Disability insurance helps to cover some of an employee’s lost income when unable to work due to injury or illness. Some employers provide this benefit, while some employees purchase private coverage.
Long-term disability is for an employee who is unable to work for an extended period of time. In many situations, coverage is denied. Sadly, such denials are not uncommon.
There are, however, specific ways to appeal.
Basics of long-term disability
Typically, long-term disability covers a person who is unable to work for six months or longer. Each policy varies, but some cover the insured individual to the age of 75 or even older. Payments are in the amount of up to 70% of the worker’s salary, and they continue until the disability ends. One of the downsides of long-term disability is that there is a waiting period before payments begin. This can last from between three months and two years.
How to deal with a denial
According to the United States Department of Labor, Employee Benefits Security Administration, if the company denies a disability claim, it must send a notice either electronically or in writing. This notice must include the reason for the denial and an explanation of the appeal process.
The plan should give a minimum of 180 days for the disabled worker to file an appeal. The appeal preparation should take into account the reason listed on the denial notice. The employee should include any additional or supportive information to support the appeal and then submit it to the specified person or department in time.
An individual must review the appeal within 45 days of receiving the review request. If there is a second denial, the claimant may appeal again. If the claim is denied again, the employee can challenge the action in court.