If You Become Disabled While You Are Employed
- There is a seven day waiting period for which no benefits are paid. Benefits begin on the eighth consecutive day of disability . If you have been disabled more than seven days, your employer must give you a Statement of Rights under the Disability Benefits Law within five days of learning that you are disabled .
- A “day of disability” is a day on which you were prevented from performing work because of disability and for which you have not received regular wages or remuneration. You are ineligible for disability benefits if you perform any type of work for which you receive wages or profit, even if performed at home.
Differences Between Disability Benefits And Paid Family Leave
- Only the birth mother is eligible for disability benefits for the period immediately after the birth of a child.
- Paid Family Leave begins after the birth and is not available for prenatal conditions.
- A parent may take Paid Family Leave during the first 12 months following the birth, adoption, or fostering of a child.
- You cannot collect disability benefits and Paid Family Leave benefits at the same time.
- There is a limited exception to this for employees who may be eligible for both disability benefits and Paid Family Leave when subject to an order of quarantine due to COVID-19. See PaidFamilyLeave.ny.gov/COVID19 for details.
You May Have To Fight For Your Social Security Benefits
According to data from the Social Security Administration, that agency denies the majority of disability applications. Between 2007 and 2016, the administration only approved 33% of the applications it received. That means most claimants must go through a time-intensive appeal process before they get the benefits they deserve.;
During a Social Security appeal, you must first file a Request for a Reconsideration. The administration will review your claim again and either approve or deny your benefits. If it again denies your claim, youll need to file a Request for Hearing.
At that point, a local Social Security hearing office, called an Office of Disability Adjudication and Review , will receive your file, assign a judge, and schedule a hearing. In Chicago, it typically takes 12 months for ODAR to assign a hearing date. If the administrative law judge denies your claim again, you can also file additional appeals.
When everything is said and done, many Social Security claimants wait years before they get a final decision on their claim. However, the administration must pay past-due benefits to those who successfully appeal their claims. While this backpay would be a welcome financial resource for many people, your LTD policys offset provisions also apply to retroactive Social Security benefits.
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How Fusco Brandenstein & Rada Pc Can Help You File An Appeal
If the insurance company denied your claim for long term disability insurance, you have the right to file an appeal. The denial letter you receive should include the reason for denying your application and instructions for appealing the decision. The process can be complicated and confusing for anyone who never filed an appeal before. Your New York long-term disability attorney will handle every aspect of your case.
When you hire us, we can complete the following steps:
Fusco, Brandenstein & Rada, P.C. belongs to a national network of attorneys who specialize in Long Term Disability cases.
How Long Must An Employer Hold A Job For Someone On Disability
It depends on whether the disability is work related or not. If work related usually 1 year. If not work related, if you qualify under family medical leave act, then you can take up to 12 weeks. To qualify, there has to be a minimum of 50 employees, you have worked there for a year, and have been full time.
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What Is The Difference Between Short Term Disability Insurance And Long Term Disability Insurance
Short term disability insurance can provide you with replacement wages in the event that you are temporarily unable to work. Long term disability insurance provides more permanent income replacement as your medical condition prevents you from working over a longer time period. Note that disability benefits are different from workplace insurance benefits as disability benefits arise from an illness or injury which is not required to occur on the job, whereas workplace compensation benefits are given as a result of being in the course of your employment.
I Just Received A Letter From My Insurance Company Terminating My Benefits What Should I Do
It is important that you try to find out why your benefits have been terminated. Carefully reading over the letter that your insurance company sent you may provide this information. For example, if your benefits were terminated because you did not send the insurance company the proper documentation contact your insurance provider and arrange for the necessary forms and documentation to be sent to them as soon as possible.
However, if the reason for your termination is that the insurance company no longer finds that you are disabled enough as to require benefits even though your doctor maintains that you are still disabled, contact a disability insurance lawyer.
What Are Ltd Insurance Benefits
Many companies provide Long Term Disability insurance benefits coverage to their employees. That was if you become too disabled to work due to injury or illness for a sustained period of time, you would have some income to support yourself and your family.
Under these plans either your company will cover the cost of these monthly premium payments, or they will be deducted from your paycheque. If you pay the premiums any benefits you receive will be non-taxable income.
In order to reduce the monthly payments, two common clauses in LTD insurance policies are the requirement to apply for CPP Disability benefits and the allowance of a deduction for any CPP disability benefits received.
The More You Earn The More There Is To Insure
Disability insurance benefits are based on a percentage of your income. Therefore, a key part of the underwriting process and a determining factor of your premium is how much you earn. This is done through financial underwriting.
For underwriting purposes, income is earned if a disability would stop or reduce it. Investment or business income that doesnât require work on your part will not be factored into your financial underwriting.
Underwriters will assess your salary, wages, regular overtime, bonus, and commissions. They may consider contributions to your retirement plan made by your employer. If you own a business, the underwriter will consider your share of the businessâs earnings.
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Unum Sues To Recover Overpayment
When Daniel reached the maximum benefits period under the policy, Unum could no longer deduct monthly benefits to recover the overpayment, the balance of which was then $65, 848.40, and Unum sued Daniel in the Georgia Federal Court to recover the amount in addition to attorney fees and the costs of litigation. The court entered a judgment in favor of Unum requiring Daniel to pay the nearly $66,000 plus the costs of the litigation.
Why Was My Claim Denied
When an insurance company reviews a long-term disability claim, they consider various factors. If you include inaccurate information, or missed an important deadline, the claim could be denied.
Before you begin the process, you should thoroughly review the policy to ensure youre eligible for benefits and complete all forms with all of the correct information regarding your disability. A long-term disability insurance attorney can handle this process for you to ensure that youre submitting a solid claim, including the necessary evidence to back your claim, and meeting all deadlines.
Claims are often denied for the following reasons:
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What Can I Do To Maximize My Chances Of Success In Filing A Disability Insurance Claim
When filing a disability claim it is important that you go to a doctor or a specialist who has an expertise in the medical condition that you are coping with. This way they have the ability to more accurately detail your prognosis and required treatment. It is also important that you discuss with them your job duties and responsibilities and how your condition may affect your ability to do these tasks. Consider the physical and mental demands that are required and what limitations you will face. This is important when evaluating whether you can fulfill the essentials of your own job as determined in the Own Occupation test.
Health Coverage For People With Disabilities
If you have a disability, you have three options for health coverage through the government.;
Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.;
Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease . Learn about eligibility, how to apply and coverage.
Affordable Care Act Marketplace offers options to people who have a disability, dont qualify for disability benefits, and need health coverage. Learn about the .
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Who Do I Sue If My Disability Benefits Are Denied
Your lawyer will discuss your claim with you and determine which person or group it is appropriate for you to sue. Most of the time you will be suing the insurance company who is refusing to give you disability benefits. However, depending on your situation it may be necessary to sue other parties, such as, the broker who sold you the policy. Your lawyer will work with you to decide the best course of action.
Why Would Long Term Disability Be Denied
Long term disability benefits are crucial for ensuring that you continue to receive income when you are disabled and cannot work. Your LTD claim can be denied due to missing medical records, legal technicalities, or conflicting evidence collected during your insurance companys investigation of your claim.
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Approval For Cpp Disability May Equal Higher Cpp Retirement Pension
Winning CPP disability payments can actually result in you getting a higher CPP Retirement pension when you turn 65. While you receive CPP disability, you are not penalized for not contributing to the CPP program.;
However, if you do not apply for CPP disability, you will be assessed as providing a zero contribution each year going forward, resulting in a lower retirement CPP payment.;
Why Checking The Policy Is Vital
Of course, it is important to remember that every long-term disability insurance policy is different and not every policy will contain an offset provision. In some cases, the policy will be drafted in such a way that the insurance company will not be able to recover your SSDI benefits.; There may also be a defense to paying back the benefits. You may also be able to negotiate a partial rather than a full repayment, allowing you to keep some of your Social Security lump sum award.
Before you sign paperwork or agree to pay back a portion of your SSDI benefits, consult with an experienced Philadelphia disability benefits lawyer. Your attorney can review both your LTD claim and your SSDI claims, and can counsel you on your obligations with respect to your benefits if both are approved.
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Can They Force Me To Apply For Canada Pension Plan Disability
Yes, an insurer can force you to apply for CPP disability. Again, the policy gives them this right. Most policies do this, but not all. Technically, you can refuse to apply. If you do, then they will guess what CPP would pay you. Then, they can deduct it from their payment.
They can also force you to apply for other benefits, including:
- Workers compensation
- Other disability insurance policies
What Is The Maximum Amount Of Retroactive Pay That I Can Receive
The SSA caps your retroactive pay at 12 months. In other words, you cannot become disabled and seek SSDI 5 years later and expect the SSA to pay you for all of that time. So, given the 5 month waiting period, in order to receive the maximum amount of retroactive pay you would have to have been disabled for 17 months or more before your application date. The SSA would deduct the 5 month waiting period and then pay you for 12 months of retroactive pay.
As an example of how your EOD and application date determine your retroactive pay amount, lets look at the following example:
Say that your EOD is January 1. You would become eligible for benefits on June 1, or 5 months later. If you applied for SSDI on December 1, then you would be entitled to retroactive from June 1 to December 1. Lets say, however, that you applied for benefits on March 1. Although you were disabled at the time you applied for benefits, you are not eligible for benefits during this time because it falls during your 5 month waiting period. Therefore, because you did not become eligible for benefits until after your application date, you are not entitled to retroactive pay.
All of these dates and terms can be confusing, so we encourage you to review multiple examples of these terms being used in practice so that you can become familiar with them. For an extensive list of examples, please see our article Back Pay vs. Retroactive Pay.
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Understanding Ltd And Ssdi Offsets
Nearly all long term disability insurance policies contain a clause that essentially states that if you receive social security disability benefits covering the same time period that your disability insurance covered you for, you have to pay back the overlapping amount. This is called an offset provision. For example, lets say that you receive a lump sum of $16,000.00 from your long term disability policy, covering you from last January to June. Then, social security comes around and awards you $10,000.00 for that same time period. You now have received $26,000.00 but cannot keep both. Under the terms of your policy, you have to take that $10,000 and give it to your disability carrier, essentially paying them back for the portion of social security that they advanced to you. If you had been denied social security, it becomes a non-issue and youd be allowed to keep the whole $16,000.00. Under the offset, you are still getting $16,000.00 but $10,000.00 comes from social security and the insurance company ends up only paying $6,000.00.; Please note that the amount you may have to pay back usually does not include the attorney fee you had to pay the disability lawyer.;
The Offset Provision In Practice
Say you pay premiums for a disability insurance policy worth $5,000 per month in benefits once you become disabled. Your policy has the offset provision, so you have to apply for SSDI as well. SSDI is free to you â itâs a tiny tax that everybody pays â so you should apply anyway.
But say you become disabled on March 1. Your LTDI policy has a three-month waiting period, also known as an elimination period, so you become eligible to receive LTDI benefits from the insurance company on June 1. You receive your first payout of $5,000 on July 1.
Meanwhile, your SSDI claim is still processing. It finally becomes approved later that year, for SSDI benefits of $1,000 per month. You receive a catch-up payout for each month you shouldâve been receiving SSDI payments.
If your catch-up payment is three monthsâ worth and youâve been receiving long-term disability insurance benefits for two months, you only owe the offset for those two months: $2,000. But, in this example, if youâve been receiving LTDI benefits for three or more months, youâll have to give the whole catch-up payment to the disability insurance company.
Additionally, once your SSDI benefits kick in, your LTDI benefits will be offset for every month. Now you receive $4,000 from the disability insurance company and $1,000 from the government.
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Work With A Philadelphia Disability Benefits Lawyer
The world of Social Security disability and long-term disability insurance benefits can be complex. If you are facing a health crisis and are unable to work as a result, the stress of handling these claims and the related paperwork can be overwhelming. A Philadelphia disability benefits lawyer can help.
Since 1985, Bross & Frankel has represented clients in both long-term disability and Social Security disability cases. We work throughout Pennsylvania and New Jersey, advocating on behalf of people with disabilities to help them get the benefits that they deserve. To schedule a free claim review, contact our office today at 856-795-8880, or reach out anytime online.
Speak with an experienced disability lawyer about your claim today.
- Social Security Disability / SSI Claims
- Veterans Disability Compensation & Pension
- Long Term Disability Claims / ERISA Benefits
- Workers Compensation Claims