Degenerative medical conditions encompass a varied group of diseases which begin slowly with slight work/life impacts, but advance in severity over time. Common degenerative medical conditions include Alzheimer’s disease, Parkinson’s disease, Multiple Sclerosis (M.S.), cancer, diabetes, osteoporosis, and Huntington’s disease, but there are many more affecting thousands of American workers each day.

Many people with degenerative medical conditions successfully adapt their work and life so they can be productive and earn good income, and their careers may remain sustainable for some time. At some point, however, most workers with degenerative diseases begin to struggle to complete daily tasks at work and start to consider their options, which often include a short or long term disability insurance claim. If you have reached a point where you are considering making such a claim, I recommend five important considerations as you prepare to move forward.

1. Develop a Financial Plan Before Leaving Your Job

Short and long term disability insurance provides partial income replacement to help you meet expenses when you stop working. Typical plans pay between 60% and 70% of your pre-disability earnings. Depending on how the premiums were paid, these benefits may be taxable, and if you are a high wage earner, there may be a cap to your monthly benefit. Going on short or long term disability insurance often means a large reduction in your monthly income. How do you prepare for this?

If you are able to save some money while you are still working, savings can provide a buffer as you transition to disability income. However, many people find it difficult to save as their disability worsens so saving may not be realistic. It will likely be necessary to consider lifestyle changes that will allow you and your family to get by on less. These are not easy decisions but planning ahead is better than being forced into making these decisions later.

Aside from budgetary planning, it is important to investigate other benefit options surrounding your work life. For example, were you injured at work? If so, you may be able to make a workers compensation claim. Do you have a private long term disability policy in addition to the policy offered by your employer? If your condition is serious enough that you will be off work for 12 or more months, you can apply for Social Security Disability. Beyond this you may have access to state disability benefits (especially if you were employed in the public sector). You also may be able to tap into your retirement savings. However, before doing any of these things, you should carefully research the terms of your long term disability insurance plan so you understand what impact, if any, these other sources of income will have on your claim.

2. Learn About Your Policy Without Raising Red Flags With Your Employer

So how do you research the terms of your long term disability insurance plan? Plans are required to provide you with a summary of the plan terms, called the Summary Plan Description or “SPD.” If you have your Summary Plan Description, this is a great place to start. You will also want a copy of the actual plan document, which is the document the Summary Plan Description is summarizing. You most likely do not have a copy of the plan document; to see it, speak with someone in your employer’s Human Resources department.

You may ask: Won’t this raise a red flag with the employer? Won’t the employer now know you are planning to take a disability leave? Will you be retaliated against for making such an inquiry? These are all fair questions. Discussing disability insurance benefits with your employer is not necessarily protected by HIPPA. However, if you couch your questions about disability insurance in a discussion about your health insurance or medical issues, those conversations are now protected by HIPPA. If you have a choice, speak with someone in Human Resources whom you trust to keep your conversation in confidence. It may seem counterintuitive, but discussing your underlying medical condition may provide you with more protection than if you do not as this may trigger protections under the Americans with Disabilities Act.

3. Read and Understand the Terms & Limitations of the Disability Insurance Plan

Once you have a copy of the plan document, you will want to understand the requirements for making a disability insurance claim. Pay close attention to the definition of “disability” in the plan, as this spells out the exact requirements for obtaining long term disability insurance. In addition, make sure to read over the section on limitations. Some plans allow only limited benefit periods for certain conditions, such as mental health claims or pain disorders. It will be important to know what the potential benefits are. Additionally, check to see what the maximum benefit claim is. Most plans pay until age 65 of normal Social Security Retirement age. However, each plan is different and it is important to understand this term. There are numerous other terms contained in the plan document; please consult with an attorney if you have questions about them.

4. Talk With Your Doctors

Beyond knowing your rights under the plan, it is important make sure your doctors are supportive of your disability claim. Some doctors will recommend their patients leave work on disability. If you are uncertain whether your doctor believes you need to stop working, just ask your doctor. This will be a good conversation and allow you to understand whether your doctor believes you are able to continue working or not. It will also provide you with an opportunity to tell your doctor you are planning to make a disability insurance claim and make sure he or she is willing to complete the necessary paperwork for the insurance company. All of this will help avoid confusion when you are ready to make your short or long term disability claim.

5. Don’t Wait Too Long To Make the Disability Claim

The final thing to consider is exactly when you should make the disability. This can be a very difficult decision, as it can be quite difficult to admit to yourself that you are no longer able to perform the duties of your job. However, waiting too long to make your claim for long term disability insurance can have negative consequences. If you are struggling at work and have not discussed your medical condition with your employer, you run the risk of being fired for poor performance. You are then in a position of trying to make a retroactive claim for long term disability insurance, which can be difficult. Additionally, if you have a sympathetic employer who has accommodated your disability, the accommodation itself may prevent a problem. For example, most long term disability plans initially will determine if you are able to perform the duties of your own job. Most plans will look to see what you are actually doing for a job at the time of the disability. So, if your employer has removed certain difficult tasks like travel or lifting of heavy objects, you may be judged on your ability to perform the duties of the modified job as opposed to the initial job. This may make it harder for you become eligible for long term disability benefits.  Finally, if you have just started working for your employer, you may run into pre-existing condition issues. Before making a claim, please review the plan document and speak with an attorney.

Ultimately, many of the above considerations involve tough decisions and complex information, so it can help to speak with an experienced long term disability attorney about this before making a claim for disability benefits. In order to speak with one of our long term disability attorneys for a free consultation, please contact us.

Bill Parsons

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