How To Apply For Long Term Disability
All long term disability insurance plans are backed by an insurance company in some way or another. However, there are various ways you can go about doing so.
For example, one common way is to sign up for group coverage. This is most commonly done through an employer. You may also find group coverage through:
- Industry associations
- Membership organizations
Many employers offer group disability insurance coverage to their employees as a workplace benefit. In fact, employers often pay some or even all of the premium cost.
Another option is to buy your own personal policy. You can do this through an insurance agent or directly from a reputable insurance company that offers individual long term coverage.
When Does Long Term Disability Insurance Kick In
Long term disability coverage starts after you are approved by the insurance company, you accept the offer for coverage that is made, and you begin paying your premiums.
When long term disability benefits start isnât as straightforward though.
Your policyâs elimination period will determine when long term disability benefits kick in if you become disabled. This is also known as the waiting period because it states the period of time you must wait after your disabling event before you begin receiving benefits.
When applying for long term disability coverage, your waiting period options typically include 30, 60, 90, 180, or 365 days.
What Doesn’t Short Term Disability Insurance Cover
Your short term disability insurance policy will likely include coverage exclusions. These will be listed in your policy contract.
Exclusions mitigate a carrierâs risk of paying a claim resulting from high-risk conditions or activities, and typically include:
- Intentionally self-inflicted injuries
- Neurological disorders
Furthermore, donât count on short term disability policies to cover time off to care for a sick family member or adopt a child.
If you have short term disability insurance through your employer, many of these plans require that you’ve worked a certain amount of time before coverage begins. Many employers also require that you exhaust paid sick leave or use paid time off before you are eligible for short term disability benefits.
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Long Term Disability Insurance Cost
On average, you can expect the cost of long term disability insurance to be between 1 percent and 4 percent of your current income. But thatâs just a ballpark estimate.
How much you pay for long term disability actually depends on a number of lifestyle and policy choices. Thatâs because insurance companies underwrite long term disability coverage based on the risk of an applicant filing a claim, as well as how long and how much a person might collect in benefits.
How Long Benefit Payments Should Last
People buy LTD policies to replace income for as long as theyre disabled, so benefit period length is among the most important decisions to make when applying for a policy. Standard choices include 2, 5, or 10 years to age 65 and to age 67. A few companies, including Guardian, offer coverage to age 70. While a longer benefit period is clearly desirable, it comes at a cost. How do you make right choice for your needs?
The average duration of a long term disability is 2.5 years2, but remember thats just an average. Some disabilities are shorter, but many are longer, so a 2-year benefit may not provide the reassurance youre looking for. Even though you have no way of knowing what form your disability will take , from statistical standpoint a 5-year benefit is much more likely to cover your needs. But there are good reasons to opt for an even longer period.
Consider getting benefits to retirement age. The premiums for a policy that provides benefits into or through your 60s may not be much higher than the premiums for a 5-year plan. Why? Insurance companies calculate the risks associated with each policy, and they know they may nothave to pay benefits for more than 5 years on most disability claims. So, they can offer a longer benefit period at a relatively low added cost.
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Cost Of Living Adjustment
If you’ve been approved for benefits, you can expect your benefits to increase 1% to 3% each year if your policy contains a cost-of-living adjustment . The COLA may be part of your basic coverage or offered as an optional rider, and it is usually indexed to a well-known measure of inflation, such as the Consumer Price Index .
The State Of California Pays Partial Wages If You Have Temporary Illness Or Injury That Keeps You From Working
By Bethany K. Laurence, Attorney
Update: California has made it easier for those affected by coronavirus to get SDI benefits. If you are off work due to COVID-19 illness or exposure, see our article oncoronavirus changes to California’s disability insurance program.
The State of California requires all employees to pay into its short-term disability insurance program through payroll deductions. When employees become unable to work due to disability, they can collect weekly benefits from the program until they are either ready to go back to work or the benefits expire. The program is administered by California’s Employment Development Department .
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I Got My First Benefit Payment Why Wasnt I Paid For The First Seven Days
The first seven days of every new claim is a non-payable waiting period. The first payable day is the eighth day of your claim. Review the step-by-step overview for the to learn more.
The Governors Executive Order N-25-20, signed March 12, 2020, waives the one-week unpaid waiting period for COVID-related DI claims with a start date of January 24, 2020, through September 30, 2021. You can collect DI benefits for the first week you are out of work.
Note: The Governors Executive Order N-08-21, signed June 11, 2021, returns the requirement to serve the one-week unpaid waiting period for COVID-related DI claims with a start date on or after October 1, 2021. You can collect DI benefits starting on the eighth day you are out of work.
If you are eligible, the EDD processes and issues payments within a few weeks of receiving a claim.
What Does Long Term Disability Insurance Cover
Here are the top five reasons for filing long term disability claims:
As you can see, the scope of disabling events is wide. That’s why perhaps the most important factor when considering long term disability insurance is a policy’s definition of disability.
How a policy defines disability will determine how much, and even if, you collect benefits following an injury or illness. Some policies will pay out a monthly benefit if an injury prevents you from working at your normal job, but allows you to do other types of work that will nonetheless reduce your income. Other policies will not pay benefits if you are able to work in another type of profession, even if you earn less money.
A policyâs definition of disability is based on your capacity to work. Maybe youâre unable to work in your chosen profession, but can do other work. A disability may allow you to work in a reduced capacity. Serious ailments can prevent you from working in any job.
To collect on a claim, you must meet the policyâs definition of disability. This can vary greatly by company and policy. The broader the definition, the more it will cost.
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Disability Insurance Benefits And Taxes
Generally, if you pay the entire amount of the disability premium yourself, your disability benefits will be tax-free. This may bring your income while on disability closer to your current take-home pay.
If your employer pays all or part of the disability premium, your disability benefits will be subject to income taxes.
Your Policy Choices Matter Too
So far, weâve highlighted personal factors that influence the cost of long term disability insurance. However, there are also various policy choices that will influence how much you pay in monthly premiums.
The benefit period you select is a prime example. The longer your benefit period is, the more you can expect to pay in premium. More often than not, the most cost-effective benefit period length is 5 years.
Your elimination period, or waiting period, is another example of a policy choice that impacts long term disability insurance cost. The elimination period for disability insurance is similar to the deductible on property insurance. Itâs the part you pay out-of-pocket before benefits kick in. Cost runs the opposite of your benefit period: The longer your waiting period is, the less you will pay in premium.
Elimination periods for long term disability can be as little as 30 days or as long as a year. The standard length is 60 or 90 days.
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Short Term Disability Vs Long Term Disability
The main differences between short term and long term disability insurance are:
- The injuries and illnesses they cover.
- How long you can receive disability benefits.
- How long you have to wait following a disabling event to receive compensation.
|1, 7, 14, 30 days||30, 60, 90, 180, 365 days|
You shouldn’t skip long term disability insurance coverage in lieu of having just a short-term policy. Short term coverage will not be adequate in the event you suffer a serious injury or illness. Without long term coverage, you could find yourself without any kind of income after just a few months.
The best strategy is to buy an individual long term disability insurance policy then supplement it with any short term and/or long term group plans your employer may offer. By combining different types of coverage, you can protect your income against just about any type of injury or illness that would affect your ability to earn an income.
Learn More:Short Term vs. Long Term Disability
Other Payments May Affect Your Disability Benefits
If you receive certain other government benefits, such as workers’ compensation, public disability benefits, or pensions based on work not covered by Social Security , the Social Security benefits payable to you and your family may be reduced.
For more information about how these benefits can affect your Social Security payments, please refer to the following publications:
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Ways Employees Can Disqualify Themselves From Sdi
In some situations, employees can lose their eligibility for SDI benefits. Benefits are not available for an employee who:
- missed the doctor’s appointment that the EDD set up
- is unable to work as the result of a felony he or she committed
- is incarcerated after being convicted of a crime
- is receiving unemployment benefits
- is receiving sick leave that equals his or her full salary or regular wages
- is receiving paid family leave benefits, or
- is receiving workers’ comp payments that are higher than what the employee would receive from SDI.
Do I Need A Lawyer To Handle My Long Term Disability Insurance Claim
It is a personal choice in deciding whether or not you would like a disability insurance lawyer to represent you and handle your claim. It is important to be aware of your rights and stay in control of your situation. When a person negotiates directly with an insurance company, he or she needs to understand that insurance companies have hundreds of years of experience in how to manage and settle losses. As private companies, they are always working for the benefit of its shareholders. If your claim is denied you may wish to consult with a lawyer who has the experience and knowledge necessary for advancing your claim.
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Pregnancy And Maternity Leave
If you are disabled due to pregnancy, you may be entitled to up to 26 weeks of disability benefits.
You will need to submit a medical report completed by a doctor or certified nurse midwife stating your disability is due to pregnancy.
- The medical report should describe specific pregnancy complications if your disability
- started more than four weeks before the anticipated birth date OR
- lasts more than four to six weeks after the actual birth date.
Note: Benefits are not payable for any period you are unable to work due to elective surgery .
The Other Parts Of Medicare
- Medicare Advantage Plan people with Medicare Parts A and Part B can choose to receive all of their health care services through plans that are offered by private companies and approved by Medicare. For more information, we recommend you read Medicare’s How do Medicare Advantage Plans work?
- Medicare Part D helps pay for medications doctors prescribe for treatment. For more information on the enrollment periods for Part D, we recommend you read Medicare’s How to get prescription drug coverage page.
If you receive Medicare and have limited resources and income, you may be eligible for Extra Help with Medicare Prescription Drug Plan Costs.
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Why Has My Long Term Disability Claim Been Denied Why Have My Long Term Disability Benefits Been Terminated
An insurance company may deny your long term disability claim or terminate your long term disability benefits for a variety of reasons. Some of these might have a simple solution, such as making sure that they have all the necessary forms and documentation, but in other cases it might require the assistance of a lawyer to help you in your claim against the insurer in order to get the benefits that you are entitled to.
Issues may arise if you are not examined by insurance company approved doctors, you exceeded the time limitation in submitting a claim, there was a misrepresentation on the application as you had a pre-existing condition that you did not mention, there is surveillance evidence that contradicts your claim, there was a failure to have your injury or condition properly documented by your physician, you have not mitigated your losses by maintaining your treatment regimen, or there was a failure of your employer to provide the necessary documentation.
Similarly, insurance companies may argue that you do not have a claim or that you are partially or residually disabled . Instead, you are able to work part-time or with modified tasks. It may also consider your loss of earnings as a result of the medical condition. However, the benefits you would receive would be less than if you were receiving long term disability benefits.
Watch these videos explaining the top 10 reasons why an insurance company might deny your long term disability claim :
My Health Benefits Stopped While I Was On Paid Family Leave What Can I Do
The US Department of Labor provides a temporary extension of health benefits at group rates for certain former employees through the Consolidated Omnibus Budget Reconciliation Act program. For more information, contact the DOL at 1-866-275-7922. For TTY, use 1-877-889-5627.
There are two ways you can notify us of the deceased claimants date of death to stop their benefit payments:
- Phone: Call us at 1-800-480-3287.
- Mail: Use the PO Box address printed on the payment notice.
If eligible, benefits are payable through the date of death. We will need the following information to stop benefit payments and contact you with additional instructions:
- Claimants full name
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Can An Employer Fire An Employee For Pregnancy
An employer is prohibited from firing an employee based on her pregnancy. By the same token, employers and fellow employees cannot harass a female coworker because she is pregnant. However, a pregnant employee can still be fired if her entire department is also being let go or she has been a bad employee. An employer is not allowed to discriminate against an employee on the basis of her pregnancy in the state of California.
Employer/insurance Carrier Requests Examination By A Health Care Provider
- Your employer/insurance carrier may designate a health care provider to examine you. You must submit to requested examinations under the following conditions:
- Exams may occur at intervals, but not more than once a week.
- You do not pay for the exams.
- Exams occur at a reasonable time and place.
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Factor In Possible Disability
Your health insurance will probably cover most of your care. However, many people have to pay a high deductible before receiving care or have a health insurance policy that doesnât cover every medical expense. Since you may not be earning an income while disabled, your LTDI coverage should be high enough to get you the care you need and help you recover.
You Meet The Specific Criteria For Receiving Ei Sickness Benefits
EI sickness benefits are payable only to those people who are unable to work because of sickness, injury or quarantine but who would otherwise be available for work if not for their incapacity due to medical reasons. To receive sickness benefits, you need to obtain a medical certificate signed by your doctor or approved medical practitioner.
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Find Your Base Period
Your benefit amount is based on the quarter with your highest wages earned within the base period.
A base period covers 12 months and is divided into four consecutive quarters. The base period includes wages subject to SDI tax that were paid about 5 to 18 months before your disability claim began. The base period does not include wages paid at the time your disability begins. For a DI claim to be valid, you must have at least $300 in wages in the base period. The following information may be used to determine the base period for your claim.
If a claim begins on or after January 1, 2021:
The base period is the 12 months ending last September 30. Example: A claim beginning February 14, 2021, uses a base period of October 1, 2019, through September 30, 2020.
The base period is the 12 months ending last December 31. Example: A claim beginning June 20, 2021, uses a base period of January 1, 2020, through December 31, 2020.
The base period is the 12 months ending last March 31. Example: A claim beginning September 27, 2021, uses a base period of April 1, 2020, through March 31, 2021.
The base period is the 12 months ending last June 30. Example: A claim beginning November 2, 2021, uses a base period of July 1, 2020, through June 30, 2021.
You can get a general estimate by using our online calculator.
Note: The calculator is intended to provide an estimate only. Your actual WBA will be confirmed once your claim has been approved.