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What Are Some Key Provisions in LTD Benefit Plans?

What Are Some Key Provisions in LTD Benefit Plans?

In many cases, employees fail to take the time necessary to read the provisions of their long-term disability policies, or those related to other employee benefits, as they typically are quite lengthy and complex. Nonetheless, failing to read and understand some key provisions in your employer-sponsored LTD benefit plan can cause an unwanted surprise when you become ill or injured and the insurer denies your claim for benefits. As a result, you should be aware of the likelihood that your policy contains some provisions that limit coverage and understand how those limitations might apply to you.

One common limitation in LTD policies is coverage for mental health or nervous disorders. In many cases, policies will limit the amount or duration of benefits payable to cover disability caused by mental health conditions. This provision can be more complicated when you suffer from both mental and physical medical conditions. In this case, your insurer might attempt to limit your coverage based on this limiting provision, even though you have physically disabling conditions, as well.

Your policy also is likely to contain strict time limits for filing applications for benefits after a disabling condition occurs or starts, in addition to time limits for appealing the denial of benefits by the insurer. If you miss these important deadlines, then you are likely to be denied benefits under your LTD plan.

Pre-existing medical conditions also may subject to exclusions from coverage by LTD policies. In many cases, if you have been treated within the previous 90 days for a medical condition, you may not be able to claim LTD benefits for that same medical condition.

There also is likely to be an elimination period before you are entitled to any benefits. This is a period of time that must pass before the policy begins paying out benefits. In many cases, however, the elimination period may coincide with the payment of short-term disability benefits. When you apply for long-term disability benefits, you need to be aware of your rights and responsibilities under your long-term disability plan. At Bonnici Law Group, we offer you client-centered representation at all stages of the long-term disability benefit claims process. When you need the kind of help that only an experienced long-term disability benefits attorney can offer you, contact Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

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