If a medical issue is stopping you from working, it’s important to know about long term disability (LTD). LTD is a benefit that is available by virtue of your benefit plan with your employer. Check your benefit booklet to see what your LTD coverage is like. There will be a schedule of benefits, showing what the benefit formula is and definitions within the policy. If you are unable to continue working, or are considering a medical leave, it’s important to review your coverage. Knowing what LTD is and when to apply is the first step in securing your financial future. Once you understand your coverage, the next step is to apply for long term disability benefits. This blog will walk you through the steps, considerations and common mistakes made when applying for long term disability.
What are Long Term Disability Benefits?
LTD benefits is an income replacement benefit intended to provide a portion of your income should you become disabled from working. Your LTD policy will provide the particular benefit amount. It could range from 50% to 80% of your income, depending on your plan.
The LTD policy is meant to be a “peace of mind” agreement, meaning the insurance is supposed to help provide a monthly income if you’re unable to work due to an illness or injury.
How do you Apply for Long Term Disability Benefits?
There are usually three forms that are required to complete an LTD application:
- The Plan Member Statement (PMS). This form completed by yourself. It provides some employment details, information about your condition and treatment particulars.
- The Attending Physician Statement (APS). This form will need to be filled out by your doctor. The APS provides information about your medical diagnosis, current treatment, other doctors you are seeing and your anticipated return to work or a date of reassessment.
- The Plan Sponsor Statement. The LTD insurer will forward this form to your employer for completion. The form has details of your date of hire, job particulars and income.
Once all 3 forms have been submitted to the insurance company, the ball is now in the insurers court to make a decision on your claim.
How do you Qualify for Long Term Disability?
Each policy will have a definition of total disability. Initially, the insurance company will determine whether your injury or illness prevents you from completing the essential duties of your own occupation. This is referred to as the own occupation period as the insurer evaluates whether your medical restrictions and limitations prevent you from working in your current role.
After two years, the definition under the policy changes and becomes more difficult (for you). A “Change of Definition” (COD) occurs. At the COD, the insurer evaluates whether your medical restrictions and limitations prevent you from working in any occupation that you are reasonably qualified for via education, training or experience.
Common and Easy Mistakes to Avoid if You’re Considering an LTD Application
- Get your paperwork in as early as possible.
Policies have timelines for submitting LTD applications. Generally, you get some grace, but insurers will want an application submitted earlier rather than later. Usually, when the waiting period is close to expiring and before LTD benefits commence, you can submit an application. An early application is not harmful and may help expedite a decision on your claim.
- Work with your Doctors!
Submitting an LTD application requires your doctor’s support. If your doctor provides you with reasonable advice, you have a duty to listen and act on appropriate treatment recommendations, so long as it is within your capabilities. Insurers are notorious for denying a claim because they believe you are not following appropriate medical advice.
- Be Careful with your Communications with Insurance Case Managers
Case managers assigned to adjudicate your claim may sound comforting and approachable, but they ultimately work for the insurance company. It’s important to provide them with updates regarding your medical condition when prompted but be aware they are taking notes or could be recording your calls with them.
If you are still unclear on how to apply for long term disability benefits or if you have questions about any of the scenarios reviewed, help is just a call away. Reach out to our disability team at Whitten & Lublin and we can answer any questions regarding your short-term or long-term disability claim. We offer a free consultation for short and long term disability claims. Contact us online or call (416) 640-2667.
Author – Aman Chaggar
