What happens when an injury keeps you from working? For some people, the answer is financial devastation. For people with long term disability (LTD) insurance, the answer is supposed to be not worrying about missing income.
Each policy has specific terms that outline the requirements for eligibility for long term disability insurance in Clearwater. Some policies cover if you are unable to do your job. Others only cover total disability, meaning you cannot work in any job. Most cover you if you are unable to do your job for a certain number of months, then pay only if you are unable to do any job. Some plans include partial disability, meaning you can still work but not at full capacity.
Qualifying for an LTD insurance benefits payout in Clearwater requires that you have a medical condition severe enough to prevent you from working and that you expect the condition to last for an extended period. This time period is normally 3 to 6 months. You must meet the criteria for both duration and severity.
Proving your medical condition requires extensive documentation. It is not enough to allege an injury. You need to provide plenty of evidence to insurance companies, including:
A lack of detailed medical evidence can lead to delays or denials.
Pre-existing conditions can affect LTD insurance eligibility depending on the terms of your policy. Some insurers will not cover conditions that existed before the policy started. Others will impose a waiting period before benefits become available for certain pre-existing conditions. Some will require the condition to have worsened since the policy began.
Deadlines are critical in disability claims. In Clearwater, failing to file a claim or appeal on time can result in losing your eligibility for LTD benefits.
ERISA, 29 United States Code § 1001 et seq., governs most LTD policies provided by employers. This federal law sets strict rules for how claims and appeals are handled. If your claim is denied, you must follow ERISA’s procedures to appeal.
If the insurer denies your claim, you still have options. You can submit an appeal with additional medical evidence and legal arguments. However, filing an appeal is not as easy as sending in a letter asking for an appeal with some medical records. It is a very complex process that requires specific medical and vocational information. A doctor writing that you are “disabled” or “can’t work” will not win your appeal.
The LTD application process is frustrating. You are making a claim based on the fact that a disability prevents you from doing regular work, but qualifying for the claim often requires taking actions you may not be able to take.
If you are struggling with a disability claim, we are here to help. Contact Herman & Wells today for a free consultation and to learn more about eligibility for long term disability insurance in Clearwater.
