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What is the Right Procedure to Apply for a Long-term Disability Claim?

Long-term Disability Claim

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The administrative processes of the insurer are not only a required step in your long-term disability claim, but they frequently set the stage for whether your claim will be successful in any subsequent litigation. They also provide an excellent opportunity to improve your chances during the administrative process and in court.

ERISA, the Employee Retirement Income Security Act, which governs employee benefits, requires that every long-term disability plan maintain a reasonable claims procedure, which includes a mechanism for deciding your initial claim for long-term disability benefits and a mechanism for deciding at least one level of appeal. All decisions must be made within the time frame specified by the Department of Labor. Although ERISA is silent on the subject, courts require that you exhaust all administrative remedies with the insurance company before filing a lawsuit. The following outlines the right procedure to apply for long-term disability and some strategies to remember during the critical administrative process.

1. Hire an Attorney

The first step after being disabled and obtaining medical attention is to contact a long-term disability attorney who can help you with the long-term disability claim application procedure, increasing the likelihood that your claim will be approved. A long term disability attorney Seattle may walk you through the application procedure and ensure you have all the required paperwork and evidence.. Applying for long-term disability compensation without legal counsel is not recommended.

2. Notify Your Employer

The next step is to inform your employer that you cannot return to work (temporarily or permanently) due to your disability. You may be eligible for FMLA temporary leave (Family and Medical Leave Act). You should also notify your employer that you intend to apply for long-term disability. This is because some insurance companies require employers to submit an employer statement.

3. Review Your Policy’s Time Limits

The third thing you should do is review the time limits for filing an application for long-term disability insurance in your insurance policy. If you do not apply for long-term disability benefits within the required time frame, you risk having your benefits denied.

4. Review Your Policy’s Definition of a Disability

The fourth item on your to-do list is to thoroughly read your policy to learn your insurance company's definition of disability. Some policies may require a person to be completely disabled before receiving long-term disability (LTD) benefits. Others will only accept applicants who are partially disabled. Find out exactly what your policy says about how it defines disability, and make sure that your disability meets those requirements.

5. Filing an Employee Statement

Depending on your insurance company, the application process for LTD benefits will differ slightly. Most insurance companies, however, will require you to file an employee statement. The employee statement will include information such as your primary care physician, the source of your information, your place of employment, medical information, and any workers' compensation information. You must file your employee statement within the timeframe outlined in the policy.

6. Seek Medical Care and Gather Medical Evidence

You should apply for LTD benefits when you and your doctor decide your condition is serious enough to keep you from working. This is usually within three months of your last day of work. Gathering medical evidence is one of the most important aspects of your LTD application. If the medical evidence cannot substantiate your disability, your application will almost certainly be denied. Explain your situation to your medical professional when you meet with them. Your doctor must provide evidence that speaks to the severity of your condition and explains why it prevents you from returning to work.

7. Think About Your Other Benefit Options

Long-term disability insurance is not your only option for benefits. The insurance company may require you to apply for additional disability income. Social Security disability benefits (either Social Security Disability Insurance or Supplemental Security Income) and workers' compensation are two options you should consider immediately. The latter is only applicable if your disability results from a work-related activity.

Bottomline

It is difficult to deal with a sudden illness or disability. Filing for disability benefits can be difficult, but understanding the process and breaking it down step by step can be beneficial. We hope you found this article on effective steps to applying for long-term disability benefits useful.

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