Short & Long Term Disability

Whether your policy comes through your employer or is purchased privately, disability insurance is designed to protect your income if a medical condition prevents you from working. Typically, these policies are funded either through payroll deductions or direct premium payments, allowing you to continue receiving a portion of your salary while you’re temporarily or permanently unable to work.

This financial safety net can make all the difference during difficult times, giving you stability and security when you need it most.

How Do Disability Insurance Policies Define “Disabled”?

Now, you might be wondering what insurance companies actually mean when they say someone is “disabled.” Typically, a policy considers you “disabled” if you’re unable to perform the duties of your regular job due to illness or injury. The details can vary from plan to plan, some policies use language like “your own occupation,” while others might require that you’re unable to work in any job at all, depending on the stage or duration of your disability.

In any case, it’s crucial to review your policy closely so you understand exactly how your coverage kicks in should the unexpected happen.

Understanding Employer-Provided vs. Privately Purchased Disability Insurance

When it comes to disability insurance, the kind you have—whether it’s through your employer or purchased on your own makes a big difference in how claims are handled.

Employer-provided disability policies usually fall under the federal Employee Retirement Income Security Act (ERISA). This means there are very specific rules, strict deadlines, and a set process you’ll need to follow if you’re filing a claim or appealing a denial. It can feel a bit like navigating a maze, one wrong turn, and you might run into delays or even lose your chance to appeal.

On the other hand, privately purchased disability policies aren’t governed by ERISA. Instead, they’re regulated according to the terms spelled out in your policy agreement and overseen by state insurance laws. This typically allows for a bit more flexibility and, in many cases, more transparency when it comes to the appeals process.

Understanding which type of policy you have is the first step to ensuring your claim is handled as smoothly and efficiently as possible.

How to Obtain Short & Long Term Disability Insurance

Securing short-term and long-term disability insurance isn’t as daunting as it might seem—and doing so is a proactive way to safeguard your finances in the unexpected event you’re unable to work. In most cases, you’ll find two clear paths for obtaining coverage:

• Through Your Employer: Many employers offer disability insurance as part of their benefits package. Coverage may start automatically when you join the company, or you might need to opt in during your benefits enrollment period. Premiums are often conveniently deducted right from your paycheck, making the process simple and hands-off.
• Purchasing a Private Policy: If employer coverage isn’t available—or if you want extra protection—you can purchase an individual policy from trusted insurance providers like Guardian, MetLife, or Northwestern Mutual. Private policies give you flexibility in coverage amounts, policy terms, and premium payment schedules.

Each option comes with its own benefits. Employer plans are often more affordable, while private plans offer more customization. Whether you’re working through HR or shopping around for the right private insurer, what matters most is choosing a plan that fits your lifestyle—and brings you peace of mind.

Regardless of which path you take, keeping an eye on the policy details (such as waiting periods, coverage limits, and what circumstances qualify as a disability) ensures you and your loved ones have the protection you expect when you need it most.

How Are Disability Insurance Policies Paid For?

When it comes to paying for short and long-term disability insurance, most people either have premiums deducted right from their paychecks through their employer, or they pay for them out-of-pocket as a direct premium. Whether you’re enrolled in a workplace plan at a company like Nationwide or opting for an individual plan with a provider such as Guardian Life, these payment methods ensure your coverage continues, so your income is protected if the unexpected happens.

Surprisingly enough, our attorneys have seen hundreds of cases where insurance companies denied coverage of legitimate claims for both short-term and long-term disabilities. Too often, the reasons for denial go far beyond what most people expect, it’s not just about paperwork errors. Claims administrators, who often work directly for the insurance company, may deny your first claim even when you have a valid case.

Common reasons for denial include:

• Insufficient medical evidence: This could mean missing records, infrequent doctor visits, or a lack of a clear physician statement supporting your disability.
• Not meeting the policy’s definition of disability: Every policy has its own fine print, and companies use technicalities to argue someone doesn’t qualify—even if they clearly can’t work.
• Video surveillance: Sometimes, insurers will use footage they believe contradicts your claim, even if the context is misleading or incomplete.
• Missed deadlines: Missing a single application or appeal deadline can give insurers all the excuse they need to deny your claim.

Understanding these common pitfalls is the first step toward a successful claim. It’s times like these that people need to focus on healing and getting back to normal instead of dealing with a drawn-out disability claim process. At Agee Clymer, we provide the full spectrum of short and/or long-term disability legal services.