What is Not Included in Long Term Disability Coverage?

long term disability insurance benefits

An increasing number of Americans are looking into long term disability insurance coverage and they have good reason to. A study conducted by the Council for Disability Awareness reports that one out of four 20-year-olds will have a long term disability before they reach the age of 65. Furthermore, the study estimates that, on average, they will be out of work for over two years. Whether through an employer or bought on your own, long term disability coverage is provided through private insurers who will not pay for things not included in their policies. For more information on what is not included in your long term disability coverage, please continue reading, then contact one of our experienced nation-wide LTD benefit lawyers today.

What is not offered by long term disability coverage?

Most insurance policies have clauses that allow the carrier to deny coverage under certain conditions or circumstances. Typical exclusions include:

  • Self-inflicted injuries or illnesses
  • Acts of war or consequences of armed service
  • Criminal offenses

We can’t stress enough how important it is that you read your policy to fully understand the coverage offered. Even if your disability is not outright excluded it may be subject to reduction.

What factors will your long term disability coverage consider?

Considerations include:

  • Fully disabled Vs. partially disabled: A major issue in coverage is the consideration of what the policyholder is no longer able to do. Some policies will pay benefits if the individual can no longer perform the functions of their current profession, while others expect the person to accept any sort of work that they can do even if their income is considerably less.
  • Work-related injury: Long term disability benefits are not payable to those injured at work. Those who are injured as a result of an accident while on the job or who contract an illness or disease due to the requirements of their job are expected to file for workers’ compensation.
  • Social Security offset: Most long term disability policies require the claimant to pursue SSD benefits. Should the claimant succeed in receiving SSD benefits, the long term monthly benefit will be reduced by the amount of their monthly SSD benefit check. Be forewarned that the SSD system is severely backlogged and can take months or even years to approve your application for an offset.
  • What the insurance company says is not covered: Given that insurance companies are in business to earn a profit, they are not always objective and partial. They may reject your claim because:
    • The medical records do not support a disability determination
    • The claimant does not meet the policy’s definition of “disabled”
    • The claimant is able to perform the duties of their occupation
    • The claimant has a mental condition

If you have encountered or expect to encounter any difficulty in receiving your LTD benefits, please reach out to our knowledgeable long term disability insurance attorneys.

Contact our experienced nationwide firm

If you or someone you know is looking to receive long term disability benefits, contact Walker & Hern for a free consultation.

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Contact us today for a free consultation.

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