In the employment sector, employee benefits entail a wide range of insurance and compensation policies. Among the benefits that a full-time employee can expect to be provided for by the organization is disability insurance. These are usually categorized as long-term or short-term disability benefits. Unlike work-place injury claims, long-term disability benefits cover a significant part of your income, usually 50% or more in the event you become vitally ill or injured. These illnesses or injuries cannot have occurred in the work-place.
In the USA, the long-term disability benefits provided by your employer are due to the Employee Retirement Income Security Act (ERISA). The law proposes that any applications made should be reviewed by a claim administrator, which in most cases is from the insurance company providing the cover. As you may have already guessed, there is a likelihood that the administrator may be biased to protect the interests of the insurance company.
In such a case, it is not surprising that they may illegitimately reject the applications of deserving employees. However, with a good attorney, you can always fight this decision in court.
How to Apply for Long-Term Disability Benefits
- Filing the application with your employer
Not everyone possesses the right long term disability qualifications. As such, you have the task of providing evidence that the extent of your illnesses is severe. Therefore, make it a point to liaise with your human resource department so that they can provide you with the necessary forms and guide you on how to make the application.
However, the employer may not always guide you on the best way to press your claim. This is why you need to consult an attorney that specializes in this field. Their legal advice is particularly important when completing the section that requires your statement. Most of the failed applications were because the applicants contradicted themselves while filling this section.
- Obtain the employer’s statement
Part of the application requires the employer to provide some basic employee information. This is mainly from your human resource records as it covers issues such as date of employment, a return to work date if any, your salary level, other insurance benefits you are entitled to and an evaluation of your mental and physical state.
- Obtain a report from your doctor
This is also an important section on the form. The doctor will be required to provide a statement detailing their diagnoses, symptoms, dates treatment were administered, the type of treatment offered and whether the said sickness may have been caused by work-related factors. The doctor is also expected to provide an assessment of whether the illness may have caused any form of mental or physical impairment on you.
- Submission of any material that supports your disability claim
Since you do not want to give the claim administrator a reason to reject your claim, it is important that you back with any relevant evidence you can find. This may include any records provided by the hospital, including test results for medical assessments made. You can also consult your attorney on any other submission you think may help strengthen your claim.
Reasons Why a Long-Term Disability Claim May Be Rejected
As earlier suggested, the rate of rejection for long-term disability claims is quite high. Having a clue of some of the reasons why they get reject may serve as a viable guide for when you make your application. These reasons include:
- Lack of enough medical evidence
- Failure to meet the criteria set by the insurance for long-term disability
- Failure to submit the claim within the required deadline
- Contradicting statements in the application form
The most important thing you need to understand is that you can always fight this decision in court. However, to be on the safe side, consult a credible lawyer to help you with the application process. This way, they will guide you on issues that may lead to rejection of your claim and advise you on the step forward after the rejection.