FAQs

Short-term disability covers you for up to six months of lost wages, while long-term disability begins after your short-term benefits end and can continue until retirement age. Short-term plans are typically used for temporary recovery periods, such as after surgery or childbirth, while long-term disability supports those facing serious or permanent impairments that prevent them from working for an extended period.

Most long-term disability policies pay 50–70% of your pre-disability income, up to the policy’s maximum monthly benefit. The exact percentage depends on your specific plan and whether it’s employer-sponsored or privately purchased. Some policies offer tax-free benefits if premiums were paid with after-tax dollars, while others may be taxable if the employer covered the premiums.

You can perform limited work while on disability benefits, but your policy may reduce payments based on your earnings or require an updated RFC from your doctor. Be sure to report any income accurately, as failure to do so could result in overpayment demands or termination of benefits.

An ERISA disability claim is a benefit request under an employer-sponsored plan governed by federal ERISA rules, which dictate stricter filing and appeal timelines. These claims typically require extensive medical evidence and strict adherence to procedural rules, making legal guidance especially valuable.

To appeal a denied claim, you must submit a written appeal within 60 days, include any new medical evidence, and follow your insurer’s internal review procedures. Missing the appeal deadline or failing to provide complete documentation can seriously jeopardize your chances of reversing the denial.

Disability insurance covers a wide range of conditions from orthopedic injuries and arthritis to mental health disorders so long as they meet your policy’s definition of ‘disability.’ However, some policies may exclude certain pre-existing conditions or impose waiting periods before coverage begins.

Initial benefit decisions typically take 30–90 days; if you appeal, each level can add another 30–90 days before payments begin. Delays can also occur if additional medical records or evaluations are requested during the review process.

Claims are often denied due to insufficient medical documentation, missed deadlines, or subjective policy definitions of ‘disability.’ Consulting with your doctor to ensure detailed, consistent medical records can significantly strengthen your claim and lessen the chance of denial.

Our attorneys work on contingency, which means no upfront fees, and collect a pre-approved percentage of past-due benefits only if we win your case. This percentage is typically capped by federal law, ensuring your payout remains protected.

A Residual Functional Capacity (RFC) form is a physician’s assessment of your remaining work abilities, detailing limitations in lifting, sitting, standing, and other functions to support your disability claim.

A disability qualifies under ERISA if it falls within your employer-sponsored plan’s specific definition of ‘disability,’ which typically requires being unable to perform your own occupation for an initial period and any occupation thereafter.

Disability benefits paid under a group plan funded by your employer are usually taxable if your employer paid the premiums. Benefits under an individually purchased policy are typically tax-free.

A waiver of premium provision allows you to stop paying policy premiums once your disability benefits begin, keeping your coverage active without further cost until you recover or reach retirement age.

Group policies are provided by employers and governed by ERISA rules with standard definitions and caps, while individual policies are customized contracts you purchase directly, often featuring higher benefit limits and more flexible terms.

The difference between total and partial disability is this: total disability means you cannot perform any of your job duties, triggering full benefits, whereas partial disability applies if you can work in a reduced capacity and receive a percentage of your benefits based on income loss.

Medicare does not offset private disability benefits, but if you receive Social Security Disability Insurance (SSDI) and qualify for Medicare, your SSDI award timeline and Medicare eligibility may affect your overall benefit planning.

If your insurer requests an updated evaluation, you must comply under your policy terms; we prepare you for independent medical exams (IMEs) and gather counter-evaluations if the insurer’s report contains inaccuracies or bias.

Yes, many policies include a return-to-work incentive or residual disability benefit, allowing you to earn limited income while still receiving a portion of your full disability benefit. These provisions are designed to support a gradual transition back to work without immediately losing all financial support.

Cost-of-living adjustments (COLA) increase your monthly benefit based on inflation measures. If your policy includes COLA, your benefit will rise periodically to maintain its purchasing power. This feature is especially valuable for long-term claims, helping to offset the impact of rising expenses over time.

Need Help? Give Edelstein Martin & Nelson a Call Today

If you’re navigating a disability insurance claim or facing challenges with a denial, you don’t have to handle it alone. The experienced Philadelphia long-term disability insurance attorneys at Edelstein Martin & Nelson are here to help you protect your rights and maximize your benefits. Call us today at (215) 731-9900 for a free consultation and let us fight for the financial security you deserve.