For successful professionals, managing the unexpected often includes relying on a safety net—like your long-term disability (LTD) insurance. But what happens when the safety net unravels, leaving you to navigate a labyrinth of exclusions, denials, and delays at the worst possible time? Long-term disability insurance is supposed to provide peace of mind, but many people do not realize how complicated these policies can be until they are faced with a disabling condition. Insurance companies often craft policies that are difficult to understand and even harder to use when you need them most.
Even the process of filing a claim can be more challenging than expected. Insurance companies do not always make it easy. They may request endless paperwork, require frequent updates from your doctors, or use their own experts to dispute your condition.
If you miss a deadline or fail to provide the exact documentation they want, your claim could be delayed or denied entirely. This is why knowing your policy’s requirements and limitations is essential—so you can be prepared and proactive.
At Kantor & Kantor, we specialize in cutting through the complexity of LTD claims, ensuring that insurance companies honor their commitments to policyholders. With decades of experience representing individuals who have faced unjust denials, we are dedicated to restoring peace of mind when it matters most.
Why Understanding Your LTD Policy is Essential
- A policy that seems straightforward can include loopholes and requirements that derail claims for even the most deserving claimants. Key areas where people encounter roadblocks include: Definitions of Disability: Not all disabilities are treated equally in the eyes of your insurance company. Even worse, the definition of disability contained in a policy often changes after a period of time. Specifically, most policies initially define disability as the inability to perform the duties of your current job (own occupation), and then after two years, defines it as the inability unable to perform any job (any occupation). This distinction can make or break a claim.
- Exclusions and Limitations: Policies often include exclusions or limitations for conditions that existed before obtaining coverage. If you file a claim within a specified time frame after your coverage begins, the policy may exclude benefits for disabilities linked to pre-existing conditions from that earlier period.
- Deadlines and Elimination Periods: Understanding the deadlines in your policy is crucial to avoiding unnecessary delays or denials. These deadlines may include the time frame for submitting a claim, providing required documentation, or filing an appeal. Staying aware of these critical dates ensures you take timely action when necessary.
- Documentation Requirements: Insurance companies often require extensive medical documentation to prove your disability. Being aware of these requirements upfront can help you work with your healthcare providers to gather the evidence you will need.
- Appeal Rights: If your claim is denied, your policy will outline the process for filing an appeal. Missing these deadlines or failing to meet the policy requirements can make it much harder to secure the benefits you deserve.
By proactively understanding these elements, you can protect your financial future and minimize stress during critical moments.
How to Review Your LTD Policy
For professionals, the stakes are higher. The financial strain caused by denied LTD benefits can interrupt your lifestyle, jeopardize investments, and shift the focus from healing to fighting bureaucracy. Taking the time to review your policy now can save you a lot of stress and confusion down the road, especially if you ever need to file a claim. Here is a step-by-step guide to help you make sense of your LTD policy.
Start With the Summary Plan Description (SPD) as a Guide
The Summary Plan Description (SPD) can serve as a helpful guide to understanding your LTD benefits and how the plan works. However, it’s essential to verify any critical information by reviewing the full policy, as the policy governs in cases where there are discrepancies. Relying solely on the SPD can lead to misunderstandings if it contains errors or conflicts with the policy.
Consider Additional Features and Riders
If you obtained your policy through a broker, or are considering purchasing through one, look for extra features or riders that could enhance your coverage. These may include cost-of-living adjustments (COLAs), which increase your benefits over time to keep up with inflation, or waiver-of-premium provisions, which forgive your premiums if you become disabled. However, most employer-sponsored policies do not offer these options, and any enhancements typically come through an optional buy-up, which is relatively rare.
Understand the Definitions
Pay close attention to how the policy defines “disability.” LTD policies vary, and the specifics of what qualifies as a disability can significantly affect your coverage. Look for definitions of “own occupation” and “any occupation,” as these terms will influence what conditions qualify for benefits.
Also, review any specific exclusions or limitations which could reduce or eliminate your coverage, such as pre-existing condition exclusions, mental health limitations, and/or “objective evidence” limitations.
Determine the Benefit Amount
Review how much of your salary will be replaced by your LTD policy. Most policies cover a percentage of your regular income but may exclude bonuses, commissions, or other variable pay. Additionally, many policies impose a monthly maximum benefit cap, which can significantly impact high earners. Since many group policies are not designed with higher salaries in mind, this cap may result in benefits falling short of the expected replacement amount.
Review the Elimination Period
Understand the elimination period, which is the waiting period between when an injury or illness begins and when benefits start to be paid. This period typically ranges from 30 to 180 days. Knowing this information will help you manage your finances while you wait for your benefits to begin.
Check the Benefit Period
Review your policy to understand how long your benefits will last. Most policies pay benefits until you reach retirement age, such as age 65 or your Social Security retirement age. Some rare policies may provide benefits for a set number of years, while others offer lifetime benefits that continue until death.
Know Your Rights to Appeal
Familiarize yourself with the appeals process if your claim is denied. Your policy should outline how to challenge a denial, including timelines and the information required to support your appeal.
Ask Questions
If any part of your policy remains unclear, do not hesitate to reach out to your HR department (if it is an employer-sponsored plan) or your insurance provider. We recommend reaching out in writing. You can also consult our LTD attorneys who can provide legal insights and clarify complex terms.
How Kantor & Kantor Can Support You
Whether you are just starting to explore your LTD policy, need help filing a claim, or have already been denied benefits, we have the knowledge and experience to guide you through the process. Here is how we can help:
- Filing Claims: Preparing a disability claim requires more than just filling out paperwork. Insurance companies often require detailed medical evidence, documentation of your work limitations, and proof that your condition meets the policy’s definition of “disability.” We will help you build a strong case to increase your chances of approval.
- Appealing Denials: If your claim has been denied, do not lose hope. Insurance companies often deny valid claims, hoping policyholders will give up. We know their tactics and will fight to appeal the decision, presenting the evidence needed to turn things around.
- Deciphering Policies: Long-term disability policies are filled with legal and technical jargon, making them difficult to interpret. We will review your policy with you, breaking it down into plain language so you understand what is covered, what is excluded, and what steps you need to take.
- Litigating When Necessary: If your insurance company refuses to honor your policy, we are prepared to take legal action. Our team has a proven track record of holding insurers accountable and securing the benefits our clients deserve.
The Necessity of Clarity and Control
You have built a life where precision matters—from your career achievements to your investment portfolio. Your long-term disability coverage should align with the same standard of excellence. At Kantor & Kantor, we deliver not just legal representation but a tailored strategy that acknowledges your unique position and expectations.
If your claim has been denied or you are unsure about the terms of your policy terms, we invite you to explore how we can assist. The road to recovery—both financial and physical—should never be a solitary one.
Insurance companies are experts in minimizing payouts, and the claims process is rarely straightforward. With an experienced attorney by your side, you can push back against denials, ensure deadlines are met, and build a strong case for your benefits. At Kantor & Kantor, we are people helping people and we are ready to fight to get you the compensation you need.
Contact our experienced Long-Term Disability Attorneys today at 818-886-2525 for a complimentary consultation.
