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How Long Do You Have To Be Out Of Work To Apply For Disability Insurance Benefits?

When it comes to applying for long term disability benefits, timing questions—in particular, when to apply for benefits—tend to be the types that keep claimants up at night. At Dell & Schaefer, we’ll be the first to tell you that the answer to this question is often, “it depends.” Though most claimants can benefit from filing early, in some cases, it may make more sense to delay the application as long as possible. Learn more about the factors that go into determining how much time a disability claimant should put between their temporary exit from the workforce and their application for long term disability benefits.

GREG DELL: Hi, I’m Greg Dell with attorneys Dell & Schaefer, here with Stephen Jessup. And we’re going to discuss an important disability question which is, “How long do I have to be out of work to apply for disability benefits?” And this question comes up almost daily on every application in which we assist clients to apply. But the answer varies on multiple factors. So let’s discuss some of those factors that apply– how long a person has to be out of work before they should apply.

Before Applying for Benefits: Factors That Apply To How Long A Disability Insurance Claimant Needs To Be Out of Work

STEPHEN JESSUP: Yeah. Well, I think the first one is if you were a short term. A lot of times, you’re going to have short term before you’re long term. So we’ll start there. Say, for instance, you’re having surgery, or there’s a procedure planned, a lot of times, even in your employee pamphlet, it’ll say to notify them in advance. And that way, they’ll know you’re going to be out for a certain amount of time from it.

So if you have a surgery that you know is going to be coming up, see what the employee benefits handbook says you have to do. But you can set up the claim prior to going out. Now, if something happens, and you’re just out of work, and you think you might be out for usually more than a week– a lot of short-term disability has a seven-day elimination period– that’s the amount of time they’re not going to pay you any disability benefits for being out.

So if you think that it’s going to be longer than that, it may be wise at that point to consider, at least notifying, putting the insurance company on claim that a claim may be coming. That’s separate and apart from what you need to do in your application per se, but at least letting them know because we discussed in some other videos, say, for instance, your job isn’t protected. You’ve gone on FMLA, and your employer terminates you– there could just be some problems later on.

GREG DELL: So in terms of a person who says, well I’ve been out of work for a week. My doctor says put me out for another 30 days. My long-term disability policy has a 90-day limitation period. And they say, can I apply for long-term disability now?

STEPHEN JESSUP: Well, if you have short term – so if there’s no short term, you could technically apply for the long term. And it’s good if they get it pre-approved prior. And if you go back to work before then, then the long term just never becomes effective.

When Should a Claimant Put The Insurance Company On Notice That You May Be Applying For Benefits?

If you’re on short term – and most employers are going to provide a short-term policy along with the long term. If your doctor says you’re going to be out for potentially 30 days or any extended period of time over what you have for allotted absences like sick time or anything like that, it’s probably best to, at that point, start to think about putting the insurance company on notice that a claim’s going to be coming.

GREG DELL: Yeah. You see – and I know we all have our own style of how we notify people. But depending upon the severity of my client’s particular claim and the language in their policy, which is usually “unable to do the duties of their own occupation,” and depending again on who the disability company is – because we know that they all have different tactics – I usually tend to error to notifying the company within maybe 30 days of the elimination period running.

Now, some policies say that you have to notify us within 15 days. That doesn’t mean that if you don’t, that you’re waiving your right to a claim, or that you’re breaching the contract. They may argue and jump up and down about that. But we’ve never seen a case where you didn’t notify us within the 15 days, and therefore we’re not paying you. The advantage to waiting to notify them as close to the elimination period as possible is that you don’t have them breathing down your neck.

STEPHEN JESSUP: Well, that’s a context of long term. Short-term disability, you can’t wait.

GREG DELL: Well, of course, with short term. But in a situation where you don’t have the short term– which many people don’t have short term; they just have long term– then I would suggest that you wait because you know they’re going to run the video surveillance immediately. They’re going to want to interview you. They’re going to start calling your doctors.

And they’re putting this unnecessary pressure on the claimant, on the doctors. It’s making the claimant feel completely uncomfortable not knowing what’s going on, feeling that they’ve got to look over their shoulders all the time. And they don’t need that added pressure and that situation.

Now, the counter to that, which you know, is people don’t like the uncertainty of saying, wait a second, it’s a 90-day elimination period. You’re telling me you want me to wait till day 75 to get my application in. Now I’m going to be without money for a certain period of time. And I didn’t even know if I’m going to get approved. So–

STEPHEN JESSUP: That’s a give and take. It’s a balance.

Disability Insurance Claim Decisions Are Rarely Made In Under 60 Days

GREG DELL: So we work that balance as the attorneys helping them with their claim. But you know, Steve, the reality is they almost never, especially in long term, make a disability claim decision in less than 60 days.

STEPHEN JESSUP: That’s true, usually. Even if they have everything, it’s going to take a while. The law gives them the time. And they will use it. And it’s a tactic, a stall tactic, to see if the person is going to go back to work.

GREG DELL: But I think you’re exact– so it’s not necessarily deny, but it’s delay, delay, delay. And that’s where I believe we add tremendous value to a claim on behalf of claimants because we know it’s not the initial things they send you– the claim form, the attending physician statement, the employer statement. There’s so many more documents that they’re going to ask for that when we send in an application on behalf of a client, we send them everything at once.

We send them– I mean, it’s hard. I can’t address every single thing because there’s so many different things beyond what they asked for. So that there’s no back and forth. When they do come back with their 30-day status letter, we say, we hope you have a decision in the next 15 days because we sent you everything. And with us having helped thousands of people to apply, they know already that that form letter doesn’t fly with us because we’ve already sent them everything.

STEPHEN JESSUP: Well, that and with some changes to ERISA regulations, I’ve even had in the application process where they’ve sent over their doctor’s reports that were not favorable, and then say, we’ll give you x amount of time to comment. So it can drag, delay, delay, and maybe-pay kind of situation there. So they will find ways to slow down the process.

And you got to kind of keep pushing and driving it. And some things I’ve run into even recently in a case. They sent me the report of their doctor. The doctor’s report was written three days before all the new MRI and objective evidence was sent over to them. But they still sent me a letter saying, well, our doctor thinks she can work.

And my first response was then, he doesn’t have the most recent medical information. How can you make that call? So there’s always going to be ways that they’re going to have to delay. So you have to keep the gas pedal on.

GREG DELL: So you were continuing to do what you could to save a claim denial from coming up.

STEPHEN JESSUP: Correct. Correct.

GREG DELL: So this is just a snapshot one question in the big scheme of what’s considered applying for disability benefits. It’s a service in which, like I said earlier, we’ve helped thousands people around the country to apply for benefits. And the best way to see if it’s something where we can help you is to contact us either through the phone number at the bottom of this video, go to our website at diAttorney.com and click on the free consultation form.

You will immediately be put in touch with one of our attorneys. What we’re going to do is request a copy of your short- and long-term disability policy, in which we’re going to provide you with an immediate free review of that disability policy. And we’ll let you know how we can help you.

Now, we hope that you find this video that you’re watching helpful. And we have lots of people that have subscribed to our channel. And we encourage you to please subscribe to our channel so that you can watch many of our other videos and videos in the future that we hope will help you with your future claim as you go through this difficult disability insurance process. So thank you again for considering us. And we look forward to the opportunity to help you.

As you’ve learned, the question of when to apply for benefits is a multifaceted one that doesn’t lend itself too well to a Google search. Every disability claimant can benefit from legal advice, especially from an attorney who specializes in disability insurance law and can evaluate the factors that make your case unique. At Dell & Schaefer, we only handle disability insurance law and have extensive experience in negotiating with the major (and not-so-major) long term disability insurance providers. To learn more about your potential next steps, set up your FREE consultation with a member of our nationwide team of long term disability insurance attorneys.

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