Going from STD to LTD Video
Mason Waring: Hi. My name is Mason Waring. I’m an attorney and partner at Chisholm Chisholm & Kilpatrick. I’m joined here by my colleague, a CCK attorney, Leah Small. We’ve devoted much of our practice to handling long-term disability claims, appeals and court litigation for disabled workers. These are individuals who receive long-term disability insurance coverage through their employer or a policy that they purchased for themselves.
Today, we’re talking about the process of going from short-term disability to long-term disability benefits. We’ll be discussing the difference between short-term disability and long-term disability, the changes in the definitions of disability under short-term disability and long-term disability, transitioning from short-term disability to long-term disability within the same insurance company and working with 2 different insurance companies. So, let’s get started. Leah, can you tell us a little about what short-term disability and long-term disability insurance is?
Leah Small: Sure. Short-term disability insurance protects a portion of your income when you become temporarily disabled and cannot work. Usually, it kicks in after you’ve been unable to work for a certain period of time, usually 1 or 2 weeks and typically, last for a period of 3 to 6 months. Usually, it’ll cover conditions like, temporary injuries, surgery rehabilitation, pregnancy, things like that. On the other hand, long-term disability protects a portion of your income if you become disabled and cannot work for a longer period of time. So, typically, you must remain disabled for 90 to 100 days before you can begin receiving LTD benefits. Oftentimes, short-term disability benefits can cover this waiting period before long-term disability benefits begin. And once you’re approved for long-term disability benefits, if you continue to remain disabled, your benefits may last for a certain number of years or until you reach a certain age, depending on the terms of your specific policy.
Typically, if you receive the max amount of STD benefits under your policy and you’re still unable to work, you’ll then transition to long-term disability benefits if you have that coverage available to you as well. Oftentimes, short-term and long-term disability insurance is offered as part of your employment benefits or you can also privately purchase it from an insurance company. Now, you don’t need to have STD and LTD coverage from the same insurance company, though, it may make transitioning from STD to LTD a little simpler.
Mason: Thanks, Leah. Beyond the length of time that the benefits are paid, what are some of the core differences between short-term disability and long-term disability?
Leah: One of the big differences is that your STD and LTD policies might have different definitions of disability. Most short-term disability policies require you to be disabled from your own occupation, which means that you must be unable to perform the duties of your own job. STD policies may also require you to be receiving appropriate treatment for your disability while you’re receiving benefits. But typically, the definition of disability you must meet for short-term disability benefits doesn’t change during the course of your STD claim. On the other hand, long-term disability will generally require you to be disabled from your own occupation initially, but then after a certain period of time, usually 24 to 48 months, LTD policies often transition to what we call the any occupation definition of disability, which means you must be unable to perform any occupation in order to continue receiving benefits.
Long-term disability policies are also often more restrictive than short-term disability policies. LTD policies will often have restrictions that can limit the types of conditions that may be approved for benefits or limit how long you can receive benefits for certain conditions. For example, if you recently obtained both STD and LTD coverage and you become disabled due to a condition that existed prior to obtaining that coverage, your STD policy may provide benefits for that disability, but your LTD policy may not. And that’s because many LTD policies have what we call a pre-existing condition exclusion, which excludes coverage for disabilities caused by conditions you treated for prior to you obtaining the coverage. Because of this, don’t assume that just because you were approved for STD benefits, that you’re also going to be approved for long-term disability benefits. It’s really important to read both your STD and LTD policies carefully to fully understand the requirements that you must satisfy under each in order to receive benefits.
And this is where having an attorney help you can be really beneficial. If you’re having trouble understanding the terms of your STD and LTD policies, or you want to make sure that you’re going about the process of transitioning from STD to LTD correctly, it can be helpful to contact an LTD attorney.
Mason: Great point. And as we’ll talk about later, there’s a lot more financial liability for the insurance company to the long-term disability benefits because they might be liable to pay for a longer period of time. So, they often get more aggressive with claims handling tactics and we see a lot of wrongful denials when people are transitioning from short-term to long-term disability.
Moving on, when a person has STD and LTD coverage through their employer, they often have it with the same insurance company. Not all the time, but we often see that. Leah, can you tell our viewers what they might experience if their STD claim transitions to LTD claim when it’s the same insurance company?
Leah: Sure. When it’s the same insurance company, the insurer might evaluate your claim from long-term disability benefits before your short-term disability benefits and to eliminate a gap in benefits. But it’s important to remember your STD and LTD claims are separate. You’ll likely still have to complete paperwork and it’s important that the evidence you supply for your LTD claim is consistent with what you reported for your STD claim. If there are inconsistencies between the 2 claims, that could endanger the likelihood of being approved for long-term disability benefits. But having said that, it’s also important that you’re ensuring you are demonstrating why you meet the terms of your LTD policy.
As we mentioned earlier, it’s important that you carefully review your LTD policy to ensure you understand the requirements of that claim as it could be different from the requirements for your STD claim, despite it being with the same insurance company. And as we mentioned, an approval for STD benefits does not guarantee approval for LTD benefits, even though the claims are with the same insurance company. This can be because of different policy requirements, as we discussed earlier, or because as you alluded, Mason, the insurance company has a conflict of interest. Unfortunately, we often see insurance companies approve a claimant’s STD benefits but then deny LTD benefits because they don’t want to be on the hook for paying extended benefits. And this can be especially likely to occur where the insurance company only administered your STD claim while your benefits were actually paid by someone like your employer but the insurance company is responsible for both administering and paying your LTD benefits.
Even if your LTD claim is approved though, you’re still going to need to provide updated information periodically to the insurance company so that they can ensure and you can demonstrate that you’re still disabled and still entitled to benefit as time goes on.
Mason: Now, Leah, what might our viewers expect when transitioning from STD to LTD with a different insurance company?
Leah: Ones at different insurance companies, the new company may not have any of the records that supported your short-term disability claim. So, you may need to start from scratch with them, providing all the information you had submitted in support of your STD claim as well as updated information. This just means you might need to submit claim forms as well as all the medical records and reports from your doctors. Again, make sure that you’re demonstrating that you meet the definition of disability under the LTD policy.
As we said before, it’s really important to review that LTD policy, especially if your LTD coverage is with a different company because their requirements and standards can vary greatly from the prior company that provided your short-term disability. And although it is with a different insurance company, you may want to submit documentation of your short-term disability approval with your application for long-term disability benefits as that can help demonstrate that your condition has already been determined to be disabling by another company. And as a reminder, again, don’t assume that because one company approved your STD benefits, that the insurance company will approve your LTD benefits. You want to be as thorough as possible in the evidence you’re submitting to this new insurance company to demonstrate that you’re entitled to long-term disability benefits with them.
Mason: Good advice. Leah, what are the key takeaways for our viewers?
Leah: Number 1, when you’re in that transition from short-term disability to long-term disability, you want to make sure you understand how the definition of disability or other claim terms and requirements will change. Your LTD claim is separate from your STD claim. It’s going to have its own deadlines and requirements that must be met in order to be entitled to benefits. When you’re transitioning, you may need to provide the LTD insurance company with updated or additional evidence, and it’s important to keep in mind that LTD claims tend to have more stricter requirements than STD claims. As we said, an approval for STD benefits is not going to guarantee an approval for LTD benefits.
Attorneys at CCK, we have experience working with different insurance companies and know how to aid claimants who may be confused or having trouble transitioning from STD to LTD benefits. We have experience assisting individuals with their LTD claims, gathering the evidence that’s going to prove their disability, meet the applicable definition of disability in their LTD policy, such as medical records from treating physicians, reports, evidence from vocational experts or other experts that may not have been necessary for the short-term disability claim, but may become important for the long-term disability claim. And so, we understand that this transition from short-term disability to long-term disability can be a difficult and confusing process, especially with all the different requirements that must be met. It costs nothing for people to reach out to us and see if we’re able to assist them with their claim.
Mason: Thanks, Leah. If you want to reach out to us to see if we can help, you can contact us through our website, cck-law.com or by phone, 401-331- 6300. Leah, thanks for this great information today and thank you all for joining us.
Leah: Thank you.
Mason: Have a great day, everybody.
[END]
