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I Have Been Denied Long Term Disability Insurance. Am I Eligible for SSDI?

Frustrated Couple With Woman In Wheelchair Reading Letter

If you have become unable to work due to injury or illness, you have options available to ensure that you and your family are still provided for. Employer-provided insurance often either includes long-term disability insurance (LTDI) or offers LTDI as an additional purchase option. You can also purchase LTDI separately. You may be eligible for government-provided Social Security Disability Insurance (SSDI) coverage as well. Are the two systems dependent upon one another? What happens if your LTDI claim is rejected? Read on to learn about the interaction between LTDI and SSDI policy coverage, and reach out to a knowledgeable California social security disability insurance attorney with questions or for help securing disability coverage.

You Can Receive Both LTDI and SSDI Benefits

Individuals who are unable to work can collect benefits under short-term disability (STDI) policies, LTDI policies or SSDI. STDI provides benefits shortly after the worker becomes disabled, while LTDI kicks in only if the policyholder is disabled for a sufficient period of time. These are private insurance policies, typically available through an employer.

SSDI is state-sponsored disability insurance. LTDI providers typically require policyholders to apply for SSDI, and if the applicant is approved for SSDI benefits, the LTDI provider will offset the applicant’s long-term disability benefits with the social security disability benefits. For example, if the applicant receives $1,500 per month in LTDI benefits and is then approved for $500 in SSDI benefits, the LTDI provider will start paying $1,000 per month instead.

LTDI and SSDI Eligibility Differ

LTDI and SSDI are separate programs and are not dependent upon one another. Securing approval for LTDI benefits does not guarantee SSDI benefits, nor does approval for SSDI guarantee LTDI benefits. The reverse is true as well: Having a claim rejected by one does not necessarily mean your claim for the other will be rejected. Because they both concern whether you are disabled, however, approval or denial for one may be used as evidence to support or reject your claim for the other.

LTDI and SSDI each define “disability” differently, and each has additional, separate requirements. Typically, to be eligible for LTDI, you must demonstrate the following:

  • You are disabled. LTDI policies may specify that you are disabled from performing your current or most recent occupation, meaning that you can receive benefits even if you can perform other duties. Other policies may specify that disability means you cannot perform any occupation relating to your training, education, or experience.
  • You were working full-time. LTDI usually requires a policyholder to have been working at least 30 or 35 hours per week to obtain benefits.
  • You satisfy the waiting period. LTDI typically requires at least three or six months of disability before kicking in.
  • Your disability is not based on a preexisting or excluded condition. LTDI policies might not provide coverage if your disability was caused by a preexisting condition or if your disability was caused by an excluded condition or type of incident. Some policies will limit the duration of coverage for certain conditions such as disability caused by alcoholism or drug addiction.
  • You have not missed your premium payments.

To be eligible for SSDI, you must typically demonstrate the following:

  • You are disabled. To be disabled for the purposes of SSDI, you must be unable to work in your previous occupation, unable to adjust to new work, and be unable to work for at least a year. Your disability must be “total,” not “partial,” meaning you cannot perform even some of your workplace duties or work part-time.
  • You have sufficient “work credits.” Part of your taxes goes to Social Security. In order to collect SSDI, you must have paid enough into Social Security over your years of working.
  • You pass the elimination period. SSDI benefits typically take at least five months to kick in.

The fact that your LTDI claim was denied does not necessarily mean that your SSDI claim will be denied. If your disability was based on a condition excluded by your policy, for example, or if you failed to pay your premium, your LTDI claim may be denied for reasons that will not affect your SSDI eligibility.
If, however, your LTDI claim was rejected because you do not satisfy the definition of “disabled,” then you face an uphill battle proving SSDI eligibility. LTDI typically has a more forgiving standard for proving disability than does SSDI. For example, LTDI may cover partial disability or disability that may not last more than a year, while SSDI does not. While an LTDI denial is not determinative of your SSDI eligibility, the government will be evaluating the same medical evidence to make its determination. Talk to a seasoned disability insurance attorney to discuss your injury and your eligibility for the various programs.

Get Help With Your California Disability Claim Today

For help obtaining disability benefits in southern California or statewide, call the knowledgeable and effective Social Security Disability (SSD/SSI) attorneys Drake & Drake at 818-914-4055.

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