Understanding your rights as an employee with an LTD claim and what to do if they’re violated.
Navigating a long-term disability (LTD) claim is a challenging process in itself, but for many claimants, the difficulty is compounded by issues with their employer. Employers may be hesitant to provide information, slow to cooperate with procedural requirements, or even concerned about how the claim affects their operations. These challenges can leave employees feeling unsupported and uncertain about how to proceed, particularly when balancing health struggles alongside the stress of a pending claim.
If you find yourself in this position, it’s essential to understand your employer’s role in the LTD claims process and the steps you can take to hold them accountable. Following procedures and maintaining clear communication can protect your rights and strengthen your claim.
Understanding Your Employer’s Role
An employer’s primary role in LTD claims is facilitating processes and providing documentation. This includes offering plan details, assisting with claim submissions, and communicating with the insurance company or plan administrator. However, the employer is not the decision-maker for approving or denying claims – that typically lies with the insurance provider or administrator.
While employers are expected to cooperate in the process, their interest is often divided. They may be more concerned with whether the employee plans to return to work and how long they’ll be out, particularly if it impacts operations. Employers might also worry about potential unemployment claims or the optics of terminating an employee while a disability claim is active.
Unfortunately, some claimants face additional hurdles with uncooperative employers. Employers may need more time to provide information or offer clear guidance on how to file a claim. In rare cases, employers may even collude with the insurance company to deny or undermine a claim.
Filing a Claim: The First and Most Critical Step
If you’re dealing with an uncooperative employer, the firs step is to ensure you’ve filed your claim. Many LTD plans are tied to your employment status, so if you lose your job before filing, you may lose access to benefits entirely.
To file a claim, you’ll need a copy of your LTD plan documentation. If your company has HR, go directly there to request a copy of the Summary Plan Description (SPD). Ideally, you should ask for the full plan document for reater clarity. Be persistent—your employer is legally obligated to provide this, particularly if you’ve paid part of the premium for the plan. The documents should include instructions on how to file a claim, including where to submit it, what forms are required, and any deadlines. If your employer is unresponsive or unhelpful, this will serve as your guide.
Communication Between Employers and Insurers
An aspect claimants overlook is the relationship between employers and insurance providers. Employers and administrators will often share details about the claimant’s job duties, employment status, and even statements made by the employee. Whether appropriate or not, assume that what you tell your employer may make its way to the insurer—and vice versa.
This communication underscores the importance of a consistent narrative. If you tell your employer you plan to return to work soon while informing the insurer that you cannot work, these conflicting messages could harm your credibility. While honesty can be intimidating, particularly if you fear termination, maintaining consistency is essential for your claim.
Steps to Take If Your Employer Isn’t Complying
If you suspect your employer is not meeting their responsibilities, thoroughly review the plan you received from HR. Understanding the requirements outlined will give you a clear sense of your employer’s obligations. Next, document all communications. Keep a record of emails, calls, and conversations related to your claim. If your employer fails to provide the requested information, create a paper trail. These records will be invaluable if you must escalate or involve a lawyer.
If you’re not getting anywhere with your direct supervisor or HR, escalate the matter within your organization. Larger companies may have a dedicated benefits team or compliance officer who can intervene. Be polite but firm in your requests, and emphasize your right to access the benefits you’ve paid for through your LTD plan.
Finally, if your employer continues to be uncooperative, it may be time to seek legal counsel. An LTD lawyer can communicate with your employer, ensuring compliance with requirements and addressing potential rights violations. They can also represent you in disputes with insurance providers, protecting your interests and helping you navigate the process more effectively.
The Risks of Employer Non-Compliance
Employer non-compliance can have serious consequences for claimants. Delays in providing documentation can result in missed deadlines, jeopardizing the claim. Miscommunication between employers and insurers can create discrepancies that doubt the claim’s validity. In the worst cases, claimants may face retaliation or even termination while accessing benefits.
Claimants should also be mindful of the employer’s focus on their return. Employers are often eager for clarity on if and when an employee will return, but claimants may not have definitive answers as they await guidance from their healthcare providers. Balancing expectations with the realities of a disability claim can be challenging, but clear, consistent communication is key.
Conclusion
Filing a long-term disability claim is never easy, and dealing with an uncooperative employer can make the process even more stressful. However, you can protect your rights and move your claim forward by taking proactive steps to understand your LTD plan, maintain clear communication, and document every interaction.
If your employer’s actions—or lack thereof—jeopardize your LTD claim, don’t hesitate to seek legal advice. A knowledgeable LTD lawyer can provide the guidance and advocacy you need to ensure compliance, secure your benefits, and focus on what matters most: your health and recovery.
If you’re facing challenges with your LTD claim or employer, schedule a consultation with us so we can help you navigate the process and fight for the benefits you deserve.