How to File a Long-Term Disability Insurance Claim in Philadelphia

How to File a Long-Term Disability Insurance Claim in Philadelphia

At Edelstein Martin & Nelson, we understand how overwhelming it can be to face a disabling condition while battling insurance delays or denials. Let us take on the legal burden so you can move forward with confidence and peace of mind.

Filing a long-term disability insurance claim can feel overwhelming, especially when you’re already dealing with the physical and emotional burden of a serious illness or injury.

Whether you’re recovering from back surgery after years of heavy lifting in South Philly, managing a chronic condition while commuting to your office in Center City, or facing cognitive limitations following a stroke, long-term disability insurance is designed to support you financially when you’re no longer able to work. But before benefits begin, there’s a detailed and often frustrating process to follow.

If you’re preparing to file a long-term disability claim in Philadelphia, understanding the key steps, deadlines, and documentation required can make a major difference in the outcome of your claim. This guide explains everything you need to know about the Philadelphia LTD claim process and how a skilled Philadelphia long-term disability insurance lawyer can help protect your rights.

Understanding Long-Term Disability Insurance: Insights from an Experienced Long-Term Disability Insurance Attorney in Philadelphia

LTD insurance provides income replacement, usually between 50% and 70% of your salary, if you become too ill or injured to continue working. Some people have LTD coverage through an employer-sponsored benefits package (governed by a federal law called ERISA), while others purchase private LTD policies on their own.

Regardless of how you’re covered, all LTD claims require you to prove that your condition meets your policy’s definition of disability. This often involves navigating complicated paperwork, interpreting vague policy language, and pushing back against insurers who are financially motivated to deny or delay claims.

Step 1: Review Your LTD Policy

Before you do anything else, locate a copy of your LTD insurance policy or plan document. Carefully review it for critical information such as:

• The definition of “disability” used in your plan (own occupation vs. any occupation)
• The elimination period, or waiting time between your last day of work and the date benefits start (typically 90 to 180 days)
• Documentation requirements for proving your condition
• Deadlines for filing a claim and appealing a denial

If your policy was provided by your employer, such as Comcast, Temple Health, or the City of Philadelphia, ask your HR department for a copy. If you purchased it privately, your insurer should provide it upon request.

Step 2: Notify Your Employer and Insurer

As soon as you realize your condition may prevent you from working long term, notify both your employer and the insurance company. Early notice ensures that you don’t miss any filing deadlines and gives you time to gather the required documents.

You may also need to file for short-term disability benefits first, if your policy requires you to exhaust those before starting LTD coverage. Keep in mind that your short-term and long-term disability benefits might be managed by different departments or insurers.

In many cases, your employer will provide claim forms to begin the Philadelphia LTD claim process. If not, request them directly from the insurance carrier.

Step 3: Complete the Initial Application

Your LTD claim application typically consists of three main components:

• Claimant Statement: You’ll be asked to describe your medical condition, symptoms, and how it affects your ability to work. Be honest and specific. If you experience daily fatigue that prevents you from completing your tasks at your job in Old City or struggle to stand for long periods while working near Broad Street, say so.
• Attending Physician Statement: Your doctor must complete a form verifying your diagnosis, prognosis, and physical or cognitive limitations. Ensure your physician understands the importance of clearly connecting your condition to your work restrictions.
• Employer Statement: If your coverage is through work, your employer will complete a section confirming your job title, duties, hours, salary, and the date you stopped working.

Make sure every section is complete and consistent. Discrepancies, such as different descriptions of your job duties between your statement and your employer’s, can raise red flags with the insurer.

Step 4: Gather Supporting Medical Evidence

In addition to the initial forms, you’ll need to submit medical records that back up your claim. The more detailed and comprehensive, the better. Include:

• Diagnostic test results (e.g., MRIs, CT scans, blood work)
• Treatment notes from your primary care provider and specialists
• Mental health evaluations (if your disability involves depression, anxiety, or PTSD)
• Physical therapy or rehab progress reports
• Functional Capacity Evaluations, if available

Your medical evidence must clearly demonstrate that your condition prevents you from performing the key duties of your job. If your policy defines disability as the inability to work in “any occupation,” you’ll also need to show that your limitations extend beyond your current role.

Step 5: Submit Your Claim and Await a Decision

Once your application is complete, submit it to the insurer according to their instructions, typically by mail, fax, or through an online portal. Be sure to:

• Keep a copy of everything you submit
• Document when and how it was sent
• Request written confirmation that your claim has been received

From there, the insurer will begin its review. This may involve:

• Requesting additional records or clarification from your doctors
• Sending you to an Independent Medical Exam with a physician of their choosing
• Conducting video surveillance or monitoring social media
• Contacting you for follow-up questions

In some cases, your insurer may hire a vocational expert to determine whether you could work in a different role, especially if your policy changes from “own occupation” to “any occupation” after two years.

The insurer has up to 45 days to decide your claim, with a possible 30-day extension if it’s determined that more information is needed.

Step 6: Dealing with a Delay or Denial

Unfortunately, delays and denials are all too common. If your claim is denied, the insurance company must provide a written explanation outlining the reasons and giving you the right to appeal.

Common reasons for LTD denials include:

• Lack of objective medical evidence
• Conflicting reports between you and your physician
• Disputes over the definition of disability
• Surveillance footage or social media posts used out of context

If this happens, don’t panic, but do act quickly. For ERISA-governed policies, you only have 180 days to file an administrative appeal, and that appeal is your one opportunity to add additional evidence to the record.

Step 7: Appeal the Decision (If Needed)

To build a strong appeal, you may need to:

• Collect updated medical records or additional test results
• Get more detailed statements from your physicians
• Submit a personal statement describing your day-to-day limitations
• Hire a vocational expert to explain why you can’t work in any reasonable occupation

This is the stage when many people choose to hire a Philadelphia long-term disability insurance lawyer, especially because ERISA appeals involve strict rules and complex legal arguments. If your appeal is denied, your attorney can file a lawsuit in federal court to challenge the decision.

How a Local Philadelphia Long-Term Disability Insurance Lawyer Can Help Victims

Filing an LTD claim involves more than paperwork; it’s a legal process, and the insurance company has a team of professionals trained to protect its bottom line. A Philadelphia long-term disability insurance lawyer can:

• Interpret complex policy language to identify your strongest arguments
• Work with your doctors to gather persuasive evidence
• Handle all communication with the insurer so you can focus on your health
• Represent you through appeals, litigation, or settlement negotiations

A local LTD lawyer is also familiar with the physicians, rehabilitation centers, and specialists throughout the Philadelphia area, which can be invaluable when gathering supportive medical evidence tailored to your claim.

Philadelphia residents benefit from working with a local attorney who understands the unique challenges of the area. Whether you’re a construction worker injured on a site near Northern Liberties, a teacher in the Philly School District, or a tech professional working in University City, a local attorney can tailor your claim to reflect your specific occupation, employer, and medical care providers.