The Centers for Disease Control and Prevention (CDC) estimates that 26% of U.S. adults are currently living with some form of persistent disability. If a serious injury, disease, or other medical impairment prevents you from working on a full-time basis, you may be entitled to receive long-term disability benefits through a type of “private” insurance Plan. Most of these Plans are actually “Work Welfare Benefit Plans marketed by an insurance company to Employers, and so these benefits would be an Employee-benefit that comes with employment with companies that signed up for the Plans. These employer-backed policies are regulated by a federal law called the Employee Retirement Income Security Act (ERISA).
So, if possible, before you raise the issue with your employer of your medical condition(s) and your possible need for disability leave, you should first double-check with your employer’s resources department to make sure your company actually has Short Term and/or Long-Term Disability Plans, and that you have worked for the company for a sufficient length of time to be vested for coverage under those Plan(s).
Are you preparing to file a disability claim through an ERISA or non-ERISA private policy? It is imperative that you know what it takes to build a strong and compelling application. Even a seemingly minor error in the documents that make up the application could result in a disability denial. Within this article, our Phoenix long-term disability lawyer provides an overview of the steps to take to bring a successful application, and to protect what continuing rights you may have with or through your Employer.
Step #1: Get a Detailed Diagnosis from a Supportive Doctor, and the Proper Follow-Up Care
Every person who has a significant disability needs proper medical attention. The right medical care is crucial to protect your health, your well-being, and your ability to bring a successful Short Term Disability and/or Long Term Disability claim. Indeed, a key first-step to a successful disability application is to obtain a detailed diagnosis, if possible and time-permitting,, from a medical professional. The diagnosis should be based on a comprehensive assessment of your medical condition and should include all relevant tests, evaluations, and documentation. Beyond that, it is vital that you follow your doctor’s recommendations for treatment and care. Consistent follow-up care and medical records will be essential for providing evidence of the severity and ongoing nature of your condition. Keep in mind that insurance companies will carefully review your medical records. So before you give notice to your employer about needing to apply for Short-Term and/or Long Term Disability, you should check with your doctor or medical provider to make sure that they agree you would need to go out on medical leave, because that doctor will need to fill out a supportive statement or form for the application, typically within 30 days of the filing of the application.
Step #2: Obtain and Review Your Long-Term Disability Plan Details
Medical needs always come first. Another key initial step is to ensure that you have all of the details about your specific long-term disability plan. To maximize your chances of submitting a successful disability application, it is imperative that you have a full grasp of the specific details of your long-term disability plan. Review your Plan documents and familiarize yourself with the terms, conditions, and eligibility requirements. Pay close attention to the definition of “disability,” as it may vary between plans. Understanding the coverage, waiting periods, and possible exclusions. If you have any questions about the terms of your policy, a top Phoenix disability lawyer can help.
Step #3: Notify Your Employer of Your Disability
When you have a sudden or urgent medical condition or emergency, you might have to quickly approach your Employer about going out on medical leave, and that is understandable. But if, like many employees, you have had a more gradual onset of your medical condition(s) and you have some time for planning, you should try to have your supporting doctor and supporting medical documents in place BEFORE notifying your employer about the need to go out on medical leave and your intent to file Short Term and/or Long Term Disability claims.
And once you have prepared it is a good idea to inform your employer in writing about your disability and your intent to file a claim; indeed, that Notice should be done through your employer’s Human Resource or other Benefits-contact person, so that your Employer can make the necessary accommodations and arrangements for your position, and can make sure that any available FMLA (Family Medical Leave Act) protection available for you are in place. FMLA protection can require an Employer to hold your job open for a number of weeks, which may give you an opportunity to recover from your medical conditions if possible, and perhaps return to a job that has been held open for you. Keep a copy of your written notification for your own records.
Also it is VERY important that you do NOT simply quit or resign your position instead of properly arranging your medical leave through the proper channel or contact with your employer, and/or before getting your Short Term or Long Term Disability application(s) filed. This is because simply quitting or resigning the position before properly arranging Medical Leave and Disability applications may well have the effect of completely severing or compromising FMLA and ERISA rights and protections, such as the ability to use the STD and/or LTD coverage, or to continue to be covered by Health Insurance that you will need to keep paying for medical treatment.
Another reason it is important to consider the timing of your notice to your Employer of your intent to apply for Short Term and/or Long Term Disability, and to have your evidence and doctor support ready as much as possible before you give notice, is that some employers may not be as supportive as you might like. A non-supportive or hostile employer may seek to terminate you from your position “for cause” if they believe that you are heading toward needing medical leave and/or disability claims. Employers are not supposed to behave this way, and most do not, but it has been known to happen. So it may be important for you to keep in mind the type of relationship you have with your employer in conjunction with timing your Leave Requests and your Disability Applications.
Step #4: Continuously Document Your Medical Condition and the Impact on Your Life
Successful disability applications depend on the strength and accuracy of the evidence provided. The big insurance companies have some legal obligation to use good faith settlement practices for long-term disability claims. That being said, these corporations are still primarily focused on protecting and promoting their own bottom-line, and many governing ERISA regulations actually favor the STD and LTD Insurance Company rather than the claimant. Do not give them any reason to delay or deny your claim.
It is crucial that you continuously document your condition(s) and their impact on your life. Among other things, you may want to consider keeping a diary of your symptoms, noting your limitations, and documenting the adverse impact on your daily activities. Beyond that, collect any additional medical records, test results, or treatment summaries. The more information that you have, the better position you will be in to bring a successful claim.
Step #5: Follow the Insurance Company’s Instructions, Submit a Well-Supported Claim
How exactly do you prepare and submit an application for long-term disability benefits in Arizona? The answer depends, in part, on the specific system set up by your insurance company. While ERISA standardizes many aspects of the disability claims process for employer-sponsored plans, there are still differences in the mechanics of the application from insurance company to insurance company.
When preparing your disability claim, carefully follow the insurance company’s instructions to ensure your application is complete and accurate. You may need to fill out specific forms, provide certain medical records, and submit some additional documentation.
Also be sure to get copies of your medical records and thoroughly review them if possible before giving FMLA and Disability notices to your Employer, because medical records quite often contain at least a few errors or inaccuracies that may make it seem that your conditions or limitations are less severe than they really are. This is part of organizing your supporting evidence in a clear, logical manner. A well-supported claim demonstrates your attention to detail and increases the likelihood of a successful application.
Step #6: Be Ready to Seek Professional Legal Representation
You do not have to figure out the intricacies of the long-term disability claims process alone. The right legal advocate can make the difference. Be ready to seek professional guidance and support from a top-rated Phoenix, AZ, long-term disability lawyer. Your attorney can protect your rights and help you effectively navigate the system. Among other things, our experienced Phoenix long-term disability attorney will be able to:
- Hear your story and answer your questions;
- Help you review all relevant supporting documents/records for accuracy and to check for other pitfalls or problems that may be present in your treatment records;
- Review STD and LTD Plan language and provisions, including disability definitions, pre-existing condition exclusions, and other conditions and exclusions that come into play during the claim and benefit processes.
- Assist with the completion and filing of the disability application;
- Provide you and your doctors with supplemental restrictions-and-limitations forms that are often more helpful to the claims process and provide stronger supporting evidence then the forms that most of the LTD Insurance Companies use;
- Help you obtain important extensions of time from the insurance company at key points in the proof-of-claim process;
- Represent you in any settlement negotiations with the insurer; and
- Have a quicker and better familiarity with your claim and your evidence in the event you need to appeal a long-term disability appeals process.
Contact Our Phoenix, AZ Long-Term Disability Attorney Today
At The Law Office of Paul J. Dombeck, PLLC, our Phoenix long-term disability lawyer has the professional skills and legal expertise that you can trust. If you need help with a long-term disability application, we are here as a resource. Get in touch with us by phone or connect with us online to arrange your free, no strings attached case review. From our office in Phoenix, we provide long-term disability representation in Maricopa County and throughout the surrounding region in Arizona.