Straight Talk on Disability Benefits

Most people who have disability benefits receive them through their employers. Generally, short term disability (STD) covers the first 26 weeks of absence from work for a disabling condition. Long term disability (LTD) may be available until age 65 for disabilities lasting longer than 26 weeks as long as the person meets the criteria for being totally disabled.

Since the terms of both STD and LTD plans may vary widely, the first essential step for anyone applying for benefits is to obtain a copy of the summary plan description (SPD). The SPD is a booklet or online document the employer must provide outlining the plan details in plain English. If you do not have a copy of the SPD, ask your human resources representative.

The second essential step when applying for disability benefits is to meet with your doctor to review the application. The doctor will be required to fill out an Attending Physician Statement. Be sure your doctor understands it is not enough to say you have a disabling condition. The doctor must be able to explain how the condition prevents you from performing the essential functions of your job.

For example, it is not enough to say someone is disabled because of low back pain. The doctor must describe how the low back pain prevents the employee from sitting at a desk long enough to work effectively, lifting objects the job demands, traveling, or other essential job functions. I recommend submitting to the insurance company with the application all the medical records supporting your application that you can gather along with a supporting letter from one or more treating physicians.

The transition from STD to LTD is a critical time to review your legal rights. Too often, employers are only too happy to encourage disabled employees to apply for LTD and then terminate their employment when they do not return to work. However, the insurance company, not the employer, determines whether LTD benefits will be granted. Employees may find themselves unemployed and without disability benefits because they failed to explore options for returning to work and the disability insurer has determined they are not disabled. The employer has an obligation to provide reasonable accommodations. Do not apply for LTD until you have explored options for returning to work or your disability is severe enough that your doctors will unwaveringly agree you can no longer perform your job.

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