Long Term Disability

Long Term Disability

When an illness or injury requires ongoing medical care and an extended absence from work, you may be covered under private or employer-sponsored Long-Term Disability (LTD) Insurance. Obtaining these benefits can be difficult given the complex rules governing LTD insurance and the exhaustive benefit claims process. Our legal team is here to help you secure the long-term disability benefits you deserve.

Birmingham, Alabama Long-Term Disability Attorney

man in a wheelchair with long-term disability in Alabama

Let’s face it — anyone can become disabled due to an injury or illness at any time. While some individuals may have long-term disability (LTD) insurance, actually obtaining benefits can be daunting. Not only are the terms of LTD insurance policies complicated and confusing, but insurance companies routinely deny benefits claims. If your LTD benefits have been denied, it takes a skilled disability benefits attorney to protect your interests.

Cox & Stansberry is dedicated to protecting the rights of the disabled. From our offices in Birmingham, Alabama, we represent individuals from a wide range of industries and professions throughout the nation. We know that a long-term disability is a physical, emotional and financial burden. The need for ongoing medical attention, coupled with the financial losses from being out of work, can be an enormous strain for any family.

Our dedicated firm can help ease that burden by providing you with first-rate legal representation and superior personal service. We understand that you may need assistance coping with the challenges of your new lifestyle. We will leverage our knowledge and experience to make sure you receive the LTD benefits you deserve.

How Does Long-Term Disability Insurance Work Under ERISA?

Long-Term Disability Insurance is usually obtained through an employer-sponsored group plan that is often governed by the Employee Retirement Income Security Act of 1974 (ERISA). However, some employees, self-employed individuals and professionals may have individual policies. Such individual policies and many government employee plans are not governed by ERISA. Whether ERISA governs your particular policy makes a difference in how the policy is administered and how claims are processed and it is important to have an attorney experienced in this area to help navigate the process.

LTD insurance is intended to replace a portion of your income for an extended period of time — oftentimes this coverage is provided by your employer at little or no cost to you. The definition of disability varies from policy to policy but typically, to be eligible for benefits, you must be unable to perform the material duties of your own occupation. Generally, this definition changes after a couple of years to the inability to perform any work due to a disability. The more stringent definition is harder to meet but with proper guidance and support from an experienced attorney, benefits can often continue even after a change in the definition of disability.

Types of Long-Term Disabilities

A long-term disability can be the result of numerous injuries or medical conditions that make it impossible to maintain a normal work schedule. Examples of disabilities covered under many LTD policies include:

  • Autoimmune diseases (e.g. multiple sclerosis, lupus, rheumatoid arthritis)
  • Brain injuries
  • Cancer
  • Cardiovascular disease
  • Mental disorders
  • Musculoskeletal and connective tissue disorders
  • Physical injuries
  • Respiratory illnesses

While benefits for some conditions such as mental illnesses or conditions involving self-reported symptoms may be limited two years or less under your policy, we have significant experience in crafting claims in such a way that we are often able to get around these harsh and overused benefit limitations.

How Do I Obtain LTD Benefits?

If you are unable to work because of an illness or injury and are covered under an employer-sponsored LTD insurance policy, coverage information can be obtained through your benefits representative. If you are covered under a private plan, you must contact your insurer directly.

It is important that you file your disability claim as soon as your become disabled as strict time limitations for filing typically apply. Oftentimes if you are receiving STD benefits from the same insurer with whom you have LTD coverage, the insurance company will initiate the process of converting the claim from short-term to long-term but that is not always the case. Upon submitting your application for benefits, you will be required to provide medical evidence documenting your illness or injury. This may include records of doctors’ visits, lab reports, imaging reports, surgical procedure notes, prescription records and records for counseling and rehabilitative care. In addition, your doctor must attest that you have restrictions and limitations that preclude you from performing work. Once this is provided, the insurance company will typically submit the evidence to a medical consultant or in-house review team to determine whether they agree with your doctor’s assessment. If there are errors or omissions in the application or sufficient medical evidence is not provided, or if the reviewers do not agree with your doctor, the insurer will likely deny your LTD benefits claim.

Even though LTD insurers are not usually bound by a favorable Social Security decision, many LTD policies require claimants to apply for SSDI. This is because a majority of group policies allow the insurer to offset the LTD benefit by the amount the claimant receives in SSDI benefits and in some cases even the amount the claimant’s children receive from Social Security as dependant benefits. While pursuing Social Security benefits may seem futile in this situation, approval may entitle you to Medicare and provide a more stable source of income than you have with your LTD insurer. Thankfully, many individual policies do not offset Social Security disability benefits. Each policy is unique and it is important to review and understand the terms of your specific policy.

Ultimately, if your LTD claim is approved, you can expect to receive a percentage of the wages you earned prior to becoming disabled. The benefits are typically paid so long as the insurance company is satisfied that you meet the definition of disability under your policy. You will likely have to provide routine updates to the insurance company about your condition. You may be asked to submit to an examination by one of their doctors, provide updated treatment records and attending physician statements to the insurance company to remain eligible for benefits. The duration of your benefits may be limited to a set number of years or until you reach a certain age.

Why Call Cox & Stansberry for Your LTD Benefits Claim?

Although insurance companies have an obligation to abide by the terms of LTD policies — which are considered contracts — insurers often deny claims for any number of reasons, some legitimate (e.g. errors, insufficient medical evidence), others not so much. Regardless of the reason for a denial, we have a proven track record of winning cases against major insurers that seek to deny LTD benefits claims.

Our legal team will design a comprehensive strategy to help you obtain the LTD benefits you deserve. Well-versed in ERISA and its application to long-term disability insurance, we routinely represent clients covered under employer-sponsored LTD insurance plans. We also regularly represent claimants with individual LTD policies. Whatever the case, we will assist you with filing an initial LTD benefits claim and throughout the entire claim process. We will help gather information about your specific job duties and collaborate with your team of medical and vocational professionals to collect the necessary evidence to document your disability.

If an insurer has denied your claim, we will explore all of your options. Our firm is highly experienced in the LTD appeals process and has a proven track record of success in ERISA litigation. Once you begin receiving your LTD benefits, we will provide ongoing advice and counsel to ensure your rights are protected.

At Cox & Stansberry, we understand the effect a disabling physical or mental condition can have on your lifestyle and will seek benefits that assist you as you move forward. We handle each case on an individual basis, knowing that there is no one-size-fits-all solution. Inside or outside of the courtroom, we are prepared to fight for you — and win. Please contact our office as soon as possible to set up a free consultation.

Located in Birmingham, Cox & Stansberry serves clients in Alabama and throughout the United States.


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