Short & Long Term Disability
Filing a Successful Short Term and/or Long Term Disability Claim Starts with Finding the Right Lawyer
It’s no secret having short- and/or long-term disability insurance provides peace of mind. There’s nothing more reassuring than knowing a policy is in place to protect you and those you love should an incident occur.
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.
As the premier disability claim attorney in Columbus, Ohio, we facilitate the moving parts that deliver a promising outcome for our clients:
- Phone calls
- Paperwork
- Negotiations
- Scheduling
Our tailored approach puts your rights ahead of insurance companies. We unite credible resources with our industry expertise and build winning cases. As an Agee Clymer client, you’ll be able to focus on your wellbeing and stay updated on your claim in real-time.
How Are Legal Fees Structured for Disability Insurance Cases?
When it comes to legal fees for short-term and long-term disability claims, most reputable disability attorneys including our team here in Columbus, work on a contingency fee basis. This means you won’t pay any legal fees unless your case results in a successful benefit award or settlement. No need to worry about upfront costs, hidden charges, or paying for expensive medical records and expert opinions out-of-pocket. We advance those expenses on your behalf, so you can concentrate on your health and recovery while we handle the financial logistics of your claim.
This approach makes quality legal help accessible, minimizes your financial risk, and ensures we’re invested in fighting for the best possible outcome—because we don’t get paid unless you win.
Can an Insurance Company Reevaluate and Stop My Disability Payments?
Absolutely, but not always for reasons you’d expect. Even after your disability claim has been approved and payments have started, insurance companies like The Hartford or Unum can revisit your case at any time. It’s their way of double-checking whether your condition still meets the policy’s definition of disability.
Here’s how the process usually works:
- They may ask for updated medical records or send you to an independent exam.
- Their medical team reviews the latest information about your health.
- If they believe your condition has improved or no longer qualifies as disabling, they can move to terminate your benefits.
If that happens, you’ll need to act fast to defend your rights often, this means gathering stronger medical evidence or appealing their decision. Our legal team is here to help you navigate these reviews and, if necessary, fight back for your benefits.
Understanding Long-Term Disability Waiting Periods and Payment Duration
In most cases, long-term disability insurance policies include an initial waiting period often around six months before benefit payments kick in. While each policy may differ, this “elimination period” is standard across the industry. After benefits begin, many plans continue payments until you reach the age of 65, or until you’re able to return to work, whichever comes first.
This is why it’s vital to review your specific policy documents and work closely with experienced attorneys who can help you navigate these timelines and maximize your benefits.
What Other Types of Income Can Reduce Disability Insurance Payments?
It’s important to know that receiving income from certain sources may lower the amount you get from a short or long-term disability policy. Insurance companies often include “offset” clauses in their policies that allow them to reduce your benefits if you’re bringing in money from:
- Social Security Disability Insurance (SSDI) for you or your dependents
- Workers’ compensation payments
- Unemployment benefits
- Some pensions or withdrawals from your 401(k) or other retirement accounts
These offsets can be frustrating, especially when you’re counting on your policy to help you through a tough time. That’s why understanding your policy—and having someone in your corner to advocate for your full rights—can make all the difference.
How Does the Disability Insurance Claims Process Differ from Social Security Disability?
Clients often ask how filing a claim with a private disability insurer stacks up against applying for Social Security Disability benefits. The answer comes down to the requirements you’ll need to meet and frankly, disability insurance often has a more straightforward path.
Unlike Social Security Disability, where an applicant must demonstrate an inability to work any job based on age and other factors, private short-term and long-term disability policies typically require only proof that you cannot perform your own occupation. In most cases, age isn’t weighed against you the same way it might be under the more rigid Social Security standards.
This key difference means that a professional—whether you’re an RN at OhioHealth or a manager over at Cardinal Health only has to show they’re unable to do their specific job to qualify for benefits under their disability plan. Social Security meanwhile, can apply a tougher lens, especially for younger workers.
When should I talk to a disability attorney?
Our legal experts suggest contacting us after being denied coverage or benefits. This helps us assist you throughout the confusing appeals process and sets your case up for success long-term.
But that’s not the only time we can help. If your disability benefits have been wrongly terminated, your claim has been delayed without a valid reason, or you’ve received a settlement offer that doesn’t reflect the true extent of your disability, our team can step in to advocate for your rights. Navigating these situations alone can be overwhelming, but with experienced guidance, you can protect your interests and improve the chances of securing the benefits you deserve. Hiring an experienced disability attorney is essential especially in the Columbus market.
What Happens If My Disability Insurance Appeal Is Denied?
If your disability insurance appeal hits a roadblock, don’t panic you still have options. Policyholders are entitled to challenge not just the original denial, but also the outcome of the appeal itself. Strict appeal deadlines apply, often 180 days under ERISA plans or private policies, so time is of the essence.
Should your appeal be denied, the next step is usually taking your case to federal court. This process looks quite different from what you see on TV; there won’t be a jury trial. Instead, a federal judge will review all the evidence, including the insurance company’s reasoning and your additional medical documentation to determine if the denial was reasonable. The judge’s focus is on whether the decision was supported by the information presented, not simply on who tells the most compelling story.
Having an experienced legal advocate by your side increases your chances of overturning a denial and ensures you meet every crucial deadline.
How Does a Federal Court Review Denied Disability Insurance Claims?
If your appeal hits another roadblock and you’re still denied benefits, the next step can involve taking your case to federal court. Unlike a traditional lawsuit, you won’t face a jury instead, a federal judge will take the reins.
Here’s what that process looks like:
- The judge thoroughly examines all documents related to your claim, including the insurance company’s reasons for denial and the medical records and expert opinions you provide.
- During this review, both sides can submit information to support their case, but no new evidence or testimony is typically allowed at this stage.
- Ultimately, the judge determines whether the insurance company had a reasonable basis for denying your claim or if the decision should be overturned.
This focused process puts your claim under the microscope ensuring that all factors are considered, and your right to a fair outcome is protected. Call our office at 614-221-3318 or click below to schedule a free consultation.
What is the process and deadline for appealing a denied disability insurance claim?
If your disability insurance claim has been denied, you have the right to formally challenge that decision but time is of the essence. Most disability policies, especially those governed by ERISA, require that you file your appeal within 180 days of the denial. Missing this window could hurt your chances of obtaining benefits, so acting quickly is critical.
Here’s how the typical appeal process works:
- Submit a Written Appeal: You’ll need to provide additional medical records, evidence, or statements supporting your claim. This is your chance to address any reasons the insurance company gave for the denial.
- Wait for a Decision: The insurance company will review all the new evidence you’ve submitted, along with your original application.
- Further Legal Action: If your appeal is denied again, you may have the option to file a lawsuit in federal court. In these cases, a federal judge examines the facts, reviews the insurance company’s justifications, and considers the expert opinions provided. The judge, not a jury, makes the final decision on whether your claim should have been approved.
Throughout this process, it’s easy to feel overwhelmed. That’s why having an experienced disability attorney in your corner can make all the difference helping you gather evidence, meet crucial deadlines, and ensure your voice is heard.
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