What to List When a Disability Involves Multiple Conditions
Dec. 29, 2022
You’ve applied for a long-term disability (LTD) insurance policy at work, or you’ve contacted a broker and purchased one on your own, figuring it will provide protection against something you never expect will happen, such as a mental or physical condition that makes it impossible for you to carry out your duties at work.
You understand that should a disabling condition prevent you from working, your LTD policy is designed to kick in to provide benefits such as replacement for lost wages, but in your own situation, you are suffering from multiple conditions that leave you unable to continue in your profession.
Perhaps you’re facing depression as well as suffering from a neurological disorder such as migraines. You can deal with one but not both at once. Can you list all of the conditions on your application, or must you pick just one when filing?
All insurance policies are different, so you need to look into how your particular plan defines disability. One of your conditions may qualify on its own, but the two combined are what’s really causing your problems. Your LTD provider is under federal scrutiny if you bought your policy at work and is under state law if you purchased it outside of your employer’s sponsorship. Either way, the insurer is obligated to be fair and thorough.
Policies supported by your employer are covered by the Employee Retirement Income Security Act (ERISA), while policies purchased from private brokers are covered by state law. This distinction can come into play if you ever need to file an appeal over an adverse decision by your provider.
If you’re in or around Minneapolis or St. Paul, Minnesota, and you need to file an LTD claim but you’re unsure which condition or conditions you should list on your claim, or what steps you should take to get your benefits, contact Beedem Law. Our disability attorneys can help you submit a comprehensive claim backed by pertinent details to improve your chances of success. We also proudly serve clients in Duluth and throughout the counties of Hennepin, Ramsey, Dakota, and Anoka.
Will the Insurance Company Consider More Than One Condition?
Your insurance company has an obligation to perform a whole-person analysis and a global review of a claimant’s health condition. In other words, it may be that none of the individual health concerns are disabling on their own, but that the particular combinations of problems are disabling. It is imperative that a claimant list all of their health problems when filing a claim for disability benefits.
What Should I List on My Claim Form?
Make sure to list all the conditions that contribute to your disability. The insurance company will consistently reference “those conditions for which you claimed disability.” Failing to list all conditions could have a negative impact on reviews down the road. Benefits don’t always last forever, and the insurance company will no doubt check in down the road to see whether you’re as disabled and unable to work as you claim.
Why Is It Important to List Multiple Conditions on My Claim Form?
Most policies have limited pay periods for certain claims. For example, there is a 24-month period for disabilities caused by mental health. If someone files for disability due to depression but fails to list their back problems that result in or worsen the depression, they could hurt their claim beyond the 24 months.
Many LTD insurers will require a person on disability benefits to apply for Social Security Disability Insurance (SSDI) to offset the benefits they’re paying out. This means they will pay the difference between your SSDI benefits and what they owe you.
The Social Security Administration (SSA) defines a disability as a condition that prevents you from any substantial gainful activity (SGA) – which means earning more than $1,350 a month – for at least 12 months. It also will consider multiple conditions taken together as being disabling, but they must appear in the SSA’s “Blue Book” of acceptable conditions.
Many policies also have stipulations regarding your “own profession” and “any profession.” Your policy may state that it will only pay for your continued disability and inability to return to your former duties for a limited term, say 24 months.
After that, depending on your education, skills, and work experience, they may ask – or even require – you to use your particular skills to find employment in “any profession.” This does not mean flipping burgers at a fast-food establishment, but finding a job that you can perform in your condition, even if you’re not fully recovered. Benefits will then be lowered or perhaps canceled.
Trusted Legal Guidance When You Need It the Most
If you’re mental and/or physical conditions combined together keep you from performing the normal duties of your position at work and you have an LTD policy, you need to press your claim expeditiously.
If you’re in or around Minneapolis or St. Paul, contact us at Beedem Law. We will assess your situation and help you file an insurance claim. If you encounter questions or resistance to your claim for multiple disabling conditions, we will help you pursue every angle to get the benefits you deserve.
Together, we have more than 50 years of experience fighting insurance companies' stalling, lowballing, and outright denial tactics. Working with us can speed up the path to having your claim considered and hopefully granted in full. Your first consultation is free.