If you’ve suffered an injury or illness and can no longer work, yet your insurance company has denied your benefits
, it is in your best interest to get a long term disability attorney in St Charles. Unlike a disability claim for Social Security, insurance companies that have long-term disability coverage are not impartial. These insurers have a vested interest in the outcome of LTD claims. When they approve and pay out too many disability claims, they are left with a not-so healthy bottom line. Instead of your health and financial obligations, the insurers are more concerned about their profit margins. However, with a long-term disability attorney on your side, you will have someone looking out for your best interests. Here are a few FAQs to give you a better understanding of what to expect.What is long-term disability insurance?
Long-term disability insurance provides wage replacement for individuals who are unable to work because of an injury, illness, or accident. Typically, the monetary benefit lasts for one year depending on the type of plan. Employers may offer this type of group insurance coverage as part of the employee benefits package. In addition, some professional and association affiliated organizations may offer a long-term disability plan to its members.
Who is eligible to receive group long-term disability insurance?
Eligibility is based on which group plan offers long-term disability insurance coverage. When coverage is from an employer, employees must be employed for a time period, which is called a service wait, before being eligible. If you are covered through a professional or association affiliated organization, your coverage goes into effect once you have been a member of the group for the time specified in membership details.
How much wage replacement will I receive?
In most cases, your monthly benefit payment is a percentage of your gross earnings before your disability occurred. Other plans may have a set dollar amount without considering a percentage of your wages. The summary plan provided by your employer or organization should provide details.
How much does it cost for long-term disability coverage? Who is responsible for the premium?
Employer-sponsored group long-term disability coverage may require no employee costs, or it could be a percentage of the premium. Employer agreements with insurance companies will determine how much – or how little – an employee pays. If the Human Resources department at your company does not explain benefit details, a long term disability lawyer in St Charles can help you find the right answers.
What happens to my coverage if I am no longer in the group that provided the benefit?
Some group long-term disability plans are portable if you did not become disabled when you left the group. If the policy does not include a portability option, you would need to re-enroll in a separate group plan. You may also need to meet all requirements such as signing up for coverage during the initial enrollment period, completing the service wait time and any pre-existing condition exclusionary period.
What is usually covered in the policy?
Generally, a long-term disability insurance policy covers a variety of conditions beyond injuries on the job. While some plans do cover job-related injuries, well over 90% of long-term disability claims are not for illnesses stemming from work. For instance, neurological disorders, cancer, mental illness and some degenerative diseases might be covered by your policy.
Is there a pre-existing condition exclusionary period for long-term disability insurance?
If you received treatment for a medical condition three to six months prior to the effective date of long-term disability coverage, it is considered a pre-existing condition. Some plans may include an exclusionary period for pre-existing conditions, which means medical conditions during this time are not covered. However, once that time expires, a long term disability attorney in St Charles will make sure your condition is acknowledged.
How do I qualify for a pre-existing condition exclusionary period under a group plan?
To qualify for a pre-existing condition exclusionary period under a group plan for long-term disability, you usually have to meet certain requirements that are outlined in the plan. These requirements may include signing up for coverage during the initial enrollment period, remaining part of the group and enrolled during the service wait and exclusionary period for a pre-existing condition. The time period for pre-existing conditions can last for a minimum of 12 months and a maximum of 24 months.
Does long-term disability insurance include medical coverage?
No. Coverage under a long-term disability insurance plan only provides wage replacement benefits. Keep in mind, with an employer-sponsored plan, continued eligibility for medical and life insurance coverage might be determined based on your eligibility for long-term disability benefits. Speaking with a long term disability attorney in St Charles will help to ensure you receive all the benefits for which you are entitled.
What is the difference between long-term disability insurance, Social Security Disability Insurance and state and federal disability programs such as Supplemental Security Income?
Although each provides some type of monetary benefit, there are distinct differences. Long-term disability insurance is considered a private insurance plan that is offered through group or individual plans. With long-term disability, there are no income and asset restrictions. Coverage will vary based on the type of insurance policy you have. Social Security Disability Insurance is administered by the Social Security Administration and is a monthly benefit for individuals who qualify based on the amount of FICA taxes they paid through previous work. Instead of a percentage of gross wages on one job, the amount you receive is based on previous earnings from all work. Supplemental Security Income is another public cash benefit for individuals with a disability and limited income. Monthly benefits are based on financial need and living situation. You do not have to be part of a group to be eligible.
What happens if my claim for long-term disability benefits is denied?
Receiving a denial letter from the long-term disability insurance company can be an overwhelming and frustrating experience. Far too often, legitimate claims by individuals who have paid premiums for many years are denied because the insurance company looks for every technical and legal angle it can find. This is bad faith when the insurer does not live up to its contract agreement, not to mention it leaves you in a precarious position dealing with a disability and loss of income. Fortunately, a denial letter is not the end of your claims process. If the insurance company rejects your legitimate claim, you need to know your rights and options in Missouri. We have a long term disability lawyer in St Charles willing to show you the next steps in getting the benefits you deserve.
Why do I need to hire a long term disability insurance lawyer?
When confronted with a denial letter and the confusing claims process for long-term disability, many people choose to miss out on what may be owed to them. They do not want to haggle with an insurance company that is unwilling to pay out any benefits. You should not risk your rights to an appeal on a technicality like an illness misclassification or for not having correct information available. Working with a long term disability lawyer in St Charles will give you peace of mind. He or she will give you correct advice and make the claims process easier during an already difficult time in your life.
Contact a Long Term Disability Attorney in St Charles
David M. Hicks knows the rules and procedures of the claims process. Call (314) 812-4885 to speak with a long term disability attorney in St Charles today.