

Filing a long-term disability claim is often a complex and confusing process. Minor mistakes made during filing can lead to an unfair denial of long-term disability benefits. You will have only a limited time to appeal before losing your chance at obtaining your benefits. Even if you did nothing wrong, the insurance company may unfairly deny your disability claim and leave you in the lurch.

If you need help applying for long-term disability benefits, appealing a denied claim, or negotiating a settlement or buyout of your existing benefits, contact the Chicago long-term disability lawyers at Bryant Legal Group today. Our attorneys have decades of experience helping workers and professionals across Illinois get the benefits they deserve.

Our long-term disability attorneys can assist their clients with every aspect of their claims:

I have been using Bryant Legal Group several years now and they have been amazing. My attorney is Jennifer Danish and she has been a pleasure to work with. She is very professional, knowledgeable, and gets positive results for her clients. I would recommend her highly to anyone in need of a disability lawyer.

- Mike W.

What Is Long-Term Disability Insurance?

Long-term disability is a form of insurance that is supposed to pay you a set percentage of your pre-disability income (up to a maximum monthly limit) if you are disabled and unable to work.

In most cases, long-term disability coverage is set to kick in once short-term disability coverage ends. Depending on the terms and conditions of your policy, LTD benefits may continue for a set number of years or until you reach Social Security normal retirement age, provided you remain unable to work.

There are two main types of long-term disability plans:

Group disability insurance may be provided by your employer, similar to other types of employee benefits (such as health or dental insurance). These plans almost always are governed by a federal law known as ERISA.
Individual disability insurance can be purchased directly from an insurance company if you are self-employed, an independent contractor, or have simply chosen to purchase additional coverage beyond employer-sponsored plans. Because individual plans are not covered by ERISA, the procedures and regulations for filing and appealing claims may be quite different from group policies.

Please note that long-term disability insurance is not the same as Social Security Disability Insurance. Bryant Legal Group does not handle standalone Social Security Disability claims.

Is My Condition Covered?

Claims related to most physical and mental conditions are covered by long-term disability insurance policies, including substance abuse. However, your LTD plan may limit or exclude coverage for certain conditions.

Generally speaking, you should be entitled to benefits under your long-term disability plan as long as the following conditions are satisfied:

You can show that you have a medical condition that prevents you from working, under your insurance policy’s definition of disability.
That condition is not explicitly excluded by your policy.

Related Article: Types of Disabilities Covered

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Common Challenges Faced by Long-Term Disability Claimants

You or your employer pays your premiums every month. You expect your disability insurance to be there for you when you cannot continue to perform your occupation. But far too often, policyholders encounter obstacles that prevent them from getting promptly approved for the benefits they need.

Satisfying the Definition of Disability

Your insurance plan documents will define what “disabled” means under the plan. There are two broad definitions:

Own occupation: you are considered disabled if you can no longer perform the duties of the job you held when you became disabled.
Any occupation: you are considered disabled if you are unable to work any job to which you are reasonably suited—even if that job is much lower-paying and less fulfilling than your previous work.

Policyholders often run into issues when they disagree with the insurance company about whether their illness or injury qualifies them as disabled under the policy definition. Claimants often need to provide a substantial amount of medical records, vocational evidence, functional test results, letters of support, and other documentation to prove their claim.

It’s also not unusual for long-term disability policies to start out using an own-occupation definition of disability, then change to any occupation coverage after a set number of months or years (often two years). This can result in a sudden loss of coverage even if you are still unable to return to your original job.

Policy Exclusions

Long-term disability policies often include limitations and exclusions regarding covered conditions. For example:

Coverage for pre-existing conditions may be excluded if those conditions were present before the policy’s effective date or during a specified look-back period.
Coverage for disabilities related to mental health issues (e.g., depression, anxiety, post-traumatic stress disorder) or substance abuse may be limited to a shorter benefit period, such as 24 months.
Conditions involving subjective or self-reported symptoms (e.g., fibromyalgia, degenerative disc disease, chronic fatigue syndrome) may have stricter requirements for objective medical evidence and/or be limited to a shorter benefit period.
Disabilities that result from workplace injuries are typically covered under a worker’s compensation claim. Your long-term disability coverage may not apply or only pay a partial benefit.

Complex Procedures and Tight Deadlines

Filing claims and appeals is often complex and confusing, with each insurance company and plan having its own set of rules. It’s easy to make mistakes if you don’t have an experienced long-term disability attorney helping you.

Furthermore, group policies governed by ERISA require policyholders to go through the insurance company’s administrative appeals process before filing a lawsuit in federal court—and the court can only consider evidence that was previously submitted as part of the administrative appeal. That means it’s critically important for claimants to put together an expansive, comprehensive claim file, often in just a few months before a tight deadline.

Related Article: 5 Essential Questions You Should Ask a Disability Insurance Lawyer

Our Settlements and Verdicts

$1.6 Million

After our client’s disability insurance benefits were improperly terminated, we negotiated a $1.6 million settlement for him.

$500,000

Our medical practice team recovered $500,000 for a physician group when an insurer failed to properly reimburse them for their services.

$400,000

We collected $440,000 in unpaid disability insurance benefits for our client and got her LTD benefits reinstated by proving she was disabled from any occupation.

How to File a Claim for Long-Term Disability Benefits in Chicago

If you’re planning to file a disability claim under a long-term disability insurance policy, we strongly encourage you to retain legal counsel with an experienced Chicago disability attorney. When we are retained to represent individuals at the early filing stage, we work with them to provide the best possible evidence in support of their claim early on, and we make recommendations about what to avoid in the process.

At Bryant Legal Group, we usually recommend starting the process by requesting a copy of your current long-term disability insurance policy. This document will include all its requirements and procedures and explain how quickly you must submit your claim, what type of proof of loss the insurance company requires, and how disability is defined.

Most insurance companies administering long-term disability claims require you to complete an initial set of forms. The forms usually include:

Insured’s claim (claimant statement) form;
Employer’s claim form or statement;
Authorization form that lets medical providers, financial institutions, and government agencies disclose information to the insurer; and
An attending physician statement.

If you become sick or injured, the insurance company may make it very difficult for you to collect the benefits you are due. Rather than help you navigate your claims, the adjuster may give you misleading information or delay paying your claim.

The filing process can be fraught with pitfalls. The Chicago long-term disability attorneys at Bryant Legal Group understand insurance companies’ tactics to delay payments and deny coverage, and can help you overcome these obstacles.

Why You Need an Airtight Claims File

It is important to ensure every piece of evidence is submitted during the claims filing process. If the insurance company denies coverage and the dispute ends up in court, you are generally precluded from adding any new information to your file.

If you provide incomplete records and evidence, the insurance adjuster is probably going to deny your long-term disability claim. Insurers have no incentive to award disability benefits in “close” cases where it is likely that the claimant has a disability, but the record is not sufficient to objectively support such qualification. They will deny reasonable claims without adequate documentary evidence.

Our attorneys know how to build a claims file that will give you the best chance of getting the long-term disability benefits you deserve. We draw upon decades of industry knowledge to collect and assemble the most persuasive evidence for your case, including MRIs, CT scans, and other medical tests and vocational evaluations.

While you might manage the process on your own, you run the risk of making a mistake that could cost you your benefits. If you’ve already filed a claim on your own and had it denied, time is running out on your chance to appeal, and you will likely only have one opportunity to add the evidence you need to support your case.

When you work with a Chicago long-term disability lawyer at Bryant Legal Group, we will make sure that everything is done right so you can maximize your chances of success.

BRYANT LEGAL GROUP:

Protect Your Long-Term Disability Benefits

If you are unable to work because of an illness or injury, you should contact a disability attorney as soon as possible. The attorneys at Bryant Legal Group have decades of collective experience helping clients get the disability benefits they need to help make up for a loss in income. Our lawyers concentrate their practices exclusively on representing policyholders—we never represent the insurance companies. This focus and commitment ensures that we will do everything in our power to achieve an optimal outcome for you.

Contact a long-term disability attorney in Chicago today by calling (312) 818-3648 or completing our online form so that we can help you take the right steps for your particular situation.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Frequently Asked Questions

Bryant Legal Group’s disability attorneys take a proactive approach to insurance claims. We help professionals at every stage of their journey:

Evaluating their coverage and identifying possible issues with the policy’s language before they need to file a claim
Guiding clients through the disability insurance application process
Negotiating with the insurance companies
Filing appeals with the insurer, state, or federal court

As soon as you have a question or concern about a claim, reach out. Often, you only have one chance (and a limited amount of time) to appeal a denied claim. The earlier you seek legal advice, the better.

Private disability insurance policies vary significantly from policy-to-policy, and so too do the coverage exclusions that apply to insureds.

Whether certain coverage exclusions apply to your policy — and the limitations imposed by those exclusions — is often heavily dependent on how “premium” the disability insurance policy is. More expensive policies tend to feature fewer limitations and more generous benefits.

Despite these variations, there are certain exclusions that are more commonly encountered than others in the disability insurance context. These include, but are not necessarily limited, to exclusions that disqualify coverage to those who have been:

Disabled through intentional or self-inflicted injuries
Disabled pursuant to military service
Disabled in an “extreme” and “risky” scenario, as defined by the insurance policy (i.e., skydiving, bungee jumping, etc.)
Disabled during the commission of a criminal offense
Disabled due to some specific condition (the insurance policy may define a range of conditions that will not qualify)
Disabled due to a mental health condition (though most disability insurance policies simply limit the time period of eligibility for such conditions)

Yes, absolutely. Not only is it likely that you will receive regular requests for updated information relating to your disabling condition (and its progression) from your insurer, but insurers will expect you to keep them apprised of any material changes to your medical condition(s). You must provide updated information as you bear the burden of the proof of loss as the insured under most disability insurance policies.

It’s critical that you do not forgo such notification, or you could not only lose your benefits, but you could also be held liable for damages.

Insurers must come up with some justification for denying your disability benefits claim — if their justification has no reasonable basis, then you should appeal the denial or pursue a lawsuit to recover your benefits.

Common justifications for a claim denial include:

Lapse of coverage
Material misrepresentations in the original insurance application
Insufficient evidence of disability
Application of a coverage exclusion
Disability is tied to a pre-existing condition
Failure to seek ongoing medical treatment

Definitions of “disability” are determined by the disability insurance plan or policy. Policies tend to define disability into three fundamentally different categories: specialty specific own-occupation, own-occupation, and any-occupation.

Specialty Specific Own-Occupation

If your insurance policy includes a specialty specific own-occupation definition of disability, then you will be entitled to benefits if you can prove that your condition renders you incapable of substantially performing the primary duties of your own occupation in the specialty in which you perform it.

For example, suppose you work as a trial attorney, but you experienced a cognitive disability. If you are unable to meet your profession’s cognitive demands, you should be entitled to benefits under the policy.

Own-Occupation

If your insurance policy includes an own-occupation definition of disability, then you must prove that your condition renders you incapable of substantially performing the primary duties of your current occupation.

For example, suppose you work as a financial analyst. Because of a disability, you cannot remain on task for more than 10 minutes at a time and are incapable of performing the complex, hours-long analyses necessary for you to perform your job as a financial analyst. In this case, you might qualify for own-occupation disability even if you can still do other, simpler work.

Sometimes, insurers deny benefits in the own-occupation context by arguing that the duties of your current occupation can be different, and that the duties of your current occupation are not indicative of the “norm” in the industry. If you experience this kind of pushback, consult with a lawyer immediately.

Any-Occupation

If your insurance policy includes an any-occupation definition of disability, then you must prove that your condition renders you incapable of substantially performing the primary duties of any other job for which you are reasonably qualified. This is an extremely strict definition of disability and often requires a nuanced approach to overcome.

In long-term disability situations, private disability carriers can make offers to buyout coverage so as to avoid having to payout benefits for the lifetime of the policy. When you accept a lump sum buyout, you must agree to forgo legal claims against the insurer for the benefits at-issue (and any related issues, such as a bad faith claim you might have against that insurer for how they mishandled the processing of your benefits). The benefits owed over the lifetime of the policy are negotiated and repackaged as a lump sum payment. If you accept the lump sum buyout, then you will not be entitled to receive monthly benefits payments.

Now, with that out of the way: is it worth it? Though it might seem like an unsatisfactory answer, the truth is that the attractiveness of a lump sum buyout depends on the circumstances of your disability claim and your own preferences.

Let’s clarify.

A lump sum offer for a buyout is less than the total present value of your maximum future benefits under your disability insurance policy. Whether or not the offer for a buyout is reasonable or “worth it” for you to accept requires complicated analysis. For one thing, disability insurance benefits are not static in nature. The insurer may conduct surveillance over time, and will absolutely expect you to update them on changes in your medical condition(s), your continued medical treatment, and any efforts to return to work. It is in the insurer’s best interest for you to improve and therefore to no longer be “disabled” under their policy, thus terminating the receipt of benefits. By negotiating a lump sum buyout, you don’t have to worry about whether the insurer will terminate your benefits at some later date — you can focus on recovery.

All insurance claimants — disability claimants included — have a duty to mitigate their various losses. The duty to mitigate generally entails the exertion of “reasonable effort” towards the minimization of your losses.

In laymen’s terms, this means attending your rehabilitation sessions, following through with treatment (by attending appointments), being consistent about taking your medication, and more. The insurer is not required to pay full benefits a disability that was exacerbated by the claimant’s own failure to act reasonably. If you fail to mitigate, then the insurer may have a reasonable basis to either deny your claim or undercut your benefits significantly.

Additionally, most disability insurance policies specifically require that you receive appropriate ongoing medical care; failing to do so, may be a separate reason for an insurer to deny your claim.

The consequences of lying — or otherwise misrepresenting the details reported in your original application for disability insurance coverage — vary depending on the nature of the misrepresentation.

In Illinois, you may still be entitled to receive disability benefits, even if you misrepresented certain facts on your original application, so long as those facts were not: 1) intended to deceive the insurer, and 2) material to the disability coverage.

For example, if you simply forgot to write about some minor health condition, the insurer cannot use that as justification for a denial (or rescinded coverage). Further, if the health condition is unrelated to the disability coverage — in other words, if they would have still extended coverage to you had you no misrepresented the facts — then the insurer is required to pay out benefits for a legitimate disability claim.

It’s worth noting, however, that the insurer may be entitled to payments to cover any difference that there would have been to the insurance premium.

Generally speaking, you are entitled to receive disability benefits, even if your disability is caused primarily by a mental health condition (such as depression, anxiety, panic disorder, PTSD, etc.), though there may be associated limitations.

It’s worth noting that some plans are extremely strict and actually exclude all mental health conditions from qualification for benefits altogether, but this is quite uncommon — most plans have a basic provision known as the “mental or nervous condition” limitation. This limitation entitles you to disability benefits for a 24-month period, after which you will no longer be entitled to receive further benefits.

Yes. You can receive private disability benefits, even if you are receiving funds through supplemental income sources, or other wage replacement benefits, such as Social Security Disability Income (SSDI) or workers’ compensation — there may be an offset for certain benefits, however.

When it comes to supplemental income sources, such as passive income, inheritance, personal gifts, etc., your private disability benefits are generally entirely unaffected.
Private disability benefits are a form of wage replacement, they are not income-variable.
Whether you are rich or poor, you are entitled to the full disability benefit that was bargained for through the insurance contract.

Now, when it comes to Social Security Disability Insurance benefits, most ERISA long-term disability plans have an offset that requires you to apply for SSDI benefits. However, private disability policies usually do not have the same application and offset requirement. This is policy specific, and our experienced disability insurance attorneys are available for consultation in order to help you understand your policy.

Young female nurse helping a happy elderly woman recovering from injury, walking with crutches during home care physiotherapy for rehabilitation and independent living

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