How Can You Improve the Odds of a Successful Disability Application?

11 February 2016
 Categories: Law, Articles

If you've recently suffered a debilitating injury or illness that you fear will leave you unable to return to full-time work, you may be wondering about your income options going forward. Once your sick or vacation time is exhausted, how will you be able to make ends meet? What will happen to your job status once you've used up the time permitted to you under the Family and Medical Leave Act? Read on to learn more about your options for disability income as well as how you can improve your odds of being quickly approved for one or more available types of disability pay.

What income options are available to you as a disabled individual?

In many cases, your employer may have already enrolled you in a short-term disability (STD) insurance policy, long-term disability (LTD) policy, or both. These disability policies are often offered as a perk of employment, much like health insurance or retirement matching benefits, and can help you keep (most of) your paycheck coming in even when you're out on an extended medical leave. Employer-based STD and LTD policies are governed by the federal Employee Retirement Income Security Act (ERISA), and are often referred to as ERISA disability policies to distinguish them from Social Security Disability. 

Most ERISA disability policies will require you to use up at least some of your vacation, sick, or personal days during the "elimination period"—a period of time that can run from 30 to 90 days or more from the beginning date of your disability. After you've passed the elimination period for STD, you'll be able to begin receiving a portion of your pre-disability pay until you reach the end of the policy period. At this point, you'll either return to work, resign from your job and find another, or apply for LTD benefits to carry you through until you can begin receiving Social Security Disability payments. 

Social Security Disability (SSD) and Supplemental Security Income (SSI) are federal benefits available to all disabled individuals (unlike STD and LTD policies, which can vary widely by employer). In order to qualify for SSD, you'll need to have worked enough quarters to qualify for Social Security retirement, and your disability pay will largely be based on your earnings during this time. Those who don't have the work history to qualify for SSD or who are indigent may instead qualify for SSI, a need-based stipend designed to cover only basic expenses. If you receive SSI payments, you'll usually be subject to an asset test, and your benefits may be cut if you accrue assets over this low limit.  

How can you improve the odds that your ERISA disability claim will be approved? 

For those who have an ERISA policy available through an employer, taking advantage of these benefits is often a no-brainer—these policies begin paying more quickly and often pay a higher proportion of your pre-disability pay than you'd be able to receive through SSD or SSI payments. However, because this claim is filed with a private insurer rather than the US government, the process (and required documentation) is often different than that required for SSI and SSD claims. By anticipating the ERISA insurer's needs and gathering paperwork as it is generated, you'll be able to efficiently prepare your application and enjoy the best possible odds of claim approval.

First, you'll want to obtain a copy of the actual STD or LTD policy to carefully review the evidentiary requirements. Although your employer's HR department may be able to help you organize and file your claim, they often can't  provide much advice on the types of medical forms or physician's statements that may be needed in order to officially categorize you as disabled. By going directly to the horse's mouth—the policy documents themselves—you'll know what the insurer needs. 

You'll also want to clearly organize your claim documents before filing—an index or table of contents can make even a voluminous claim submission easier to navigate. You may want to have a trusted friend or family member review the proposed submission to ensure it doesn't contain any extraneous or redundant information that could muddle the issues. For legal advice on this topic, get in touch with a representative from a firm like Iler and Iler.