50% of my income is Long-Term Disability insurance...the other 50% is SSDI.
I worked in employee benefits for 15 years before "retiring" to disability in 2000, and my last job included LTD for 125,000 employees before I moved to the the beneficiary side of the fence.
You have already read the pre-existing condition clause and passed that one.
Other parts you need to read, if they exist in your policy:
- Elimination Period: This would be the period of time BEFORE benefits would begin IF his claim is accepted. If it is in your policy, and it probably is, it is probably the first 90-days of disability. The 90-days would begin with the first day he no longer works.
- Duration of Coverage: Most policies are not indefinite, but his might be. For example, my LTD ends when I turn 65 years of age. At that point I will be solely on SSDI or SS.
- Amount of Income from the policy: Most plans do not cover 100% of income, and many average wages from the immediately prior 6 month period, beginning with the date of the claim. Also, many plans cover an average of 66-2/3 of the wages, but other plans cover 100% of the wages received prior to the date of the claim.
- Income Offset: This would be for example: I receive 66-2/3 of my prior income. My LTD is offset by my SSDI; e.g. my LTD amount is reduced by the amount of my SSDI. This is important to know, so that if it is a part of your policy you don't go into the LTD thinking that you will have two incomes. Also, if I was to work at all, that income would offset the LTD too; I would have to report it to Hartford/insurance company.
- If he is comfortable with the idea, he might want to check with the department that handles the insurance policy...employee benefits dept...and ask them what to do and how to do it. They would be the ones to provide the claim form.When you do file the claim take very special care with the words you use. I would suggest that you begin with a WORD documents, typing the replies and modifying them as needed. When you have exactly what you want to say then write them into the form, or type them.
- I would also suggest you collaborate with your neurologist and know what he has written into the patient file. His files WILL be requested by the insurance company, and will be reviewed by the insurance company.
- Also, check the plan to see if they plan requires you to file for SSDI when and if the claim is approved. My insurance company, Hartford, required that I file for SSDI as soon as my LTD claim was approved. They also sponsored an advocate for me, at no cost to me, to ensure that my claim filing period with SS went okay. Not that they were much help, but if I had had to court before a judge to obtain SS, they would have done this with me.
- If he is comfortable with the idea, he might want to check with the department that handles the insurance policy...employee benefits dept...and ask them what to do and how to do it. They would be the ones to provide the claim form.
Hope this is helpful. Basically, KNOW you policy inside and out, up and down. Know your right under the policy.
I was lucky, I went into my last job with the PD diagnosis. So, when it was time for me, as a new employee, to sign up for LTD, I DID!! Initial enrollment in the plan waived pre-existing conditions.
