Conditions Qualified to Receive Long Term Disability Benefits: Part 1

November 06,2012
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There are many physical and mental conditions that may render an individual unable to work. However, for those filing a claim for long term disability benefits under an existing policy, it is the insurance company that makes the determination whether the claimant’s condition fits the definition of disability by its interpretation of the terms of the policy. Additionally, a New York long term disability lawyer will explain that every policy has exclusions and limitations that may affect the claimant’s ability to receive benefits.

Work Requirements

Where coverage is offered through an employer to an employee, threshold eligibility for long term disability typically begins with what a New York long term disability lawyer may call a “service wait,” meaning the time between when employment starts and when the employee is eligible for long term disability coverage. Typical service waits are three months, six months or one year. Similarly, most employees are required to work a minimum of hours per week, which is most often 30.

Pre-existing Conditions

This is an issue that can be confusing to many long term disability policy holders. As a New York long term disability lawyer understands, different insurance companies treat preexisting conditions differently. For example, there are medical conditions that may exist but do not trigger higher rates or a decline of coverage. This may be due, for instance, to the insurance carrier’s determination that the condition is unlikely to recur or result in disability. Additionally, there are conditions that are more likely to result in a short term disability than a long term disability.

In any case, many long term disability policies have what a New York long term disability lawyer characterizes as an “exclusionary period.” After becoming eligible for policy coverage, no claims will be approved during this period that typically lasts six months or a year. The insurance company treats any conditions within this exclusionary period as preexisting.

Finally, it is important for the individual to be forthright in revealing all preexisting conditions. Most policies have the right to deny paying benefits for any non-disclosed preexisting conditions; an intentional failure to disclose may result in dropping of coverage altogether.

Other Considerations

Other policy terms a New York long term disability attorney indicates may be present include:

• Work-related injuries or illnesses – typically, if the disabling condition was the result of an employee’s job duties, workers compensation is the exclusive remedy. Many disability policies do not cover such incidents.

• Disability over age 65 – most policies exclude coverage for those who reach full Social Security retirement age.

• Social Security Disability (SSD) offset; insurance companies typically have clauses requiring a long term disability claimant to apply for SSD benefits. If they are subsequently awarded benefits, the long term disability monthly benefit will be reduced by the amount of the SSD payment.

Contact a New York Long Term Disability Attorney for Legal Advice

Filing for long term disability is not always easy. For a free case evaluation, call Hermann Law Group, PLLC, at 1-877-773-3030.