Long-term disability insurance covers policyholders who are rendered unable to work due to a disabling condition. Some policies also provide coverage for residual or partial disability. You may be eligible for partial disability benefits if you have experienced an income decline due to a disabling condition that restricts your ability to perform some of the duties of your occupation or that limits the amount of work you can complete. When applying for partial disability benefits, you must determine the trigger date – the moment an injury or sickness began limiting your ability to perform your occupation.
Your Partial Disability Benefits
The first step is to carefully examine your policy to understand your benefits and how coverage is triggered. We assist clients with filing long-term disability claims with various insurance companies, including Principal, Unum, Provident, Paul Revere, Guardian, Northwestern Mutual, Equitable, Standard, Met Life, NY Life, Mass Mutual, Hartford Group, Great West, Trustmark, Lincoln Life, Cigna, Ameritas and others, and the definition of disability varies by policy. For instance, some insurance policies provide “own occupation” coverage, which generally defines disability as an inability, due to illness or injury, to perform the material and substantial duties of one’s own specific occupation. Others define disability as the inability to perform “any occupation,” which is generally defined as any job for which the individual is reasonably suited based on education, training and experience. Still other policies change the definition of disability from “own occupation” to “any occupation” after a period of time. Check your policy to determine whether you have coverage for residual or partial disability, and, if so, how partial disability is defined and what is necessary to trigger coverage. Typically, eligibility for partial disability benefits ends when you reach age 65.
Three Factors: Medical, Occupational, and Financial
Choosing a trigger date for partial disability benefits is a complicated process that involves tying three factors together: medical, occupational and financial. You must be able to demonstrate that you have a disabling condition, that you are no longer performing your occupation to the level you were previously due to the disabling condition, and that you have experienced a loss of income as a result. Identifying your disability date may be challenging because many conditions progress gradually. It is important to consult with your physician and carefully examine your activity levels and income over time.
We speak to clients at length and gather evidence about how their disabling condition has impacted their ability to perform their occupation. For example, a physician may have performed medical procedures in addition to seeing patients for office visits prior to becoming disabled. But, due to the disabling condition, the physician is no longer able to perform the procedures, and therefore has experienced a drop in income. Or, the surgeon may still be able to perform surgery, but is limited by a disabling condition in the number of surgeries they are able to perform in a day – and therefore is earning less than previously.
Financial Evidence
For your claim to be viable, your loss of income due to your disability typically must be at least 20 percent. We examine tax returns and other financial data to pinpoint when you had a significant loss of income. We compare your financial data to your occupational history and medical records to arrive at the disability date.
Medical Evidence
You must have a treating doctor(s) who is willing to provide medical support for your claim. We will send a narrative request letter to your treating doctor(s) that provides your occupational duties, date of disability and your policy’s definition of partial disability. We will ask the doctor(s) to complete the attending physician statement and to provide us with a narrative report detailing your diagnosis and the physician’s medical opinion, based on their care and treatment of you, of how your disabling condition has restricted or limited you from performing the specific duties of your occupation. The attending physician’s statement should detail any interventions that you have tried, such as medication, therapies, lifestyle changes or surgery, to treat and improve your condition, and what the outcomes were.
Your physician’s narrative and diagnosis should be supported by corroborating evidence of your disability and its adverse impact on your ability to perform your occupation. Test results such as MRIs, CT scans, X-rays and lab tests that support your diagnosis, your symptoms and your disability date should be submitted with your claim. In some cases, we will request an analysis from a vocational expert on whether you can perform certain duties of your job. Or we may recommend that you have a Functional Capacity Evaluation or “FCE.” Other corroborating evidence can include documents that show you have a long history of performing a large volume of high-quality work as well as statements from colleagues and others comparing your activities and abilities before and after the date of your disability.
If you have questions about your long-term disability insurance claim or you are involved in a dispute with your insurance company, contact the long-term disability insurance attorneys at Schwartz, Conroy & Hack. We have the expertise and tenacity to make sure insurance companies keep their promises to policyholders like you.