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 Top Philadelphia Long-Term Disability Lawyer for Professionals

Are you suffering from an injury or sickness that is preventing you from working? Or has this injury or sickness limited your ability to work? Can you no longer perform all of your job responsibilities or does it take you significantly longer to complete your duties? Are you losing money due to injury or sickness? If you are a professional with long-term disability insurance provided by your employer, a Philadelphia long-term disability lawyer at Seltzer & Associates can assist you in filing your claim for disability benefits. Properly filing your claim and providing appropriate and necessary “proof of loss” are critical to achieving success in your long-term disability insurance claim. Contact us immediately to begin the process for submitting your long-term disability insurance claim.

Our Philadelphia Long Term Disability Lawyer Explains the Specialty Coverage for Medical Professionals

Oftentimes, physicians, dentists, psychologists, nurse anesthetists, chiropractors, and other medical professionals have long-term disability insurance policies which cover your inability to perform your specific occupation or your own. When your ability to work in your occupation has been impacted by an injury or sickness, it is important for you to understand your policy and know what provisions you must satisfy to obligate your disability insurance company to pay you benefits.

Your policy may contain:

  • “Own Occupation” coverage: Your inability, due to your injury or sickness, to perform the material and substantial duties of the occupation you were performing when you became disabled.
  • “Any Occupation” coverage: Your inability, due to your injury or sickness, to perform the duties of any gainful occupation for which you are qualified by training, education, or experience.

These rules can be confusing for people who aren’t familiar with them. Disability insurance companies sometimes try to redefine “own occupation” for medical professionals, expanding it to include roles like being an entrepreneur, administrator, lecturer, teacher, or chief of staff. This changes the coverage for your specific job duties. If you want help with your claim and to avoid this confusion, reach out to Seltzer & Associates.

Understanding Your Long-Term Disability Insurance Policy

Long-term disability insurance policies often contain the most restrictive provisions and language that can be difficult to understand. We will review your existing policies on a line item basis to help you achieve the best possible understanding of what long-term disability insurance coverage you have and when benefits should be payable. We will methodically analyze the definitions in your specific policy and how those definitions apply to your unique situation.

Let a Philadelphia Long Term Disability Lawyer Evaluate Your Policy Options

At Seltzer & Associates, we can also review prospective new individual disability insurance policies and compare them to your employer-provided long-term disability policies so you can better understand how best to protect your financial needs without leaving any gaps in coverage. Working with your insurance broker, our long-term disability lawyers can assist in providing you with an understanding of the policies you are reviewing for purchase.

Understanding the Important Provisions In Your Long-Term Disability Insurance Contract

It is important to understand your policy is a contract, which must be satisfied in order to obligate your disability insurance carrier to pay you disability benefits. While you may think this is easy to understand, your disability insurance company will require that each definition, each provision, every line, and every word in your policy be satisfied in accordance with the position of its claims department before it will be obligated to pay you disability benefits. Therefore, it is important that you fully understand your policy and what is required to obtain the benefits you seek under your policy.

Some of the important policy provisions include:

Additionally, many long-term disability insurance policies contain specific policy limitations and exclusions. When you have suffered a disabling sickness or injury, it is important to understand how each of these policy provisions works together and affects one another. It can often be a confusing process to understand what you are entitled to and how to obtain the appropriate benefits, especially at this time in your life when you are suffering a severe medical condition and in need of your benefits.

Let Seltzer & Associates analyze the specific policy provisions as they appear in your policy and apply them to your unique situation. Your employer provided you with long-term disability insurance to assist you in focusing on your health and getting back to work when you suffer a sickness or injury; however, your insurance company is a business looking to protect its profits. After careful review and analysis, your Philadelphia long-term disability insurance attorney will work for you to obtain the disability insurance benefits you deserve.

Social Security and Other Income Benefit Offsets Explained by a Philadelphia Long-Term Disability Lawyer

Most long-term disability insurance policies contain clauses that allow your disability insurance company to claim an offset of your LTD benefits based on other sources of income you are receiving. These offsets often include benefits you are receiving from Social Security, state disability benefits, other group LTD benefits, and compensation from your employer.

Do I Have to File for Social Security?

In addition to taking an offset for Social Security Disability benefits you are receiving, most group long-term disability policies require you to apply for Social Security Disability benefits at the discretion of your disability insurance company. Should your initial application for Social Security Disability be denied, your policy will usually require you to appeal the decision and continue appealing until the disability insurance company is satisfied.

While you may feel you do not qualify for Social Security Disability, as often happens when you qualify for your LTD benefits under your own occupation definition of disability, should your disability insurance company determine they believe you qualify for Social Security Disability and request you apply, then they are usually entitled to take an estimated offset if you refuse to apply or appeal a denial of Social Security Disability benefits.

Some Notes About Policy Limitations for Disability Insurance

Policy Limitations on “Mental Nervous” Conditions in Long-Term Disability Insurance

Many long-term disability insurance policies include provisions that limit disability benefits to two years for disability conditions that result from mental illness. Although there are usually only “organic” brain condition exceptions, these “mental nervous” limitations are extremely broad and encompassing. Long-term disability companies often try to limit any claim that has any “mental nervous” component under this provision. Additionally, even if your policy does not contain a substance abuse limitation, as described below, your company may still try to sweep a substance abuse claim under the “mental nervous” limitation.

Policy Limitations on Substance Abuse Conditions in Long-Term Disability Insurance

Many long-term disability insurance policies limit disability insurance coverage for disabilities caused by drug and/or alcohol addiction, use, abuse, or dependence to two years. If you suffer from one of these conditions, it is important to understand and recognize how such limitations may apply to you.

Presenting your claim in view of these limitations is extremely challenging and requires much thought and preparation. Let a Philadelphia long-term disability insurance attorney at Seltzer & Associates assist you in preparing and presenting your claim in the strongest possible way with the greatest likelihood of obtaining the maximum benefit payable under your long-term disability policy.

The Long-Term Disability Insurance Lawsuit Process in Pennsylvania

While every case is different, the following offers an overview of the long-term disability insurance lawsuit process:

  • Gathering the Facts and Collecting Evidence. To begin, we will gather as much information as we can to make our case. We will obtain and review the entire insurance company file if available pre-suit, and all medical information germane to the case. 
  • Filing the Lawsuit. Next, we will prepare all necessary court documents to commence litigation, filing them in the proper jurisdiction and court, then serving them on the insurance company.  
  • Pre-trial Motions. Your Philadelphia long-term disability lawyer may make several pre-trial appearances in court to address various matters of law and procedure. You generally will not need to be present at these hearings. 
  • Conducting Discovery Examinations.  In non-ERISA cases, when each side presents the other with the documentation it has requested, the lawyers will have the opportunity to question each other’s witnesses and experts under oath in both writings (interrogatories) and in person (depositions). In ERISA matters, discovery is generally limited to the administrative record.  We search for holes in the insurance company’s rationale for denying or terminating your claim. On the other hand, the defense attorney(s) efforts will be focused on reaffirming the reasonableness of its decision to deny or terminate your disability claim. Though you may be required to give a deposition, you should not feel overwhelmed.  We will work with you so you can be prepared and confident during your actual deposition. 
  • Negotiated Settlements and Mediation. As the pre-trial work progresses, we may be engaged in voluntary or mandated settlement discussions with the opposing party. The parties may also engage in pre-trial mediation — using the services of a third-party mediator — to reach an amicable settlement. Settlement negotiations can proceed up until the moment the case is put into the hands of the judge or jury to decide.
  • Proceeding to Trial. If pre-trial settlement efforts fail, the case will proceed to trial.  This will be a bench trial in ERISA cases, wherein the presiding judge decides the prevailing party.  It can take several weeks for each side to present its case and reach a final disposition.

Learn the Ins and Outs of Your Policy by Scheduling a Consultation with a Philadelphia Long-Term Disability Lawyer at Seltzer and Associates

It is important to understand when your long-term disability insurance company is entitled to take an offset and especially when they are not entitled to. At Seltzer & Associates, we will work with you, your Social Security attorney, and anyone else to help you coordinate your additional employment and financial options to ensure you are receiving all disability benefits to which you are entitled. The offset process can be complicated and the insurance company will always look to take the maximum offset possible; contact a Philadelphia long-term disability lawyer at Seltzer & Associates to assist you with your claim to ensure you receive the proper disability benefits.

Philadelphia Long-Term Disability Insurance FAQs

You’ve got questions, and our Philadelphia long-term disability lawyer team has the answers. We understand that this area of law is complicated. We want to ensure that you understand your rights and take advantage of the benefits offered to you – or the benefits you’ve been paying for – so you can put your recovery first and get back to a healthy state. 

What is long-term disability (LTD) insurance?

Long-term disability insurance protects injured or sick workers from a loss of income while they are out of work for a long period. Unfortunately, some illnesses, injuries, or accidents are more severe, and this type of coverage will cover a worker for a specified extended period.

The amount of income replacement available will depend on the policy, but most group long-term disability plans pay 60% of a person’s earnings. 

Do I need a lawyer to file a long-term disability claim? 

Many workers wait to hire a Philadelphia long-term disability attorney until the insurance company denies benefits. While it is critical to hire an attorney if your claim is denied, a lawyer can also help file your claim and protect your rights. An experienced attorney can provide advice and recommendations while filing your claim. Long-term disability insurance companies have a primary focus to maximize their profit margins. An attorney can help you ensure you receive the benefits you deserve. 

What types of disabilities are eligible for long-term disability claims? 

A common misconception about long-term disability is that it is primarily for employees who cannot work due to an accident or injury. However, it is also comprehensive coverage for many medical conditions, such as chronic illnesses, neurological disorders, and other diseases. 

Some of the most common illnesses and injuries that often qualify as a disability include:

What are the rules for long-term disability? 

Long-term disability provides income replacement for a portion of your earnings before an injury results in you not being able to fulfill your essential job duties. There are certain general requirements, though the specific terms vary from policy to policy. 

  • Waiting period – All LTD policies require the policyholder to remain disabled for a period of time before the disability benefit payments can start. 
  • Full-time work – Most policies provide coverage for full-time employees. If you have your own insurance, then this might not be the case.
  • Pre-existing conditions –  Most long-term disability policies have exclusions for pre-existing conditions. It is important to work with a Philadelphia long-term disability lawyer to determine if your illness or injury is covered by your policy.

Can you be terminated while on long-term disability?

Your LTD policy doesn’t offer you job protection. In many cases, an employer is legally allowed to terminate an employee who is receiving disability benefits. It is worth noting that based on the circumstance of your termination you may have a wrongful termination claim, but that is not associated with your LTD benefits.

How much does long-term disability insurance cost for doctors? 

A physician disability insurance policy can be more expensive than traditional policies and varies based on your age when you purchase the policy. A young doctor should expect to spend two to six percent of the benefit amount per month.

I am a doctor. When should I get disability insurance for myself? 

It’s important for doctors and medical professionals to secure disability insurance when they are in the early years of their careers. Purchasing insurance at an early age will keep your coverage options affordable and protects future income potential, which means you can pay off your medical school debt faster. 

How do I know if I have a pre-existing condition? 

A pre-existing medical condition can be either mental or physical. Most plans have exclusions for offering disability insurance benefits to conditions that were pre-existing, which can include any chronic physical, mental, or emotional condition that you have been treated for medically in the past. Some of the most common include asthma, heart disease, arthritis, depression, and anxiety. 

Your insurer will get access to review old medical records to identify if there was any diagnosis that might fall under your policy definition of “pre-existing.” Ask any Philadelphia long-term disability insurance attorney at our firm and we can tell you that claims are frequently challenged or denied on the basis of pre-existing condition exclusions.

How Long Will a Disability Insurance Lawsuit Take?

It is difficult to predict the timing of a disability insurance lawsuit. In the vast majority of cases, long-term disability lawsuits are settled prior to a final disposition by the courts, often within a year. Some cases don’t settle until the litigation process is well underway.  Some cases go through the entire litigation process and are ultimately decided by a court of law.  

 

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