Frequently Asked Questions
Q. What is the difference between a private Disability policy and a group, or ERISA, policy?
A. A private policy is one that is you purchase directly from an insurance carrier or through a professional organization.
A group, or ERISA, policy is one that is offered by your employer, whether you pay some or all of the premiums on it.
The main differences between these two types of Long Term Disability policies are the procedures involved in filing a claim, and which laws govern and control them. In addition, typically a private policy has a fixed monthly benefit amount, while a group policy pays you a percentage of your salary. There are many other differences between these two types of disability policies, so you should educate yourself both when you purchase a policy and if you need to make a disability claim.
For more detailed information about private policies, please click here.
For more detailed information about ERISA policies, please click here .
Q. What is the "elimination" or "waiting period" on a Long Term Disability claim?
A. Every policy sets out a certain amount of time you must wait from the onset of your disability until you may begin collecting benefits. This period of time is called the "elimination" or "waiting" period. Every Long Term Disability policy is different, but the waiting period is frequently between 30 and 90 days.
Your insurance company may determine that your disability began at a later date than you claim, in order to delay payment of your benefits. At Insler & Hermann, we will thoroughly review all of your medical records, in order to prove an earlier onset date of your disability and to ensure earlier payments on your claim. Even when a carrier agrees to make payment on a claim, we always carefully check all of their facts and dates in order to maximize your benefits.
Q. Can I receive more than one type of benefit?
A. Absolutely. Based on your individual circumstances, you may be eligible for Social Security Disability and/or Workers Compensation in addition to Long Term Disability. If you are eligible, you may receive State Employees Disability, No-Fault and company or union pensions concurrently with benefits on your LTD policy. If you have multiple LTD policies, you can also receive benefits on more than one policy at the same time.
There are many different sources of benefits that may be available to you, and the interplay between these sources is complex and confusing. At Insler & Hermann, we will carefully review what you may be eligible for, and make sure that you receive the maximum benefit from each source.
Q. I haven't applied yet. When should an attorney get involved?
A. NOW! The earlier you hire an attorney, the greater your odds of receiving the maximum benefits to which you are entitled, at the earliest possible date.
If you contact us before you file your initial application, we can help you to make decisions regarding your treatment that can make the entire application process flow more smoothly. Similarly, we can make sure that from Day 1 your health care providers properly document your disability and provide you with the medical records that best prove your case. We will also verify that your application has no mistakes or omissions that could lead to a denial or delay of benefits.
The earlier we are involved, the easier we can make the process for you. It can be extremely difficult for even the most skilled attorney to undo mistakes made at the early stages of an application or claim. Particularly in ERISA cases, your appeal options can be severely limited if you contact the carrier on your own after your claim is denied. Even if you are still working, if you hire us now we can help you to plan your disability claim more carefully.
Q. How is the attorney paid in a Long Term Disability case?
A. Fees in a Long Term Disability claim are not governed by any laws or regulations. Payment is a matter between attorney and client that we at Insler & Hermann handle in different ways depending on the unique circumstances of each person and his or her case.
At Insler & Hermann, we usually ask for a retainer to begin to pursue a Long Term Disability claim on your behalf, plus a percentage of any recovery (either retroactive payments or settlement of the claim). However, in some cases an hourly fee may be more appropriate. An hourly fee may be more logical if you need a consultation to sort out your overall disability situation, or if you require advice on how to deal with an initial application, benefit review or some other circumstance.
Q. What should I do if my benefits are reduced or stopped?
A. If your benefits are reduced or suspended, contact an attorney immediately. In order to restore your benefits, you must meet strict time limits as well as procedural requirements, especially in ERISA or group policy cases. Failure to demand certain information can have a long term impact on whether or not your benefits are ultimately restored. At Insler & Hermann, we have the knowledge and experience to make sure that everything possible is done to restore your benefits. If you need specific information from your doctors, or a clarification from your insurance carrier of what has been submitted to them, we will obtain it for you. We feel that it is our job to reduce your stress as much as possible during this difficult time.
Q. What if I return to work while receiving Long Term Disability benefits?
A. Many, but not all LTD policies have a "residual" or partial disability benefit that will pay you a reduced amount if you return to work. This reduced amount is usually based on what percentage of your former income you are earning now.
Some policies also have a rehabilitation provision. However, these provisions need to be evaluated very carefully. We have seen cases where the carrier suspended benefits simply because a claimant expressed interest in the possibility of rehabilitation. At Insler & Hermann, we will carefully review any rehabilitation provision in your policy so that we can best recommend what course of action you should take.
Q. What Happens to my medical benefits if I can't work?
A. Long Term Disability policies do not relate directly to the continuation of any other benefits, such as medical insurance. If you are covered by a Union plan, if your employer has a specific policy, or if your employment or severance agreement discusses medical insurance, that will determine what happens.
Otherwise, under a Federal law known as COBRA, any employer with greater than 20 employees must give employees who have been terminated or who have left due to a disability the opportunity to maintain their medical benefits on their own for up to 18 months.
If you are approved for Social Security Disability during the first 18 months of your COBRA coverage, you can extend COBRA for another 11 months, until you become eligible for Medicare 30 months after the month in which your disability was found to begin.
However, without your usual source of income you may not be able to afford COBRA coverage. Low cost medical programs do exist to cover individuals or families who cannot afford or have lost their COBRA benefits. For more information regarding these programs click here for the link to our article, "Saving on Prescription Drugs and Healthcare."
At Insler & Hermann, we will review all of your medical insurance options with you, and help you find and keep medical coverage during this time when you need it most.