Disability Insurance Claim Tips Everyone Can Understand

Welcome to Season 3, Episode 27 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Disability Insurance Claim Tips Everyone Can Understand."

In this episode, we tackle an overview of disability insurance claims, doling out helpful tips and insights from an industry insider. Join your host, Nancy L. Cavey, a seasoned ERISA Disability Attorney, as she unravels disability insurance claims, and covers the advice you need to know in order to succeed.

Whether you're currently navigating an ERISA disability claim, or are seeking to apply for disability, this episode provides valuable insights to help you on your journey. Tune in for expert guidance on communicating during your ERISA disability claim.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals. 

Transcript

Speaker 1: 0:00

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Speaker 2: 0:16

Hey, I'm Nancy Cay , national erisa, an individual disability attorney. Welcome to Winning Isn't Easy. Before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar says I have to say it and I've said it, but nothing will ever prevent me from giving you the easy to understand information about the long-term disability claims process and the games that disability carriers will play to try to deny or terminate your benefits. But before we get started, I'm going to , uh, tell you what we're gonna be talking about. We're gonna be exploring some key tips when it comes to navigating your ERISA disability insurance benefits. And I'm gonna talk about three things. One, tips to identifying and maximizing your risk of disability insurance benefits. Two more tips to identifying and maximizing your risk of disability insurance benefits. And three tips to identifying and maximizing your insurance benefits, the internal benefits that you may not have thought about it . So, before we get started, let's take a break.

Speaker 3: 1:25

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Speaker 2: 1:45

Welcome back to Winning Isn't Easy. Let's talk about tips to identifying and maximizing your ERISA disability insurance benefits. Can you afford to stop work and apply for your ERISA disability insurance benefits? How's this gonna impact your financial security and your ability to maintain your lifestyle? What happens if your claim is denied or terminated? You're gonna end up on the street. These are great questions and questions that I commonly get. And in this three part series, you're going to learn that the answer will depend on your personal and unique situation. And in large measure, it's gonna depend on the terms of your ERISA disability insurance policy or plan. So let's start out by talking about the sources of money or income that you might be eligible for as a result of your disability. And in my view, there are eight sources of income that you might be eligible for, again, based on your personal situation. The first four are external sources of benefits, and the last four are internal sources of income. Now, you might be eligible for some or none of these, or a combination of them, but I want you to listen to this list and think about your own personal unique situation. To get started, we're going to need a copy of your ERISA disability insurance policy or plan to determine what benefits you purchased. Is there any legal reduction in the amount of those benefits? Are there limits on how long you can collect these benefits can, and how your benefits legally be reduced by the disability insurance carrier plan? Now, you're also going to need a copy of any retirement or pension documents as there can be an interaction between your disability insurance claim and these retirement benefits. So once you've got all this information together, let's get to it. What are the four external sources of income? Uh, now these four sources of income can be number one, employer provided , um, benefits. So to figure out what employer provided benefits you might have, you may wanna get a copy of your employee handbook, summary plan description or policy , uh, from your human resource department. Don't forget to ask for a copy of your group health plan, your pension plan, and any COBRA documents as you need to convert your group health insurance to an individual plan. So then I want you to take a look at your paycheck. I want you to determine what employer or voluntary deductions are being made from your pay check . Now, that would give you an excellent idea of what benefits that you in fact have, what you've elected or what you're being provided voluntarily by your employer. That leads me to the next point. What are the common employer provided benefits that you might be eligible for? So kick this off of your , uh, your list here. It can include short-term disability and be , uh, insurance benefits, s t d, long-term disability benefits known as l t d benefits, accidental death and dismemberment benefits, a d and d life insurance benefits, long-term care benefits, disability, retirement benefits , uh, longevity retirement benefits based on your years of service, ongoing pension contribution if you are disabled. And other insurances like , uh, cancer insurance. There also may be insurance on your mortgage , uh, disability insurance policy. There might also be something , uh, in on your car insurance , uh, car uh , loan. So you need to understand all these sources. Let's get out that handbook, the summary plan description and your pay stubs and the laundry list of things that I just gave you. Let's make a list of all the benefits that are applicable to you. I want you to think of this as a checklist of the possible benefits. And as you're making this list, I want you to write down the amount of the benefits that you might be eligible for as a result of your disability. 'cause we're trying to get a list of potential income sources. Now, you might also have an individual disability insurance policy , uh, and you may have purchased that on your own or , uh, funded it through , um, you know, your personal , um, your bank account , uh, and you might have it customized to your personal needs. This can include the same kind of benefits that you might be entitled to from your employer, like short and long-term disability benefits. And you might even have a long-term care benefit policy. So again, we've got all these policies out. You wanna make sure that both the ERISA disability policy and the I d I policy don't have any limitations on the amount of coverage or the length of coverage. In other words, do you have a mental nervous condition limitation , uh, or a subjective medical condition limitation? Does the policy or plan provide for the reduction of your benefits by the receipt of social security or that of your children? Does it provide for any offset for any other disability insurance policies that you might be eligible for? So there can be an offset between the disability insurance policies. Now, since you've negotiated the terms of your I d I claim you , uh, policy, you wanna know , uh, what you've bought many, many years ago. Um, 'cause what I normally see is people don't remember what they bought. So you wanna be looking at that policy, looking at the , uh, uh, and ultimately comparing that to what you have through your employer. As you're reviewing all of these policies, there are some basic things you need to be thinking about. How long do you have to wait before you get paid? Now that's known as the elimination period. How much are the gross amount of the monthly benefits? Um, what income, if any, you can get that won't be legally subtracted? And then what income you get can legally be subtracted from your gross monthly benefits. Uh, whether there are any limitations, as I've said on how long you can collect the benefits because of certain medical conditions like depression, fibromyalgia, subjective conditions. But when does the, the benefit terminate based on your age? Um , so you gotta figure out how many years of eligibility we have here, whether there's a waiver of the premium provision so that you don't have to pay your disability, maybe your life insurance premiums. So long as you continue meet the applicable definition of disability as you're looking at the policy, is there a cost of living adjustment that's going to increase the amount of your monthly benefits? Uh, is there going to be any income that you can earn while disabled that is indexed , uh, that will impact the amount of your , uh, benefits, whether your benefits are taxable? And as I said, when your benefits are ended. So you're trying to get the lay of the land here in terms of how much, how long is it taxable? So you're getting a , a , the , uh, calculation of your , uh, ERISA disability employer provided benefits and your individual benefits. Now, as I said, you may also wanna check for other individual benefits that you might have purchased. Uh , I see people sometimes will have , uh, gotten mortgage disability insurance benefits or they've purchased a car and there is in the , that the note , uh, disability insurance coverage that would make the payment if you couldn't work. Obviously, that's really , uh, really important. And you have to understand obviously in that policy or plan the definition of disability and any limits. So you may have to run out, stop this video, go get some more , uh, policies. Certainly make a call to the , uh, mortgage company or to the car loan people, see if you got the coverage. Check your mortgage statement, your car loan statement, and if so, get those , uh, uh, policies or plans. Now we're putting this together and as I said, in an Excel spreadsheet , uh, and we want to , um, um, make sure that you've got all of these policies listed as we've talked about. 'cause we don't wanna miss anything. Um, now one of the other things that is in important is if you have group insurance, you need to understand the cost of converting that group insurance policy to an individual policy because obviously it's main important that you maintain that insurance for your own personal needs, but that of your family, you may have to look in the o open market for health insurance coverage, but you need to know the cost of that. Remember, you've gotta have coverage because you need it, but because these policies generally require ongoing medical treatment, are you making that Excel spreadsheet? If not, it is time to do so , uh, because we're gonna be filling in some numbers and those numbers are going to be , uh, crucial for us to understand your income. Now, in my next segment, I'm gonna talk about the two other external sources of income, such as governmental benefits and retirement benefits. And then the third segment, we're gonna be talking about the four types of internal income that we need to address. 'cause obviously we're interested in maximizing the income, but at the end of the day, understanding how much is gonna be coming into your house. Got it. Let's take a break. Welcome back to winning Isn't Easy. Now we're gonna be talking about more tips for identifying and maximizing your insurance benefits because obviously the question is, can you afford to stop work and apply for your benefits? And how will all of this impact your financial security and your ability to maintain your lifestyle? And in this second part of the series, I'm gonna talk about two other external sources of income that we need to consider. There are governmental benefits that you may have heard me mention, and we're gonna talk about retirement benefits and the context of an ERISA disability claim. Uh, you are required to generally apply for Social security disability benefits. You also may be eligible for state disability benefits, and that depends on where you you live. You also, as I've said, may be eligible for the social security benefits, and in fact, you probably are gonna be required to apply for them. You also may be eligible for federal, federal or state pension benefits or , uh, retirement benefits provided by your employer. Um, so we've got to look at that. And of course, if you're a veteran, you might be getting veterans benefits. If your disabling condition is caused by an accident or injury, you may be getting workers' compensation benefits. So we want to on our Excel spreadsheet start writing down these , uh, potential sources of income. And you need to be calling the necessary agencies to get information about your eligibility and information about how to apply for those benefits and how much the benefits are. So for example, you can go to ssa.gov to find out the amount of your Social Security disability benefits and the amount that your children might be eligible for. You can also find out the same information for retirement benefits. Let's talk about retirement and pension benefits provided by your employer. You may be enrolled in your employer's retirement or uh , pension plan. Uh, and you may have access to those benefits early based on disability as opposed to longevity of service. Now, it's important that you understand what retirement benefits you have and the ability to access those benefits with and without tax consequences, because withdrawals from retirement pensions that can impact your ERISA disability , uh, benefits as many policies or plans will provide that there's an offset or a reduction for your long-term disability benefits based on what you're , uh, taking from your pension or retirement fund. And that could be a double whammy when you add or consider the impact of tax on the earlier withdrawal. And of course, the penalty that the carrier is extracting by reducing , uh, your , uh, long-term disability benefits by whatever you're taking out of the , uh, the pension. So on the other side of this, there are sometimes situations where the retirement and pension are protected. Uh, and by that I mean sometimes you will see that there will be a pension contribution benefit in your disability , uh, benefits that will continue to make your pension contribution so long as you happen to meet that policy's , uh, definition of disability. And all these definitions are not the same. So we should be making a checklist and adding up the total of the external benefits. If you haven't created a checklist or you haven't updated the Excel spreadsheet, I want you to stop and do that now , uh, because again, we wanna figure out what's the amount of the benefit, when will it start, when will it end? Is there offset , uh, provisions? And obviously this is all about calculating the amount of your benefits not only today, but as the , uh, o over time , particularly through a retirement age and through the end of the policy plan period. So we wanna look at this longitudinally so that you understand what it is you're entitled to today, but uh, also how your benefits may change over time as that's going to impact your financial planning . In the next segment, I'm gonna be talking about the four internal , uh, benefits. So we're gonna take a break so that you can either complete or update your Excel spreadsheet. Got it? Okay. We'll see you in a few minutes.

Speaker 3: 15:28

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Speaker 2: 16:04

Welcome back to Winning Isn't Easy. You didn't think that this episode was going to involve a homework assignment, did you? Well, it does. Now we're gonna talk about internal benefits that you might not have thought about and , um, I call this internal because it is , um, sort of more personal to you. And again, as we've talked about before, each situation is different. And we're looking at identifying possible sources of income, determining your eligibility, how to calculate how much you potentially will get , uh, whether there are offsets. And in my view, this is just one part of the financial planning. Now, the four things I'm gonna talk about can be a , a bit , um, hard to talk about. Um, and , and what do I mean by that? Um, you obviously wanna get a a total picture of your income sources since you're gonna have to make up the difference between the loss of the income incurred, you know , caused by your disability and what you actually need to live on and maintain your lifestyle. Disability benefits are only designed to replace a fraction of your income and you need to plan for changes in your finances and lifestyle. For example, when my father became disabled, we sold our house in Maryland and moved to Florida the day after I graduated from high school. At that point, it was cheaper to live in Florida than it was in Maryland, and that was just the beginning of the changes in our lifestyle. Now, as my family a approached this issue, we considered four internal sources of income that could be tapped, and those include your spouse's income. So if your spouse is working, you need to consider the amount of their income, other savings that you might have have from investments. There might be child support or alimony, and there might be monies that your family or friend can or be willing to provide you. And that's where I think it gets a little hard because nobody really wants to ask their family , uh, to help them out and be indebted to their family. And ultimately, you've gotta add these sources to our Excel spreadsheet. Um, and , um, and they, they may result in some hard family discussions. You know, I know that firsthand because as I said, we sold our house in Maryland and moved to Florida. Um, my college plans , uh, were impacted. Um, uh, there were discussions with a buyout of of my grandfather , uh, who bought out my father's interest in , uh, the family business. A lot of tough decisions and discussions. So what I want you to do is in this Excel spreadsheet , um, you know, go through this video again if you need to. Uh, I want you to create that Excel spreadsheet. Uh, and if you haven't done it, I want you to stop and do it. Now again, we're talking about what's the benefit , um, when does it start, how long is it gonna last? Uh, are there offsets or reductions? And as you can see when we do this longitudinally, we're going to be kind of making a, a, a time map, if you will, so that you and your family can understand how your financial c circumstances may change , uh, over time. Uh, and that obviously can impact your financial planning. So we're going to add those to your Excel spreadsheet and then we're gonna try to figure out, you know, what it is you may have to do to make up the difference. It might be that it's perfect. It might be that it's perfect for a while , um, but then you are gonna have to make some lifestyle changes based on selling the house or moving or going to your family. Uh, and so I think that the consideration of these factors is important and it's better to confront them now when I think you have more flexibility and more capable, if you will, of handling it then later. And of course, one of the other factors that needs to be considered is what would happen if the disability insurance company denied uh , your benefits or terminated your benefits. That's a big factor in all of these calculations. And unfortunately, based on my experience, there's a good likelihood that at some point in your disability claim those benefits were denied or terminated. That will take potentially , uh, pull the rug out, if you will, under you and your family's financial , uh, situation. I'd rather have you think about that now than later. Got it. Tough episode. Lots of homework, but I want you to be doing this for your own peace of mind and your family's peace of mind. Our family did it. Uh, when I was a teenager, a lot of tough discussions. My parents did try to hide , uh, a lot of what was going on , uh, that really weren't successful because kids are smarter than you think they are. And ultimately this is , uh, something that I think ultimately is a family decision. I hope you've enjoyed this , uh, episode of Winning Isn't Easy. Please subscribe to our podcast that way you'll be notified every time there's a new episode. Uh , and I hope you tune in to , uh, next week's episode. Don't forget to tell your family and friends 'cause we love having , uh, people interact with us , uh, and to learn more about their ERISA disability claim. Thanks.