About a third of us have private disability insurance as an employment benefit, while many others purchase it on their own. You should qualify for benefits if you have mesothelioma and suffer from its side effects. You must go through the claims process first, and if you’re turned down, you can challenge the decision.
Do You Meet the Policy’s Definition of “Disabled”?
Private disability insurance partially replaces your income if you can’t work. Compared to Social Security Disability Insurance (SSDI), these policies usually have broader definitions of disability. You must be totally disabled and unable to perform any job to get those benefits. Depending on your policy, you may have a lower barrier to overcome.
Definitions vary, but these are the three most common:
- “Own occupation”: Policyholders qualify if they can’t perform the duties of their particular occupation
- “Own occupation” with time limits: You can’t do your job for a limited time. If you still can’t perform your job after this time frame (usually one to five years), you must show you can’t perform “any” occupation, which is the SSDI standard
- “Any occupation”: To be awarded benefits, you must show you can’t perform any job, like SSDI
Another reason private disability coverage is better than SSDI is that the benefits are usually greater. There’s a relatively low cap on SSDI benefits, while a personal policy may give you about 70% of what you were paid when your disability started.
Can You Prove You’re Disabled?
Filing for benefits requires submitting proof that you meet the policy’s definition of disability. Depending on your insurer, you may be able to apply over the phone, through the mail, or online.
You and your employer will have forms to fill out. Your physician will also have paperwork to complete and provide copies of medical records backing up your claim. The approval process is quick. You should receive a response in a few weeks to a little more than a month.
The parties involved have different information to provide:
- You: You’ll provide documents providing details of your condition, its degree, and its impact on your work. You will also provide contact information, where you worked, income sources, the identities of your healthcare providers, information about your health insurance, and other benefits you may receive
- Your doctor: Should show you meet the policy’s disability definition. They must provide a lot of information, including your diagnosis, treatment history, level of impairment, and the doctor’s opinion on whether you’re able to return to work
- Your employer: They describe what you did, your pay, how your disability affects your ability to work, and what, if any, other benefits you receive. There may be a checklist of tasks you can or cannot perform, and the insurance company will want to know your last day of work
Your policy probably requiresyou to apply for SSDI benefits. If awarded, their amount will be deducted from your private disability benefits. If they’re denied, which is unlikely, you should get these personal benefits in full.
If Your Claim’s Approved, You May Need to Wait for Benefits
If your claim is approved, there may be a delay before your benefits start. Your policy probably has a 90-day “elimination period,” which begins the day you become disabled. Your benefits may be delayed depending on how long you waited to file your claim and how long the insurance company took to decide.
Payments may last until the benefit period ends, which for long-term disability insurance can last from two years to the time of your death.
If the Company Rejects Your Claim, You May Appeal Their Decision
If your claim’s rejected, there’s a good chance the insurance carrier will say it’s because you:
- Didn’t meet the policy’s disability definition
- Misrepresented something on your initial application when you bought the coverage
- Are claiming disability for an illness that’s excluded from coverage (such as a pre-existing condition)
Their denial may be based on something simple you can resolve. They may want more medical records or claim you didn’t seek treatment before applying for benefits.
Before you file your appeal, get a copy of the insurance company’s information about you. If there are mistakes, you can correct them. You could file your internal appeal with any information or documents they claim are missing. You may have grounds to appeal through the courts if your internal appeal is denied.
Call Us Today For A Free Mesothelioma Lawsuit Consultation
In addition to disability insurance benefits, you may qualify for compensation from the asbestos industry. If you or someone you love has mesothelioma or another asbestos-related illness, Satterley & Kelley can help. Call our Louisville office at 855-385-9532 or complete our contact form to schedule a free initial consultation.