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Disability Laws: More Long Term Disability Provisions to Meet

Published on August 22, 2014 by

Last time, we talked about how just having long term disability insurance isn’t enough; your condition has to meet the requirements outlined in your specific policy. The provision we detailed in part one of this series is the definition of disability included in your paperwork. If you can’t meet your policy’s disability definition, you’re not going to qualify for benefits.

But that isn’t the only common provision out there, and today we’re going to delve into the elimination period, earnings caps, and other requirements.

Beyond the Definition of Disability – More Long Term Disability Provisions

Minimum time disabled or elimination periods. This is one of the most common requirements in addition to the disability definition. In order to qualify for benefits, many insurers put a clause in your policy that says you have to remain disabled for a certain amount of time (often 180 days) before your eligibility for long term benefits begins. It is vital that you pay attention to this provision, because in order to get the benefits you need, you’ll have to provide medical documentation proving that you were disabled for this amount of time. Additionally, you need to know the length of the elimination period because your insurer will not provide you with long term benefits until you reach the end of it.

Earnings caps. Another typical provision that can be both good and bad for those with long term disabilities is an earnings cap. An example of an earnings cap may state that you can continue to receive long term disability benefits if you work part-time, but only if the money you earn doesn’t exceed 60% of your previous earnings. It’s nice to be able to make some extra money, but go over that amount and you can lose your benefits.

Ongoing treatment. Certain policies demand that those getting benefits continue to receive regular treatment from doctors. If you stop getting medical help, your benefits stop coming.

Medical or administrative proof. It’s common that a long term disability claimant will need to prove their disability by showing medical documentation, but some policies are very specific in what they will accept – x-rays, blood tests, MRIs, and so on. There are even policies that require claimants to become approved for disability benefits by Social Security before the insurer will pay out.

As you can see, disability laws can be quite complex, and knowing all of these things ahead of time will save you head- and heartache. Next time we’ll continue with more common provisions by discussing policy limitations and appeals, but you can learn more now in our free eBook.


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ERISA Plans: How to Understand Your Long Term Disability Policy

Published on August 20, 2014 by

If you know that you have long term disability benefits as part of your insurance policy, you might think that getting those benefits is as simple as completing an application. Unfortunately, as part of an experienced long term disability law firm, I can tell you that is decidedly not the case.

There are specific terms that you have to meet in order to qualify, and those terms differ depending on the policy itself. However, there are a number of provisions that are typical to most long term disability policies. Today, we’re going to cover one of those provisions – meeting your insurer’s definition of disability.

You’ll Only Receive Long Term Disability if You Meet the Included Definition

If you look through your policy, you will see a definition for Disability or Total Disability. Frequently, these are broken into two parts – the first describing disability as an illness or injury that keeps you from doing your own occupation, and the second part saying that this same condition doesn’t allow you to work in any occupation. Generally speaking, the second part doesn’t really come into play until after 24 months. Someone suffering from the same ongoing disability that is preventing them from obtaining gainful employment should qualify for this second part, which is essentially just saying that you’re not able to work at all, regardless of the job.

Pay careful attention to the words used in this definition. Often your insurer will provide definitions for those, too, and you have to meet every part of the definition to qualify. Some common ones to watch out for include:

Own occupation. This refers to the job that you currently hold or held before your disability interfered. If you’re an accountant, you have to be able to show that your condition prevents you from doing that kind of work to meet the “own occupation” clause.

Any occupation. The word “any” tends to throw people off here, because it doesn’t literally mean that your disability keeps you from doing anything at all. Under most definitions, it means that you can’t do any job for which you have training and experience. A trained lawyer, for example, probably has experience that would allow them to work in a number of other fields, but a construction worker’s experience could limit them to physical labor.

Injury or illness. Many insurers refuse to pay disability if the injury you’re suffering from was self-inflicted or your illness involves drugs or alcohol. And these are only two of the most common conditions excluded. Look carefully at your policy to make sure your disability is covered.

Next time, we’ll talk about another provision you need to meet to quality for long term disability in ERISA plans – the elimination period.

If you’d like to learn more about long term disability in general, check out our free resources!

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Proving Neuropathy in a Long Term Disability Claim Under ERISA

Published on August 8, 2014 by

Almost 26 million children and adults in the US have Type 2 diabetes, according to the American Diabetes Association, and many of these people also suffer from peripheral neuropathy as a result of diabetes-related nerve damage. Neuropathy may become increasingly severe over time, causing pain, numbness, and weakness in the hands, feet, or other parts of the body, and eventually compromise an individual’s ability to work and complete normal daily activities.

If neuropathy makes it impossible for you to continue completing the normal functions of your job, you will likely need to apply for disability benefits and prove that this disability is legitimately preventing you from working. The following forms of documentation will help you prove your case and receive the benefits that you need to support yourself.

Medical records. The most obvious evidence you will need is your complete medical history, including a neurologist’s diagnosis of your peripheral neuropathy based on testing such as MRIs, a nerve biopsy, blood tests, nerve conduction tests, or a spinal tap.

Documentation of treatment. Presenting an initial diagnosis of your peripheral neuropathy is generally not enough in a long term disability case; you need to prove that you’ve continued the recommended course of treatment. If you cannot prove that you’ve received regular treatment from a neurologist or other medical provider, your claim may be denied.

Log of daily activities. In order to prove that you can no longer work in the capacity that you used to, you need to prove that your neuropathy hinders your completion of basic day-to-day activities. The most straightforward way to do this is tracking how long it takes you and what type of pain and other symptoms you experience while completing daily activities like showering, dressing, and performing household chores. If you write all this down in an activity log, you can use that log as evidence.

Written statement from neurologist.  To make your claim even stronger, you should have your neurologist write and sign a detailed statement explaining the symptoms you experience, how those symptoms are disabling you, and what he or she recommends for your course of treatment.

If you need more advice about how to file a long term disability claim, contact us and be sure check out our free eBook  for even more information!

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ERISA Disability Claims and the Family Medical Leave Act

Published on August 1, 2014 by

If you have unexpectedly found yourself unable to work due to a disability, you’re probably wondering what rights you have to receive disability benefits and whether you’ll still have a job if you are able to continue working in the future. The short answer is that in certain workplaces, you will receive benefits and have limited protection under the Family Medical Leave Act. Let’s look at that answer in a little more detail.

What is the FMLA? The Family Medical Act was signed into law in 1993 and protects eligible employees who need to take an unpaid leave due to a family or medical emergency. The FMLA states that eligible employees can take up to 12 weeks of unpaid leave in the course of a year and, after they’ve used up their 12 weeks of leave, still return to the same or an equivalent job with their employer. During this time, the employee will continue to receive the same group health benefits that their employer would have offered them if they had been working during this time. Unfortunately, if the employee is absent for longer than 12 weeks, the employer can legally terminate them.

Which employers must offer family medical leave? Not all employers are legally obligated to offer family medical leave. All public sector agencies, no matter what the size, must comply with the FMLA, but only private sector organizations with 50 or more employees who work at least 20 weeks out of the year are required to offer the same leave. That means that employees of small, private workplaces are not protected by the FMLA.

Who is eligible for family medical leave? Even if your employer is covered by the FMLA, there are some reasons why you might be ineligible to family medical leave. In order to be protected under the FMLA, employees must:

  • Have worked for their current employer for at least 12 months
  • Have worked at least 1,250 hours for that employer in the past 12 months
  • Work at a location where the employer has at least 50 employees within a 75 mile radius

In addition to the limited time frame and specific eligibility requirements, one problem that many employees encounter with the FMLA is the lack of support they receive from their employer during their leave of absence. Many employees who file for both family medical leave and short term disability benefits will receive the medical leave (because their employer is legally obligated to give it to them) but will be denied short term disability benefits.

If you believe that your employer is wrongfully denying you short term disability benefits, you may need to work with an ERISA attorney to file a disability claim. You can learn more about this by contacting our law firm directly and following our blog for the latest ERISA news and updates. Be sure to check out our free e-book for more information!

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