Disability insurance can protect against loss of income, if employees become disabled due to an injury or illness. Disability coverage can be either bought from private insurance companies or received through one’s employer. In case of claim denials for any of these insurance, disability insurance lawyers can help through the appeal and litigation process for which they require reliable medical record review services.
The coverage bought is mostly long-term or short-term disability insurance. While long-term disability insurance (LTDI) provides disability benefits by paying premiums that function like regular monthly paychecks, short-term disability insurance will probably only encounter as part of a subsidized employee benefits package that provides coverage just for a few months and never more than a year. At the same time, if an employee is disabled or their ability to earn an income is severely inhibited, they can file for social security disability (SSDI).
Information about the worker’s ability to perform a job as evident in the medical records can be a strong proof to support the disability claim. Also test results, examination records, medical history and the treating physician’s ongoing evaluation and diagnosis of the objective medical evidence are critical at every stage of the litigation process to prove the claimant’s disability.
Long-Term Disability Insurance
Long-term disability insurance can cover even serious injuries or illnesses that may leave the workers disabled and unable to return to work. Some employers provide LTDI coverage or employers can set their own long-term disability plan. This insurance policy provides coverage for a defined period of time until the employee reaches a certain age, just a couple of years or until retirement. The longer the benefit period, the higher the premiums will be.
Workers can also purchase “own-occupation” policy that pays benefits even if they are able to do other work. At the same time, “any occupation” policy refers to the inability to perform the duties of any job. Some LTD plans allow transition from “own occupation” to “any occupation” after a certain length of time, usually 24 months.
By purchasing a long-term disability insurance policy, there is also an option to add social benefits offset rider to the policy, which is an additional coverage that enhances or increases the benefits. With the social benefits offset rider, SSDI can complement the LTDI coverage. However, medical impairments related to substance abuse or pre-existing conditions are typically excluded from LTDI coverage. Individuals whose conditions are based on subjective complaints rather than objective testing (such as depression, fibromyalgia, or chronic fatigue syndrome) may be limited to 24 months of benefits
Common reasons for LTDI claim denials are insufficient medical evidence, missing medical records, failing to meet the policy’s definition of disability, missed deadlines and more.
Social Security Disability Insurance
SSDI is part of the larger socialized benefits system of the U.S. Approval process for this insurance coverage involves determining not only whether the worker is disabled, but also whether they may recover or adapt to other types of work. Benefits will be denied, if the claimant is so disabled that they can’t do the old job, but can do another. But Supplemental Security Income (SSI) provides financial support to low-income disabled individuals, regardless of their work history.
Under social security disability insurance, there is no benefit period. Eligible candidates continue receiving benefits until their disability improves or they are able to return to work. The SSA will review the case periodically, considering advances in medical technology that may leave their disability less severe. In cases where the disability lasts until retirement age, the SSA will automatically convert the SSDI benefits to traditional retirement benefits.
SSDI also provides health care benefits. After 24 months of receiving SSDI benefits, regardless of the worker’s age they are eligible to receive Medicare benefits. Medicare allows recipients to receive health care at a heavily subsidized and reduced cost or for no cost at all.
SSI claims can be denied, if the – claimant earns too much money to be considered disabled, disability won’t last long enough or isn’t severe enough, disability is based on drug addiction or alcoholism, claimant fails to follow prescribed therapy, the worker have been convicted of a crime or commits fraud.
LTDI vs SSDI
| Long-Term Disability Insurance | Social Security Disability Insurance |
|---|---|
| Workers apply for LTDI before they become disabled. | Workers apply for SSDI after they become disabled. |
| Generally pays out a larger benefit. | SSDI benefits are quite limited. |
| Get LTDI coverage, as long as they pay their premiums. | Get SSDI coverage, only if the worker is eligible that too at no cost. |
| Benefits are much easier to claim. | Benefits are difficult to claim. |
| Employees can purchase a policy that pays benefits even if they are able to do other work. | Workers can’t claim SSDI, if they can do the same or other job. |
| There is a defined benefit period with LTDI. | There is no benefit period under SSDI. |
| Claims are often handled promptly. | Appealing process takes a long time. |
To deal with both SSDI and LTDI cases, lawyers have to submit key pieces of evidence during the administrative review process, to prove the claimant’s eligibility to receive benefits. Disability benefits are mainly determined on the basis of accurate medical record analysis and proper medical records organization is important for disability lawyers.
