Dealing with the complexities of your Long Term Disability policy can create tension and frustration, which can move the focus away from self-care and healing. Our clients contact us with many questions, including the concern about their group Long Term Disability (LTD) claim being impacted by their Social Security case. The frequently misunderstood relationship between group LTD benefits and other disability benefits can be simplified with further examination.
Why is this relationship important? You should understand that most Plans give the insurer the right to “offset” Social Security Disability benefits if your Social Security Disability claim is approved. For example, if your group LTD benefit is $2200 per month and you get $1000 per month in Social Security Disability, the LTD benefit will “offset” the $1000 and pay you $1200 per month. From your perspective, you still get a total of $2200 per month. From the insurer’s perspective, they have reduced the amount of their liability to you. It is for this reason (and to their advantage) that your insurer has a motivation to assist you with obtaining your Social Security Disability benefits. Often, even if you are not yet receiving Social Security Disability benefits, the Plan allows your insurer to estimate these benefits and take this estimated amount as an offset.
Social Security has approved my disability case, but my LTD Claim has been denied.
Even though many courts have recognized the inconsistency between getting Social Security disability benefits and yet being denied LTD benefits by an insurer, insurance companies still continue to deny these claims. Insurance companies will argue that the criteria for determining disability is somewhat different between Social Security Disability Benefits and Group Long Term Disability Benefits. One reason that your insurer might deny your LTD claim is something called the Treating Physician Rule. Unlike your insurer, the Social Security Administration must apply a “treating physician rule” in which they must defer to the opinions of your treating physician. The insurer might also argue that it had evidence (such as medical opinions or surveillance) which the Social Security Administration did not.
Perhaps even more disturbing is when your insurer continues to deny LTD benefits even after arranging for a third-party firm to handle your Social Security claim, and that party successfully obtains Social Security benefits for you. Again the insurer will argue that the disability definitions and the available evidence were different. As to the evidence, unless you insist, it may be that the Social Security advocate selected by your insurer never provides the insurer with the evidence it developed in support of your disability. In this way, the insurer retains the benefit of having an advocate for the Social Security offsets, but protects itself from being confronted with the evidence supporting your disability. If your insurer has retained a third party to assist you with your Social Security claim, it is essential that you make sure the insurer’s file includes all correspondence and evidence contained in file of the Social Security advocate.
We encourage you to contact our office when things become too complicated or confusing, and to read through the information we provide so that you may become well-informed as an advocate for the benefits to which you are entitled. If you have questions about your Long Term Disability claim, call Kantor & Kantor at (800) 446-7529 for a no-cost consultation or find us on the web at www.kantorlaw.net.