Long term disability insurance policies pay a portion of an insured person’s income while they are unable to work due to illness or injury. Many employers offer long term disability benefits as part of their group insurance plan. Private plans are also available for individuals to purchase. These benefits are designed to protect you financially while you recover, and to provide an income if you are permanently disabled from working.
Most long term disability policies have a qualifying period which is often 6 months. In order to be paid benefits, the policy holder has to show that they have been disabled from returning to work during the entire qualifying period.
There are two main types of long term disability coverage: “own occupation” and “any occupation”. “Own occupation” coverage pays benefits while the policy holder is unable to work at their own job due to an illness or injury, whereas “any occupation” coverage only pays benefits if the policy holder is unable to work at any job for which he or she is reasonably suited.
Many policies include both types of coverage, typically providing “own occupation” coverage for the first two years of disability and then switching to the more difficult “any occupation” requirement thereafter.
A policy holder has the right to dispute an insurer’s decision to deny or terminate a claim for long term disability benefits. There is often an internal appeals procedure whereby the policy holder requests that the insurer review its decision. If this is unsuccessful, the policy holder can sue the insurer for non-payment of benefits.
Every long term disability policy is different and a policy holder’s right to benefits will depend on the wording of their individual policy and the specific facts of their case. The terms of the policy can be quite complicated. Contacting a lawyer promptly will ensure that your rights are protected.
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