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Hellmuth & Johnson PLLC

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Most asked questions regarding disability benefits

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1.  Who decides if I am entitled to disability benefits?

The benefit plan document provides all the eligibility requirements and is the governing document.  The plan document should also state who makes decisions regarding your benefits.  That person or entity is known as a fiduciary, and is typically an employer representative or an insurance company.

2.  How do I collect my benefits?

A claim file must be filed with the claims administrator.  You need to review your short or long-term disability summary plan description or plan document to determine where to obtain an application and to whom the application should be submitted.

3.  How much can I collect?

The amount of benefits to which you are entitled depends on the plan document.  Many short-term disability policies provide 100% of your pay.  Long-term disability policies typically offer 60% of pay, but it can vary.

4.  Am I able to work and still collect disability benefits?

Some disability policies allow part-time work while collecting disability benefits.  You should consult your policy to determine if your it allows part-time work.  If your policy is an “own occupation” policy, you are able to work in jobs which are not your occupation.  However, you need to be careful that working at any job may give the appearance that you are capable of performing your own occupation.

5.  What information do I need to provide?

The plan administrator usually does not state specifically what you need to provide to support your disability claim.  We recommend that you file any and all information that supports your claim, including medical records, statements from co-workers, family or friends, information relating to your disability to educate the plan administrator regarding the symptoms of your illness, cause of your illness, etc.

6.  What if my doctor thinks I can work when in fact I cannot?

You may need to find a new doctor, or you may need to educate your doctor on what it means to be disabled under your policy and the nature of your job functions.  Entitlement to disability benefits is different than your right to social security benefits or workers compensation benefits.

7.  Do I need to apply for social security benefits too?

Most long-term disability policies require you to apply for social security benefits, and if you fail to do so, the plan administrator will deduct from your benefits an amount of social security benefits as if you had applied and were granted benefits.  If social security benefits are granted, then those benefits will be deducted from your long-term disability benefits.  If social security benefits are denied, then the plan administrator cannot make a deduction. 

8.  How long will I receive benefits?

Your policy will determine how long you will receive benefits.  However, typically you will receive benefits as long as you are disabled until age 65.  Most policies limit benefits for certain types of conditions, such as mental illness, typically to 24 months. 

9.  What if my employer or the plan administrator fails to respond to my request for information relating to my benefits?

A plan administrator, which may include your employer, is required to act in a fiduciary capacity, which means the plan administrator is required to act as a neutral party and in the best interests of all participants.  ERISA requires a plan administrator to provide certain information to participants within 30 days upon request.  There is a penalty of up to $110 per day for failure to provide information within the time required.

10.  Can I file a lawsuit without filing an appeal if my claim is denied?

No, ERISA requires that you exhaust all of your administrative remedies, which means that you must go through any and all appeal processes offered by your disability plan before you can litigate. 

11.  Can my employer terminate and discontinue the benefit plan?

Yes, unless the plan document or SPD gives protection to plan participants from termination by the employer.