Long Term Disability Insurance (LTD) and Social Security Disability (SSD) benefits
Long Term Disability Insurance (LTD) and Social Security Disability (SSD) benefits
Free advice from a Lawyer with lots of experience in both types of cases
By Barbara B. Comerford
I have written and presented papers on the topic of long-term disability insurance and Social Security Disability Insurance benefits to Judges, lawyers and disability organizations throughout the country for decades. And while I will certainly continue to do so, I wanted to provide some basic and free advice for those of you who took the time to visit my website. So here goes:
- You are not lazy if you are too ill to continue working.
If you are reading this, you might be considering filing for these benefits. If that is the case, I am sure you have been thinking about this for some time as your mind and/or body have been challenging your ability to continue working. As I explain to my colleagues in the law: this area of practice is the legal equivalent of going to the dentist, in that most people, contrary to what insurance companies and the government would like you to believe, hate the idea of not working because they know they will likely be judged unfavorably if they do. In almost 30 years of practice, I can tell you that most of my clients (and I have represented several thousand during that period of time) resist filing for these benefits until they have no other choice. Whether young or old, rich or poor, educated or not, we live in a capitalist society where the ability to support oneself is a badge of honor to strive for, not to be discarded. Most of my clients work well past the time they should because they want to feel productive, pure and simple. When their minds and/or bodies fail them, they are embarrassed and often ashamed.
I find myself explaining to those who reach out to me that long term disability insurance, like Social Security Disability (SSD) benefits, is funded by them either directly through payroll deductions (such as SSD and some long-term disability (LTD) benefits provided by employers) or with direct payment in the form of premiums to the insurance company. I share with them memories of my childhood where those of us who celebrated Christmas trekked to the bank with our birthday money or other meager savings to make deposits into our Christmas Club bank accounts. And before Christmas each year, we would remove those funds to purchase our Christmas presents. Friends and colleagues from other religious backgrounds share similar stories, all of which revolve around saving for contingencies. We all took pride that we saved for those events, and were not made to feel like thieves when we removed funds for that purpose.
LTD and SSD contributions are the same: there to be used when the situation calls for it. We contribute to those disability funds with income derived from years of hard work and when we need it, we should be allowed to access it. Only those politicians in Congress looking to pave their campaign coffers with distorted headlines, or self-interested insurance executives would have the audacity to argue that these funds are only to flow one way, and that is to them. And trust me, neither the government nor insurance companies give these benefits away. If they did there would be no need for attorneys like me. We often have to fight years, armed with reports and records from physicians, vocational experts and others to finally obtain the benefits which my clients worked years to fund, and for which they are rightfully entitled.
While the media too often focuses its attention on the small percentage of fraud in these systems, my concern is always for my clients’ daily reality: Facing foreclosure, bankruptcy and economic Armageddon while they try to keep their heads above water as they drown in medical bills (which their health insurers refuse to pay, if they are lucky enough to still have health insurance), delinquent mortgage or rent notices, and myriad other economic shortfalls. While the delay and denial of legitimate claims by SSD and LTD insurance companies may not make the headlines or the 6 o’clock news, it should. Most of my clients have paid FICA (SSD) taxes and/or LTD premiums throughout their work lives hoping never to have to file a claim. And when they have no choice but to do so, it is our society that should be ashamed of its finger pointing at them, not the reverse. The old adage, walk a mile in my shoes comes to mind. So please know, we will not judge when you call, we will try to accurately assess your chances of success, and if we think we can help you, we will.
- Talk to your doctors about how your illness is affecting you.
My clients often tell me they are embarrassed to tell their physicians how sick and functionally limited they are. They often feel rushed when visiting their doctor and don’t want to burden him or her with complaints. Again this goes to the issue of not wanting to appear sick, even to a doctor, since the client may be judged as a complainer, or someone looking to go out on disability. Indeed, the insurance industry has spent quite a bit of your premium payment on campaigns to convince everyone that to file a disability claim is tantamount to fraud. (In my opinion, the only “fraud” taking place is on the part of the insurance industry in taking billions of dollars in premiums only to deny legitimate claims as part of its cost of doing business while insurance executives are rewarded with millions of dollars in bonuses for doing so.) And most disability attorneys I know carefully vet cases because they are decent and honorable human beings who believe enough in the system to maintain the integrity of the process. So my advice is: Tell the truth to your doctor about how and what you are feeling, even if it takes a bit more time in the office. But if you feel too pressured once in that office, come prepared for the visit with a written list of symptoms and limitations, side effects of medications and all aspects of how your illnesses (all your illnesses) functionally impact you in your daily life and in your ability to work. And if you hire a disability attorney, make sure you let him or her know you have done this so they know to request that information when they obtain medical records. And please disclose EVERYTHING to your attorney. Full disclosure is the only way your attorney can tell you your legitimate chance of success.
- Before filing for SSD or LTD benefits, make a list of your past work for the last 15 years and why you can no longer do those jobs.
Often when filing for SSD and/or LTD, a claimant must document why he or she can no longer do their most recent job, and why he or she cannot perform work they have done over the last 15 years. I receive calls every day, from professionals to laborers, asking whether they can work part time when applying for disability benefits. The answer is: it depends. After satisfying the 12-month durational requirement (meaning after not having worked for 12 continuous months as a result of a medically documented severe impairment), SSA allows individuals to try work attempts, as long as it is disclosed to SSA immediately, and does not exceed specific time parameters (while the application is pending, and after the durational requirement has been satisfied, roughly 6 months, unless it is sheltered work). SSA also allows individuals to attempt work after they have been found eligible for Social Security Disability and SSI benefits, again, as long as those work efforts are immediately reported to SSA (always in writing, please) and in general do not exceed 9 months (again unless it is sheltered work or not considered substantial gainful activity.)
And some long-term disability insurance policies provide for payment of LTD benefits to individuals who are unable to perform the material and substantial duties of their own occupation but can do some other type of work that does not involve the same skill sets or functional abilities (for example, an orthopedic surgeon with an “own occupation” disability policy, may not be able to perform surgery anymore as a result of severe arthritis in his hands, or withstand the stress of an “on call” requirement as a result of a severe cardiac impairment, but can serve as a consultant in a medical practice in a non-surgical capacity.) And others with LTD coverage may not be able to work at all. It depends, and so an experienced disability attorney should review your policy.
So, if you are considering applying for any of these disability benefits, please give us a call. The initial consultation is free.