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What Is a Long-Term Disability Insurance in California?

Apr 5, 2022 | Insurance

What Is Long-Term Disability Insurance?

Long-term disability insurance policies provide financial assistance to those who can no longer work due to an injury or prolonged illness. It typically covers disabilities that prevent those from working for at least two years, as opposed to short-term disability insurance, which covers disabilities that last shorter than that.

These policies generally do not pay the disabled party’s full salary upon stopping work, and depending on the policy, tend to pay between half and three-quarters of it. Many full-time employees already have long-term disability insurance through their employers.

How Do I File a Long-Term Disability Insurance Claim?

The process of filing a claim can be done by following these three steps. Keep in mind that you may want to submit any other documentation that is not required for submitting a claim but that you think will help your case. The steps are as follows:

  • Step 1: Fill out the initial claim form through either your employer or through your insurance provider website directly.
  • Step 2: Submit employee and employer statements. These will confirm all of the facts regarding your disability, how it has affected your ability to work, and the medical treatment you received due to your disability. They will help the insurer decide whether your occupation could accommodate your disability.
  • Step 3: Submit a doctor’s statement. Your doctor will be required to provide information regarding your diagnoses, symptoms and lingering health issues, treatments provided and medications taken, the nature of your disability and whether it was work-related, and their official estimates on your limitations at work and when/whether you could return. This will further help the insurance company to accurately assess the severity of your disability and how it will affect you in the workplace.

What Happens If My Claim Is Denied? How Can I Appeal?

Insurers can deny a long-term disability insurance claim for a variety of reasons.

For example, they might claim that your disability is not severe enough to prevent you from performing the duties of your job, or that your treatment history does not offer compelling evidence that you are too injured/ill to work. They may also reject it based on you missing a deadline that was agreed upon in the policy, so it is imperative that you are aware of when you must submit the claim in order to gain compensation.

There are instances when insurers act in “bad faith” when rejecting a claim, meaning that the insurer wrongfully denied your claim or denied it based on an insufficient reason. Some examples of acting in bad faith are:

  • Making an insufficient settlement offer based on the evidence provided
  • Ignoring medical documentation of legitimate disabilities
  • Unnecessarily delaying/denying benefits for a long period of time, often done to influence the claimant into taking a low offer given their financial situation

Are you in need of additional information regarding long-term disability insurance claims in California? Our employment law attorneys at KAASS LAW would be happy to help you out. Get in touch with us anytime at 310-933-5171 or fill out the form below.