Long-term disability (LTD) is a private disability payment system, typically operated by a large insurance corporation (e.g., Prudential, MetLife, or Unum). It is a benefit sometimes offered by the employer and can be a valuable asset to the employee should said employer elect to offer it. When an employee is denied benefits under an LTD plan, the Federal Court has jurisdiction to hear these claims. Federal court access is conveniently located just minutes from the Cleveland, Ohio office of Margolius, Margolius and Associates. Federal court jurisdiction in Columbus, Ohio and adjacent states is also part of the representation by Margolius, Margolius and Associates.
Understanding Your Long-Term Disability Policy
While long-term disability plans are premised on the inability of the employee to work, much of the battle is defined by the definitions and limitations within the LTD contract itself. For example, most policies have two relevant time periods used to evaluate claims.
The first period is called “own occupation” and requires that an employee be found disabled if he or she is unable to perform his or her own occupation. This “own occupation” period typically applies to the first two years an employee is disabled.
Following the “own occupation” period, the insurance company will apply an “any occupation” standard. In order to receive benefits during this period, an employee must establish an inability to perform any kind of work at all, not simply that work which is confined to one’s own occupation.
The Social Security Administration uses a similar standard when evaluating claims for disability benefits. However, the legal standard used by the Court in LTD claims is much more stringent than that used for Social Security claims.
The Importance of Medical and Vocational Evidence
Other evidentiary issues distinguish LTD claims from Social Security claims. Little or no deference is given to the treating physician’s opinion and, more importantly, once the administrative portion of the case is over, no new medical evidence can be submitted. Given these difficult standards, it is particularly important to have aggressive advocacy during the early stages of a long term disability case.
Experience With Long-Term Disability Insurance Companies
Our attorneys have extensive experience representing individuals whose long-term disability benefits have been denied or terminated by many of the nation’s largest disability insurance companies and claims administrators. We understand how these companies evaluate disability claims, the medical and vocational evidence they rely upon, and the strategies they use when denying benefits.
Margolius, Margolius & Associates has successfully challenged long-term disability decisions made by carriers and administrators including Unum, The Hartford, Lincoln Financial Group, MetLife, Prudential, Cigna/New York Life, Aetna, Guardian, Reliance Standard, Standard Insurance Company, Sun Life, Principal, Mutual of Omaha, and other disability insurers and claims administrators.
Whether your long-term disability claim has been denied from the outset or your benefits have been terminated after months or years of payment, we can evaluate the decision, the terms of your disability policy, and the evidence needed to pursue an appeal.
Long-Term Disability and Social Security Disability Benefits
Another pertinent caveat is that virtually all the long-term disability policies require that the employee apply for Social Security. If the employee receives Social Security, then the long-term disability benefits are reduced by the amount of the Social Security check.
At Margolius, Margolius & Associates, great care is taken to ensure the availability of both private and federal disability benefits. Our approach is to ensure that the appropriate medical and vocational evidence exists to support the claim. This involves close, detailed work with both the client and the medical providers. We also strive to identify all vocational issues in support of our arguments.
When Should You Contact a Long-Term Disability Attorney?
Clients with long-term disability issues should not wait until they have been denied to hire an attorney. Waiting until a claim has been denied can make it more difficult to develop a complete record of the medical and vocational evidence needed to support the claim.
If your long-term disability claim has been denied, your benefits have been terminated, or you need assistance with an LTD appeal, please contact Margolius, Margolius & Associates to schedule a consultation.
