Long Term Disability

You did not ask to be disabled. You wanted to work, but you have a serious medical condition. Reasonable accommodations under disability law and sick leave under the Family Medical Leave Act (FMLA) are not enough to save your job. But your employer does have a long term disability policy. The problem is that the insurance company says you are not qualified under the company insurance policy. Despite all your medical problems, you are not disabled enough, in their opinion, to qualify, and now they don't want to help you. It is important to document your claim properly with the insurance company. We can help you with the documentation and processing of your claim with the insurance company and take the matter to court in New York State or New York City if you are being improperly denied long term health care benefits.

Employers in New York must carry short term disability policies. They will cover a portion of your income up to a maximum of 26 weeks, whether you are injured on the job or off the job. On the other hand, employers are not required to have a long term disability policy, but if they do, and if you qualify, the benefits may include long periods of incapacity and significant income replacement value, in the range of 50% to 70%. The long term disability policy will generally kick in after statutory short term benefits have been exhausted.

If your employer has a long term disability plan, you should be given a summary plan description, which will have important information, such as how your company’s insurance carrier defines disability. The process of filing a disability claim with the insurance can be complicated, and detailed attention must be given to following all required procedures and submitting comprehensive medical information in relation to your claim. Submitting your doctor’s reports without review by an attorney can lead to trouble. Doctor’s know the medicine and your condition, but they are not familiar with the nuances of the requirements of the long term disability policy.  The description of your job duties must be both complete and accurate as it relates to the definition of disability in the insurance policy. You don’t want to mistakes which may allow the insurance company to deny your claim.

If the insurance company denies your claim, you have the right to go to court. The court will review the administrative record in the insurance company’s files, including your statement and your doctor’s reports, your employer’s statement and the employer’s doctor reports, plus the decision of the insurance company. The standard of review for a denial is not as favorable to employees as in other areas of employment law, so it is very important to have made a good administrative record.

Contact us online or call us at (212) 949-1001 so that we can review if your are properly documenting your claim with the insurance company or whether your New York City employer has unfairly denied you long term disability benefits.