A Guide to Your Rights

• An Overview and Introduction
• Health Insurance
• Patient Safety
• Private Benefits:
  Motor Vehicle Insurance
• Private Benefits: Disability Insurance
• Private Benefits: Workers Compensation
• Public Benefits:
  Commonwealth Of Pennsylvania
• Public Benefits:
  Crime Victims Compensation Fund
• Public Benefits:
  Federal Government
• Public Benefits: Attendant Care
• Disabled Children
• Rehabilitation Hospitals
  & Facilities
• Vocational Rehabilitation Services
• Civil Litigation: Claims For Damages
• Resources
• Support Groups
• Entitlements And Benefits
• Acknowledgements

 

Private Benefits: Disability Insurance

While a catastrophic injury may bring the life of a family to a halt, it does not stop the business of mortgage companies and utility companies, and does not stop the need for food and other necessities of life. Disability insurance can help fill this gap.

This section discusses private disability insurance, which many people have through work. Public disability benefits are potentially available from the federal government through Social Security programs, and potentially through other sources as well. These public disability resources are discussed below.

In general, there are two different types of private disability insurance: short-term disability and long-term disability. Short-term disability insurance generally begins at the time an individual becomes disabled and, as its name suggests, does not last very long (for example, a typical short-term disability policy may provide coverage for ninety days or six months). Long-term disability coverage generally does not begin until after an individual has been disabled for a certain period of time. Usually, long-term disability picks up when short-term disability terminates. For example, a 90-day short-term disability policy would be paired with a long-term disability policy that would begin to provide benefits after 90 days.

This insurance can be of critical importance. It is important that short-term disability benefits be pursued as early as possible. Most insurance policies have procedures in place that set up deadlines and timing requirements that are important to attempt to meet. If your employer sponsored or purchased the policy, human resources personnel at work can often help handle the paperwork necessary to apply for disability (although it is important that you stay involved in the application process and make sure that the necessary paperwork is being taken care of).

Often medical review is required to establish eligibility for benefits, and it is important that the disability insurer be provided the medical records and reports that document the extent of the victim’s injuries and disabilities. Even if an employer’s human resources department is helping with the paperwork, much of the burden of gathering this medical information from doctors and therapists often falls on victims and their families. This is a chore that needs to be taken care of, because disability carriers often claim that they are only required to consider the documents and information placed in front of them, and disability carriers might be less than diligent in their own efforts to gather medical records and information.

If a disagreement arises between the insured and the insurance company about whether or not an individual is disabled, it is important to get a copy of the disability policy (sometimes this is a document referred to as a “plan document”), and to review carefully the policy’s definition of “disability”, as this term can vary from policy to policy.

Most disability policies guarantee an income level that is a certain percentage of pre-disability income, and many long-term disability policies provide that the private disability benefits will be reduced by the amount of Social Security benefits that are received (Social Security benefits are discussed below). Because social security benefits can reduce the disability insurer’s obligations, many policies cover the cost of representation during the social security application process. Normally, if an award of social security benefits includes a retroactive award for previous time periods that were also covered by disability insurance, the insured is required to reimburse the insurer for all or part of these retroactive benefits.

Some short-term disability policies may also require the insured to reimburse the disability carrier for amounts received from social security. Many do not. It is important to review the language of the particular policy at issue.