Getting a claim means you’re getting full compensation – or does it?
Long-term disability insurance is designed to provide financial support when an individual can no longer work due to a disabling condition. However, many policyholders may not understand their policy’s terms, leading them to receive fewer benefits than they are entitled to. Knowing your policy, recognizing insurer tactics, and self-advocation are key to maximizing benefits.
Understanding Your Disability Policy
A disability policy outlines the coverage you receive, including the percentage of income replaced, benefit caps, and duration of coverage. One of the most critical elements of an LTD policy is how it defines disability. Some policies follow an “own occupation” standard, meaning benefits are provided if the claimant cannot perform their specific job. Others use the “own occupation” standard and later convert to an “any occupation” definition, requiring the claimant to prove they cannot work in any reasonable job.
Many policies also contain pre-existing condition clauses, waiting periods, and exclusions that impact eligibility. Review the fine print, as insurers often include limitations on certain conditions, such as mental health disorders and subjective symptoms, which can reduce or deny benefits.
Signs You May Not Be Getting the Most from Your Policy
Many claimants assume they are receiving the full policy benefits, but there are several warning signs that indicate otherwise. If you receive less than the expected amount, offsets for Social Security Disability, or other benefits may be applied incorrectly. Delays in claim processing, repeated requests for excessive documentation, or unclear communication about policy terms or claim status are also red flags. Additionally, if you receive a denial based on vague reasoning or shifting insurer explanations, it may indicate that you are not being treated fairly.
Steps to Maximize Your Disability Benefits
The first step to ensuring you receive the full benefits of your disability policy is obtaining a copy of your policy, and not just the Summary Plan Description and any amendments. Many claimants do not have a copy and may be unaware of specific terms or limitations. Once you have the policy, carefully review it to identify exclusions, limitations, and how your benefits are calculated.
Keeping detailed documentation is another essential step. Maintain medical records, including doctor’s notes, treatment plans, and any test results that support your disability claim. Document all communication with your insurer, including phone calls and emails, to track claim progress.
Advocating for yourself is also critical. Follow up regularly with your insurer to ensure your claim progresses and push back if they request redundant or unreasonable documentation. Insurers often rely on claimant passivity to delay or reduce payments. Understanding how offsets and adjustments affect your LTD payout is crucial. If you receive SSD benefits, your insurer may deduct them from your LTD payments, but should not exceed what the policy allows.
Common Policy Features
If you encounter obstacles such as denied claims, unexplained payment delays, or difficulty interpreting policy language, seeking legal representation may be necessary. An experienced LTD lawyer can review policy terms to identify underpayments, file appeals, and advocate on your behalf to ensure fair treatment. Insurers frequently use vague policy language to reduce benefits, and a lawyer can help clarify your rights and challenge wrongful denials.
Many LTD policies offer additional benefits that claimants overlook. Residual or partial disability benefits provide coverage if you can work part-time but not full-time, helping you supplement lost income. Cost-of-living adjustments (COLA) ensure your benefits keep pace with inflation, and recurrent disability provisions allow benefits to restart if the same disability returns after an initial recovery. Claimants who are unaware of these features may leave benefits on the table simply because they do not know to ask about them.
Proactively Protecting Your Benefits
To ensure you comply with your policy requirements, meet all deadlines for submitting documentation and follow-ups. Insurers often deny claims for missing paperwork, even if it was requested late. Additionally, attend all required medical exams and consultations, as failing to do so may be used as a basis for denial.
Being aware of insurer tactics is also important. Some companies engage in bad-faith practices, such as unnecessary denials, excessive delays, or misleading claimants about their rights. If you recognize these patterns, consider consulting a lawyer to hold the insurer accountable.
Monitoring your benefits over time is another key strategy. Regularly review payments and policy terms to ensure that they align with what is promised. If your benefits change unexpectedly, investigate why and seek clarification from your insurer.
Conclusion
Understanding your disability policy and proactively managing your claim are essential to maximizing your benefits. Many claimants unknowingly accept reduced payments, miss out on key policy features, or fail to push back against unfair insurer practices. By staying informed, maintaining thorough documentation, and seeking professional help when necessary, you can ensure that you receive the full benefits you deserve. If you suspect that you are not getting the most from your policy, consider consulting with an LTD attorney who can evaluate your case and advocate for your rights.