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Long term disability eligibility: what qualifies?

A disability insurance policy is essentially an agreement wherein the insurer promises to provide you with financial support when you can no longer support yourself in return for the premium payments made by you or your employer on the policy. While the arrangement seems straightforward, insurance companies and their policyholders are frequently at odds.

To you, being disabled means that because of a sickness or injury you can no longer work and collect a paycheck. When you have paid the premiums on the policy you rightly believe that you are entitled to the disability benefits you have paid for. Insurance companies sometimes have a different outlook as they are more concerned with their profitability than with making good on their promise to you. 

How is disability defined?

Although the specific definition of disabled will differ for each insurance company, most companies will define disability as the inability to perform any type of work that you are qualified for. This differs significantly from the inability to do your current or former job and opens up a range of alternative work options the insurance company may claim you can do. In the eyes of the insurance company, simply because you can no longer perform your old job duties that does not mean you can no longer work at all.

What factors are considered?

When reviewing your disability claim, the insurance company will take into consideration your education or training, work experience and ability to transfer your skills into a different field or position. Depending on the level of your disability and the prevailing economic conditions, finding this type of work may be near impossible. Nevertheless, the burder of proving your disability falls to you.

Before starting the claim process, review your plan description to see what is covered. The document might be filled with complicated language, but it could give you an idea of what you are up against.

Whether contemplating an ERISA claim or a claim with a private disability provider, working with an experienced long term disability attorney will help you understand your policy's requirements and how best to approach filing a claim. 

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Roboostoff & Kalkin, A Professional Law Corporation

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