In New York State, all employers are required to provide short term disability insurance for their employees. This insurance pays benefits for up to 6 months of disability.
Many individuals also have insurance that pays benefits for disabilitities of more extended duration ("long term disability"). Some workers purchase these plans on their own. Others are covered by long term disability plans maintained by their employers. Employers are not mandated to provide this type of insurance, so not all workers have it.
Long term disability plans must conform to the requirements of the federal Employees Retirement Income Security Act, which includes provisions allowing individuals whose disability claims are initially denied to appeal those determinations. Our office regularly handles such appeals. However, we prefer to get involved in a case sooner than that, and we encourage prople facing extended disability to consult with us before filing claims for either short or long term disability.
The initial application and supporting medical reports should be carefully prepared. The information submitted on the short term claim should be consistent with what will later be submitted on the long term claim. Disability insurance carriers are notoriously difficult to deal with. Appeals of adverse determinations are expensive and time consuming. Careful preparation from the outset increases the likelihood of a favorable initial determination that obviates the need for an appeal.
The rules for determining whether an individual is eligible for long term disability insurance vary from plan to plan. Some plans use a standard similar to that employed by Social Security. They require proof that a claimant is unable to perform essentially any kind of work before benefits will be awarded. Other plans only require proof that a claimant is not able to perform the duties of his or her former job. However, many of these less stringent plans pay benefits for only a defined period of time. After that, there must be proof of total disability for benefits to continue.
There are a number of other provisions that complicate long term disability claims. Many but not all plans pay a prorated benefit for partial disabilities, i.e., disabilities that do not preclude work but result in a reduction of earnings. Most allow the insurance carrier to reduce or offset the amount of the monthly indemnity when other income sources, such as Social Security disability benefits, are available. People who qualify for long term disability are often suprised to learn that the offset often takes into account the SSD benefit paid to them and to family members who receive benefits on their earnings record.
Individuals who contemplate filing claims under long-term disability insurance plans should be familiar with these and other provisions so they can plan realistically for life after the onset of disability and avoid procedural pitfalls that can delay and sometimes preclude the award of benefits. Call us. If you don't need our help, we will tell you. If you do, it's better to find out sooner rather than later.