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Long-Term Disability (LTD) Claims for Pharmacists

Mason Waring

September 19, 2022

Updated: June 20, 2024

Long-Term Disability (LTD) Claims for Pharmacists

Pharmacists are essential as they assist many people in obtaining the medicine they need.  However, pharmacists can develop debilitating medical conditions that prevent them from working.  Cognitive abilities are vital to their profession and any condition that hinders these abilities can make working impossible.

When a pharmacist develops a condition that prevents them from working, they must consider filing a long-term disability (LTD) claim.  However, the process of filing an LTD claim can be overwhelming.  This blog post will address some common questions pharmacists may have about their LTD claims.

Why Should Pharmacists File Long-Term Disability Claims?

Many people rely on pharmacists to fulfill their prescriptions when they have a medical condition, injury, illness, or other disability.  Pharmacists work with patients to provide expert advice on how to take their medications.  This can include explaining what the drug is, how to take it, other drugs it may interact with, and how much to take.  As such, a pharmacist’s cognitive abilities are crucial to providing adequate help for their patients.

Long-Term Disability (LTD) 101

Moreover, pharmacists spend years studying to get where they are—usually upwards of six to eight years.  These professions are highly skilled and focused, and a debilitating condition can bring it to a sudden halt.  Coping with the loss of cognitive or physical abilities is difficult for anyone.

Since pharmacists play such an important part in their community, they should file for long-term disability benefits to protect their income and their patients.  For example, if a pharmacist suffers from insomnia, their cognitive abilities can suffer.  They may become forgetful, fatigued, and irritable.  This can result in wrongly fulfilled prescriptions, which can have devastating effects on all involved.  If a patient were to receive the wrong prescription and not realize it, they could ingest a medication that could cause an allergic reaction, or worse.

It is evident why a pharmacist should file for LTD benefits.  To improve their health, they must have the time to mend.  Long-term disability benefits allow pharmacists to focus on treating their condition.

How Can I Find Out More About My Long-Term Disability Coverage?

Generally, there are two ways in which a pharmacist can receive long-term disability coverage.  They can either receive it directly from their insurance company, or they may receive it as part of a benefits package from their employer.  When a pharmacist buys their coverage directly from an insurance company, it is called an individual policy.  On the other hand, when a pharmacist receives their coverage from their employer, it is called a group policy.

Having Both a Group and an Individual Long-Term Disability Policy

If you believe you have a group policy, you can ask your employer directly.  Human resources can check to see if you have a policy through your workplace.  If they determine that you do, they will provide you with your policy and any related documents.

Likewise, if you believe you have an individual policy, you should first check your financial statements.  If you make premium payments to an insurance company, you may have an LTD policy.  Should you see these premium payments, you can contact the insurance company directly and inquire.  If you do have a policy with them, they will provide you with all relevant documentation.

Why Is It Important to Read and Understand My LTD Policy?

Your LTD policy explains the requirements you must meet to receive benefits.  It also contains a lot of valuable information concerning your benefits, such as the maximum benefit period, specific deadlines, how to appeal a denial, exclusions and limitations, information regarding a waiting period, and more.

What is the Long-Term Disability Elimination Period?

Therefore, it is vital that you thoroughly read and understand your long-term disability policy.  Many claimants make simple mistakes that could have been avoided had they read their policy more carefully.

Additionally, your LTD policy also includes a definition of disability.  This definition is perhaps the most important element of your policy.

The Definition of Disability

A vital element of any long-term disability claim involves the definition of disability located within the claimant’s policy.  This definition is what a claimant must prove they meet to be considered disabled and receive benefits.  If an insurance company decides that a claimant did not sufficiently meet its specific definition, it will issue a denial.

Typically, there are two types of definitions: the own occupation definition and the any occupation definition.  Sometimes a policy may contain both definitions.

The own occupation definition asks whether you can perform the duties of your specific job.  For example, does your condition specifically prevent you from carrying out the duties of your job as a pharmacist?

Own Occupation Insurance Claims: What Are They?

The any occupation definition, conversely, asks whether you can perform the duties of any job whatsoever, regardless of your specific profession.  For example, does your condition prevent you from doing certain duties?  Could you reasonably work in another profession, such as administration?

In certain policies, an own occupation transitions to an any occupation definition after a certain period.  This period is usually around 24 months.  In the time immediately preceding this transition, the insurance company will reevaluate your condition.  If your insurer believes that your condition does not satisfy the requirements of the any occupation definition, they will terminate your benefits.  Generally, the own occupation definition is far easier to prove than the any occupation definition.

Nonetheless, once you know and understand the definition of disability located within your policy, you can begin collecting the proper evidence to prove your claim.

What Issues Do Pharmacists Face When Filing for Long-Term Disability Benefits?

A pharmacist may encounter several issues when filing for long-term disability benefits.  Insurance companies, for example, are difficult to deal with during the LTD claim process.  Unfortunately, insurance companies do not want to pay claims.  In fact, they try to avoid it if possible.  The result is multiple denied claims.

How ERISA Impacts Long-Term Disability Claims

Nonetheless, it is important to understand the issues you may face as a pharmacist while filing for your benefits.  These issues can include:

  • Independent medical exams (IMEs): Often, claimants must attend an independent medical exam. However, these exams are often biased, as the doctors who conduct IMEs are paid by the insurance company.  This creates a conflict of interest that generally favors the insurance company rather than the claimant.
  • Surveillance tactics employed by the insurance company: Insurers routinely perform surveillance tactics on claimants to inject doubt into a claim so that they may issue a denial. Surveillance tactics may include a private investigator staking out at a claimant’s home; photographs and videos of the claimant at home and in public; audio devices planted near the claimant’s house; social media surveillance; and more.
  • ERISA law: If you have a group policy, then it is governed by ERISA law. ERISA law brings its own set of strict deadlines and rules.  For example, under ERISA you may not submit new or updated evidence after the appeal stage, which means no evidence may be submitted during the litigation stage.  Moreover, during litigation under ERISA, the court generally favors the insurance company.

A denial of your initial claim can make receiving your benefits seem impossible.  However, you have the right to appeal.  Regardless of whether your initial claim is denied or not, it is important to have evidence to bolster your claim.  The right evidence can help you avoid many issues.

While medical records are normally your primary source of evidence, they should not be your only source of evidence.  Supplemental evidence (e.g., witness statements and specialized reports from your treating physicians) is often vital in proving your claim.

What Other Benefits May Be Available to Pharmacists?

Long-term disability benefits may not be the only benefits for which you are eligible.  Some pharmacists may also be eligible for Social Security Disability Insurance (SSDI) benefits.

However, SSDI has its own set of rules and requirements.  For example, if you are unable to perform any substantial gainful activity, or if your disability could last more than a year or may result in death, you may be eligible.

It is important to note that if you are considered disabled under your LTD policy, you may not be considered disabled under SSDI, and vice versa.

What Do I Do If the Insurance Company Denies My Claim?

As mentioned, if your insurance company denies your claim, you have the right to appeal.  The administrative appeal stage of the long-term disability claim process is crucial to winning your appeal.  It may be beneficial to contact a long-term disability attorney to assist you.

The LTD lawyers at Chisholm Chisholm & Kilpatrick can help you obtain your benefits.  We believe that you should not have to worry about dealing with your insurance company.  Instead, we will alleviate the burden of filing for long-term disability benefits so that you can focus on what is most important: your health.

Regardless of where you are in the process, we are ready to assist you.  Call CCK today at (800) 544-9144 for a free case evaluation and see how we may be able to help.

About the Author

Bio photo of Mason Waring

Mason joined CCK in 2008 and is a Partner at the firm. He has an active civil litigation practice in the federal and state courts, focused on representing individuals in the application, appeals, and litigation of life, health, short-term disability, and long-term disability insurance benefits under the Employee Retirement Income Security Act (ERISA) and under private insurance contracts. Mason’s practice also includes litigation of personal injury disputes. Nationally, Mason represents claimants in ERISA and non-ERISA administrative appeals of denied benefits.

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