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Long-term disability or LTD insurance policies can vary in various respects. First, the length of the elimination period can differ. The elimination period is the amount of time for which you must be disabled before you qualify for LTD benefits under the policy. Likewise, the duration of the benefits that you receive under the plan may vary widely. Some policies permit you to draw benefits until retirement age if you remain disabled until then. Other policies limit your benefits to a specific number of years. Still other policies place time limitations on benefits for some disabling medical conditions that differ from those on different types of conditions. For example, LTD policies may limit your benefits to two years for disability based on mental health conditions, as opposed to physical health conditions.
LTD insurance policies also may differ in their definitions of what constitutes a pre-existing medical condition for which they exclude coverage. Some may exclude coverage for medical conditions for which you received treatment within three months of your effective policy date. Others may exclude coverage for up to 12 months for pre-existing conditions.
The claims process and appeals process also may be different from one policy to another. For example, an employer-sponsored LTD plan that is subject to ERISA is subject to numerous restrictions that a private LTD insurance plan is not. These restrictions have a significant impact on your ability to appeal a denial in coverage. Under ERISA, you must exhaust all administrative remedies with your insurance companies before filing suit in federal court, which strictly limits your available remedies. Under a private LTD insurance policy, you generally are not subject to ERISA requirements. As a result, you may have a greater ability to challenge the denial of LTD benefits in court and obtain relief as a result of the denial if you are successful.
Bonnici Law Group has the experience and knowledge that you need when you are filing a claim for long-term benefits. We know how to help you create and maintain a strong claim for benefits and obtain the best outcome possible in your case. Do not hesitate to contact Bonnici Law Group at 858-261-5454 or help@bonnicilawgroup.com.
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