If you are already receiving long-term disability (LTD) benefits or you are in the process of making a claim, one of your biggest concerns may be what happens when your benefits period runs out.
If your insurance company terminates your LTD benefits while you are still considered disabled under your policy, you may have a lawsuit against the company. In most cases, LTD benefits run out because the policy’s definition of disability has changed, even though the recipient’s health has not improved.
It’s important to understand that your policy’s definition of disability can change at pre-set time periods. For example, many policies define disability as an inability to perform the essential duties of your own occupation for the first 24 months. After this point, your policy may require that you be disabled from any occupation you are qualified to perform, even if it’s in a completely different industry with dramatically reduced pay.
Most LTD benefit policies contain this change in the definition of disabled which means your benefits can run out after two years, even if you have not improved, simply because you could potentially seek a job in an unfamiliar field for pay that is far less than you made in your previous occupation. This is the most common reason for long-term disability benefits to run out.
If this happens, you do have options available to you.
You have the right to apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) while you are receiving LTD benefits or after your long-term disability benefits run out. Just keep in mind your LTD benefits can be reduced if you receive SSDI or SSI while your benefits are in effect.
SSDI pays benefits to people who have worked long enough and paid into the program through Social Security taxes if they meet medical criteria. SSI, on the other hand, pays benefits based on financial need.
To decide if you are disabled and eligible for benefits, the Social Security Administration uses a 5-step process that begins with learning about your past work to determine if you can still do your job. You are not considered disabled under the program unless you have a condition, illness, or injury that prevents you from doing your prior work or adjusting to other work. Whether or not you are considered able to adjust to other work depends on your age, education, and work experience.
Whether or not you meet the definition of disabled according to the insurance company is at the center of many LTD disputes. If you believe you have a claim against an long-term disability insurer or you need assistance appealing a denied LTD claim, an LTD attorney can help. Contact Edelstein, Martin & Nelson – Philadelphia for a free consultation with a Philadelphia disability insurance lawyer to discuss your case.