Elimination Periods - What an Elimination Period Is in a Long-Term Disability Insurance Policy, and How It Can Destroy Your Claim

Welcome to another episode of Winning Isn't Easy with your host, nationwide ERISA Disability attorney Nancy L. Cavey. On this week's episode, we will be talking about elimination periods, what they are, and how they can destroy a claim for disability benefits. Generally speaking, elimination periods refer to how long a claimant will have to wait before an insurance carrier will pay benefits. This period starts from the date of injury or diagnosis, and can have a broad time range. Choosing the wrong date of disability, or making errors during the elimination period, can have catastrophic consequences for a claim. Today, Nancy L. Cavey will discuss elimination periods further, and how to navigate their waters so you don't sink your claim.

Winning Isn't Easy is a podcast dedicated to exploring the complexities of the Employee Retirement Income Security Act (ERISA) Long-Term Disability world. Each episode, we delve into the challenges and triumphs of navigating this intricate landscape and bring to light the key issues affecting disabled individuals seeking benefits under ERISA. Get ready to listen in on a captivating listen as we uncover the truth behind Winning Isn't Easy.


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/


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Transcript

Speaker 1: 0:17

I'm Nancy, Cavey a national ARESA and 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 association says that I have to say this. So I've said it, but nothing prevents me from giving you an easy to understand overview of the disability insurance world, the games that carriers play and what you need to know to get the disability benefits you deserve. So off we go in this episode, I'm going to be talking about the disability carrier. Second best policy defense to a claim, the elimination period game, the MIS the disability interest policy holders believe about Orissa and individual disability insurance. Add the truth and the story of a senior principal product strategist, and his struggles with the elimination period. We're gonna take a quick break, but when we come back, we'll continue, stay tuned.

Speaker 2: 1:19

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Speaker 1: 1:39

Ready to get started the disability carriers, second best policy defense to a claim, the elimination period game. Do you know that the disability insurance company can deny a legitimate claim under the preexisting condition clause or the 90 day elimination clause? I've already talked about the preexisting condition clause defense game. Today. I'm going to talk about the carrier's second favorite policy defense. It's called the 90 day elimination clause defense. Many disability policies have a provision that will require a policy holder to be totally disabled during an elimination period, you might be asking, well, what is an elimination period? An elimination period is a period defined by the terms of your policy or plan during which you have to be totally disabled before benefits become payable. In other words, to qualify for benefits under the terms of the plan of the policy, you have to prove that your medical condition or diagnosis renders you unable to perform your job as of the date of the disability and for the length of the elimination period. Every disability policy has an elimination print, which as I said, is a time specified in your policy that starts with your last day work. L D w generally the elimination period matches the time you're covered by short-term disability, but I've seen elimination prays as long as a year. The bottom line is though you're disabled. You won't start getting benefits until the elimination period runs in the course of my practice. I've identified elimination period traps. It's crucial that you avoid these traps because otherwise you can screw up your elimination period and get a claimed it out from the disability carrier. And you don't want either a delay or denial. So let's start out by of course, getting out that policy war your plan. When you apply for your benefits, think carefully about the date you list as a date, you become disabled. In fact, before you even stop working and apply for benefits, I think we need to get the policy out and start answering these questions. What does the disability policy say about the elimination period? Now, I want you to understand about the terms of that elimination period, but the traps that I want us to avoid are not understanding the length of the elimination grid and not understanding if you can work during the elimination period in the next segment, we're going to talk about myth-busting. And with we're talk about today is I don't need to worry about the two elimination pre traps in my claim. It's solid, stay tuned. So welcome back to our myth-busting segment. The MIS that disability insurance policy holders believe about Orissa and individual disability insurance and the truth. I love being a MythBuster and I hear these myths from neighbors, friends, lawyers, insurance agents, and potential clients. And my job is to set everybody straight. So what's today's myth. Well, the theme of our podcast today is elimination periods. And so the myth is I don't need to worry about elimination. Period traps in my claim gets solid. When you apply for your disability benefits, I want you to think carefully about the date you list as the day you became disabled, because there are two traps. First is not understanding how long the elimination period is. And second, not understanding if you can work during the elimination period. So let's talk about elimination, period, trap one, a few disability policies pay benefits immediately after you become disabled. But most of the time there's a waiting or an elimination period that can range from two weeks a year. Even more before you stop work, you need to know the length of the elimination print. So you know how you're going to be able to pay your bills while you're waiting it out. Because during that elimination period, you're not getting paid, picking that that right date to become disabled can make or break your finances. Now, some policies will allow you to work during the elimination period and a policy provision w can read like this. You must be continuously disabled for a 90 day elimination print. We'll treat your disability as continuous if your disability stops for 30 days or less during the elimination print. So that means that if you're not disabled this time, won't count towards your elimination. Drip. Now, I think that's rather confusing, don't you? And I think it's equally difficult to apply. What I think that says is you can work during the elimination period so long as it isn't gainful work well. What are those gainful work gave a work means wages at least equal to your gross disability payment. So everyday you worked on the elimination print is reviewed to determine if the wage was gainful. Now days during the elimination period that you have had gained for work, do not count towards satisfying your elimination grid. You'll only have 30 such gainful days during the elimination grit. So if you have more than 30 days, you've got to start the elimination Brit all over again. And that's 30 total, not 30 consecutive days of gainful work. So let's try to translate the policy language that I just read to you. You can work this as long as it's not gainful work. So I'm going to tell you the story of Jack, who like a lot of people were in denial or are in denial about their disability. Now he tried to work during his elimination period, got a pen and pencil. Cause I'm going to give you some dates and we're going to have to do a little bit of math. Yeah, I know we all. Didn't go to school to become math majors, but math is what this story is about. So his date of disability was April 1st, 2015. His 90 day elimination period was from April 1st, 2015 through, um, uh, June 29, 2015. Now his benefits were to begin on June 30th, the 31st day, his disability benefits were 3090$6 per month, which translates to$697 and 68 cents a week or$17 and 44 cents an hour. During the elimination Brit, he tried to work and he was paid$25 an hour because that rate is higher than his disability benefit. His wages were gainful. So one day he worked eight hours and he earned$200. But because his wages were gainful that day couldn't be counted towards satisfying that 30 day elimination period. Remember every day of gainful work up to 29 days gets tacked onto the back end of the elimination period. So if Jack had 29 days of gainful work, his eliminate elimination period would have extended from June 30 to July 27. Now carriers will make numerous errors in making these calculations. And as an experienced disability attorney, I can help you catch errors that work against you. Let's talk about elimination period, trap to another posse. Minefield reads like this you're disabled when Dewey chewed them out insurance company determines you're limited from performing the material and substantial duties of your regular occupation due to your sickness or injury. And you have a 20% or more loss in your index earnings due to the same sickness or injury during the elimination rate, you're unable to perform any of the material and substantial duties of your regular occupation. The difference between this policy and the one above is that the clause says during the elimination period, you're unable to perform any of the material and substantial duties of your occupation. In other words, by the terms of this policy, you can't work during the elimination period. So if your employer is begging you to come back to work, you have to resist and resisting can be a tall order. If you're in financial difficulty, I've had this happen to one of my clients before she returned to work prematurely and then had to stop working yet. And she had to start all over again and meet the full elimination Brit. So the carrier asks, well, why did you start working now after your doctor told you to stop working early for what we, what, what changed medically and the carrier might use your attempt to return to work against you? Where she at the very employer who encouraged you to return to work could terminate you. And that's what happened to my client. The carrier then said, look, um, you didn't, you weren't to say, well, because you were working and your employer has let you go and you don't have any coverage. So the saddest thing I think that can happen to anyone is where the employer terminates a client during an unsuccessful return to work her coverage lapse during the elimination rate. And she got nothing. The employer used this clause to not only Terminator, but deprive her of her long-term disability benefits. So the truth is that the two elimination period traps can destroy an otherwise solid claim. Next week, I'm going to take on the myth of applying for your disability. Benefits is easy. And in the next segment, I'm going to tell you the story of a senior principal product strategist, and his struggle with the elimination, grit stay tuned.

Speaker 3: 11:42

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Speaker 1: 12:18

Welcome back to winning. Isn't easy. I read every disability case that comes out in the United States every week. And I find that these court cases really teach me not only about the law, but how judges think about cases and the tactics and strategies that carriers will employ to try to delay and deny people who have this way claims the rightful benefits that they're doing. Knowing sometimes these court cases read like mystery stories. Sometimes they read like horror stories and sometimes they read like a fairy tale. Today. I'm going to tell you the story of James Lewis. He was employed by Oracle as a senior principal product strategist. Now he began intermittently missing work, but nothing was enough frequency to satisfy his 90 day elimination, prey, and Oracle terminated his employment on October 30 13th, 2017. He filed a claim for disability benefits, which unfortunately it was denied. So the 90 day elimination period for his claim began on October 13, 2017. And it ran through January 12 to tan, rather 2018. So that's October 13, 2017 through January 10, 2018 Hartford life that this way carrier reviewed his medical records in that particular timeframe. Unfortunately, he got spotty medical treatment. He literally didn't visit any of his treating physicians for the first 55 days of the elimination Brit and his doctors really couldn't provide any objective evidence of his disabling medical condition or continuous total disability through the elimination period. So you can imagine that he was not happy when his claim was denied and ultimately he sued. And I'm going to tell you about what the court did in the case of Lewis versus Hartford life. It's a case out of Washington state and the court upheld that claims denial because they found that the medical proof was not sufficient to, uh, establish based on, uh, objective evidence that he, his disabling medical condition, uh, kept him totally disabled through the elimination print. Now had mr. Lewis gotten medical care and had his doctor supported his claim. I think we would've gotten a completely different result. And of course he would have had to have met that 90 day, uh, elimination pre I know it can be really tough for people to make that decision, to stop working, um, and apply for their benefits. And some people will do a stop. They'll do a start. They're not sure they want to give it their best, um, but that can potentially be held against you. And as I told you, the, uh, the story, uh, in the last segment, I actually had one of my clients who was terminated by her employer during the elimination period, uh, not withstanding the fact that she had tried to work and had not been successful, got some medical care and was bound and determined to come back and work for her employer. And they ultimately terminated her during this elimination period. And she wasn't entitled to her benefits. So this elimination, uh, trap can really destroy a claim before it gets out of the box. Uh, because more often than not, uh, if you are still covered by your, um, carrier's policy and you go back to work, you're going to start all over again with a new elimination period. And hopefully by that point in time, you will consult within the sprays Arista disability attorney, and understand what the length of the elimination period is, whether you can work. And if so, how you can work in a way that does not result in a denial of the claim we're having all those days tacked onto the end of the elimination period and having to go even longer to satisfy the elimination period. Well, that's it for this episode, if you liked this podcast, consider liking our page, leave a review or share it with your friends and family. Remember our podcast is weekly, so stay tuned for our next episode in the coming week. Take care.