Long Term Disability is a private disability payment system, typically operated by a large insurance corporation (e.g., Prudential, MetLife, or UNUM). It is a benefit sometimes offered by the employer and can be a valuable asset to the employee should said employer elect to offer it. When an employee is denied benefits under an LTD plan, the Federal Court has jurisdiction to hear these claims. Federal court access is conveniently located just minutes from the Cleveland, Ohio office of Margolius, Margolius and Associates. Federal court jurisdiction in Columbus, Ohio and adjacent states is also part of the representation by Margolius, Margolius and Associates.
While Long Term Disability plans are premised on the inability of the employee to work, much of the battle is defined by definitions and limitations within the LTD contract itself. For example, most policies have two relevant time periods used to evaluate claims. The first period is called “own occupation” and requires that an employee be found disabled if he or she is unable to perform his or her own occupation. This “own occupation” period typically applies to the first two years an employee is disabled. Following the “own occupation” period, the insurance company will apply an “any occupation” standard. In order to receive benefits during this period, an employee must establish an inability to perform any kind of work at all, not simply that work which is confined to one’s own occupation. The Social Security Administration uses a similar standard when evaluating claims for disability benefits. However, the legal standard used by the Court in LTD claims is much more stringent than that used for Social Security claims.
Other evidentiary issues distinguish LTD claims from Social Security claims. Little or no deference is given to the treating physician’s opinion and, more importantly, once the administrative portion of the case is over, no new medical evidence can be submitted. Given these difficult standards, it is particularly important to have aggressive advocacy during the early stages of a long term disability case.
Another pertinent caveat is that virtually all the Long Term Disability policies require that the employee apply for Social Security. If the employee receives Social Security, then the Long Term Disability benefits are reduced by the amount of the Social Security check.
At Margolius, Margolius & Associates, great care is taken to ensure the availability of both private and federal disability benefits. Our approach is to ensure that the appropriate medical and vocational evidence exists to support the claim. This involves close, detailed work with both the client and the medical providers. We also strive to identify all vocational issues in support of our arguments.
Clients with long term disability issues should not wait until they have been denied to hire an attorney. At that juncture, the ability to develop and maintain completeness of evidence is greatly weakened. If you or a friend have a long term disability or social security issue, please set up a consultation so that we may assist you in receiving the benefits you deserve.
