How a New Long Term Disability Claim Is Handled By an Adjudicator

When you need to apply for long term disability, the formal process takes some time, especially if the Massachusetts court adjudicators are backed up. While the process varies based upon your employer and medical situation, you can expect it to take up to 6 months. Your disability lawyer can help you understand the disability adjudication process and may be able to help you with any appeals or paperwork submissions that you need to do for your case.

Determination of Disability

The first task of a disability claim adjudicator is to determine whether or not you are completely disabled. The adjudicator is typically a physician or a team of nurses and physicians. The adjudicator may take into account your physical limitations and how they relate to the type of work you do.

Determination of the Benefit Period

The adjudicator must also determine the disability benefit period. In Massachusetts, most people can continue to receive long-term disability benefits until they reach the age of 62. After this, social security benefits take over the disability payments.

Determination of the Qualifying Period

Another task of a disability claims adjudicator is to determine the qualifying period for your disability. Most long-term disability claims require that you will be permanently and completely disabled for more than one year and that you are incapable of doing paid work. The adjudicator may consider time periods when you had a partial disability.

Video Records Do Not Show the Entire Story

When an individual has been injured or has become too ill to work, long-term disability insurance can provide them the financial protection they need. It can be frustrating for a sick or injured employee when their company’s insurance plan denies them their benefits.

There is a stark difference between disability claims that are filed with the federal government, such as Social Security disability, and those that are filed with private insurance companies. The government strives to be impartial whereas private insurance companies generally do not. The more claims private insurance companies are able to deny, the healthier their bottom line becomes.

To this end, some insurance companies might use certain tactics in order to deny benefits unfairly. For example, it is not uncommon for them to use surveillance to monitor the activity of individuals applying for benefits. They may take photographs or record video of an applicant taking out the trash, grocery shopping or bending over to pet a dog. They may even accuse the applicant of lying about their condition.

Video footage is deceptive because it does not show the entire picture. An applicant may be recorded bending over to pick up a heavy bag, however, the video may not even show the pain the applicant is in for the rest of the day because of making that small movement. Attorneys work with their clients to fight partial video evidence with the goal of painting an accurate picture of their client’s condition.

Appealing the Denial of an LTD Claim

There are different reasons why a long-term disability (LTD) claim may fall on deaf ears. Where will you be, however, if your own claim gets denied? If the latter happens, giving up is not an option—at least not yet. All LTD claims allow for at least one (at times even two) levels of administrative appeals, and it is through this that claimants who got denied the first time can get compensated for their trouble.

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ERISA and Long Term Disability

The Employee Retirement Income Security Act, or ERISA, is a Federal law that was made to protect employees’ rights to their benefits. In the case that an employee has become disabled and is unable to work, they may be qualified for long term disability benefits under the ERISA plan, which is usually included by the employer as an employee benefit. ERISA does not apply for disability insurance plans that have been purchased individually.

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