Long Term Disability
"Long-Term Disability" (LTD) claims are situations where a disabled person has a claim against a trust fund or insurance policy for a monthly benefit starting on the 31st, 91st, or 366th, day (rarely) or more commonly on the 181st day of disability. Generally the claimant has to have first fulfilled an "elimination period" of disability that was continuous during which he or she could not perform his or her occupation. LTD Plans and Policies can be either totally private (individuals purchased and paid for coverage directly) or more commonly through an employee benefit plan. Employee benefits plan LTD is subject to ERISA (a Federal Law) and therefore if the claimant loses on administrative level and the claims administrator has discretionary authority to decide eligibility, it is very difficult to overturn since the Plaintiff (claimant) has burden of showing the decision by the Plan (employer, insurance company, or claims administrator) was arbitrary and capricious. Lawsuit must be brought in US District Court. Plans that are self paid and not purchased at work are resolved in State Court if lawsuit is necessary and the standard is usually preponderance of evidence.
LTD is not like Workers' Compensation, SSD or SSI where all rules and plans are the same. Each varies. This means the claimant should always request a copy of the "Summary Plan Description" and the actual Plan whenever making a claim.
The most important single issue to most claimants is how the Plan defines "total disability" and whether all his/her treating doctors say the claimant meets that definition.
Most LTD Plans are subject to an offset for any SSD or Workers' Compensation benefits received.
Anyone who is denied on an LTD claim should see a lawyer as soon as possible.
Mr. Heller is one of the few claimants' attorneys in Upstate, Western, and Central New York with extensive experience. He does not charge for an initial interview.