You have been off of work for a while and have been receiving short-term disability insurance benefits. Now the disability insurance company is letting you know that you are nearing the end of your short-term disability benefits. What happens next?

Confirm that You Have Long-Term Disability Coverage

If you have long-term disability (LTD) insurance, the end of your short-term disability insurance period is typically the point at which your LTD benefit could begin. First, it is important to confirm that you had LTD coverage as of your date of disability. If your disability insurance coverage is through your employer, your employer will be able to tell you if you had LTD coverage and will be able to provide you with information on the terms of your coverage. You should ask your HR or benefits department to review the “Plan Documents” for your disability insurance coverage. If you purchased disability insurance privately, contact your insurance agent for more information on your coverage and the terms of your policy or policies.

The Next Steps in Transitioning to Long-Term Disability

Once you have confirmed that you have LTD coverage, it’s important to understand what may happen next. You may assume that because you were paid for the entire short-term disability period, you will seamlessly transition to receiving LTD benefits. While that may be the case in some situations, other times it is a more complicated process. There are a few reasons that this transition may take some time. First, the insurance carrier may be assessing your claim under a different standard. For example, your policy may have a slightly different definition of disability for short-term disability compared to long-term disability. Additionally, the LTD policy also may include a provision that excludes payments for pre-existing conditions, which is something that is generally not present in the short term disability insurance policy. That means that the claims reviewers may need to look further back in your medical records to confirm if your condition is considered pre-existing under the terms of your policy. Second, because LTD benefits can potentially pay out for much longer than short-term disability insurance claims, the insurance company may be more incentivized to take a hard look at your claim and try to find any shred of evidence that could be used to deny your claim.
When you begin nearing the transition period, the insurance company will likely reach out to you and advise if they need any additional information from you in order to process your LTD claim. They may ask you to sign an additional medical authorization, complete additional paperwork, and/or have an interview over the phone with you to gain a better understanding of your condition. They may also request additional medical records and updated information from your doctors. It may take some time for the insurance company to review your LTD claim and render a decision, so you should be prepared for a gap in your benefits. (If your long term disability insurance benefits are approved, the insurance company will issue a “back pay” check that pays a lump sum going back to the date that your benefits initially could have started.)

Getting the Insurance Company’s Decision on Your Long-Term Disability Claim

If your LTD claim is approved, there unfortunately will still be some hurdles down the road. The insurance company will continue to ask for updated medical records and updated information from you and your doctors as long as you continue receiving benefits. Additionally, under most policies, the definition of disability changes after a certain time period (generally two years). In the initial time period, the insurance company will be assessing whether you are able to perform your own occupation, but after that time period is over the insurance company will then be assessing whether you can perform any occupation. In other words, it becomes more difficult to continue to receive LTD benefits after the change in definition of disability.

If your LTD claim is denied, the insurance company will send you a letter detailing the reason for their decision and advising you of your right to appeal. The appeal process is very important because you may only be allowed one appeal and you likely will not be allowed to submit additional evidence for a judge to consider if you need to proceed with a lawsuit against the insurance company.

Contact an Attorney for Help

Navigating disability insurance claims can be difficult. If your long-term disability insurance claim has been denied or you would like consult with an attorney to learn more about the long-term disability process, please contact our office to speak with one of our experienced disability attorneys.

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