Seattle Disability Lawyers

​Have you been diagnosed with a severe medical or mental health condition, or sustained a serious injury, and are considering ceasing working and applying for disability insurance benefits? Have you already stopped working and applied for disability insurance benefits, but your claim was denied? Maybe you stopped working and were receiving disability insurance benefits, but the benefits were terminated before you were released to go back to work by your doctors? If so, the Seattle disability lawyers at DeBofsky Law can help.

What Are the Different Types of Disability Insurance Benefits?

Disability insurance protects your income in the event you become disabled and can no longer work. While many employers sponsor group disability benefit plans for their employees – in which case the benefits are commonly referred to as short-term disability (STD) and long-term disability (LTD) benefits – some employers do not. If your employer does not offer disability coverage or you are self-employed, you can purchase individual disability insurance (IDI) on your own.

Short Term Disability (STD) & Long Term Disability (LTD)

Many employer-sponsored disability benefits plans will cover short-term disability benefits (STD) for the first three to six months you are out of work, and then long-term disability (LTD) benefits for those conditions and injuries lasting for more extended periods. LTD benefits are typically payable until you reach retirement age.

STD and LTD benefits are typically paid based on a percentage of your pre-disability monthly income, such as 60% or 66.67%. Employer-sponsored disability benefits are also often coordinated with other benefits you may be eligible to receive, such as Social Security disability benefits.

Individual Disability Insurance (IDI)

You can purchase individual disability insurance (IDI) on your own if you:

• Are self-employed;
• Work for an employer that does not offer disability insurance; or
• Have disability insurance through your employer that only covers a small portion of your income.

IDI policies typically pay a defined monthly benefit amount based on your pre-disability earnings.

What Laws Apply to Disability Insurance Benefits?

If you work for a private-sector employer that offers disability insurance, your benefits are likely governed by the federal benefits law called the Employee Retirement Income Security Act of 1974 (ERISA). If you work for a government or church-related entity, your benefits are exempted from ERISA coverage. If you purchased your own disability insurance policy, your benefits are governed by the State of Washington’s bad faith insurance laws.

What Does the Disability Insurance Benefits Claim Process Entail?

The disability insurance benefits claim process starts with an application for benefits, typically initiated by requesting and completing claim forms supplied by your employer, plan administrator, and/or insurance company. As part of your application, you may need to produce supplemental documentation, including, but not limited to, your treatment records, job description and/or resume, and earnings records. If your claim is approved, then you should start receiving benefits on a weekly or monthly basis once you satisfy your plan’s elimination period.

Unfortunately, though, short-term disability (STD), long-term disability (LTD), and individual disability insurance (IDI) benefits claims are denied all the time. Some common reasons why disability insurance benefits claims are denied include that you no longer qualify for coverage under your plan, your disability is subject to an exclusion and/or limitation in the plan, or your medical condition is not severe enough to prevent you from working and meet the definition of “total disability” under your plan.

If your disability insurance benefits claim is denied, you will likely have to appeal the denial to the plan administrator and/or insurance company. You will typically have up to six months to prepare and submit your appeal, and then the plan administrator will typically have up to three months to render its decision. However, certain types of disability benefit claims will be subject to different timeframes. If the denial of benefits is maintained after you submit your appeal, you can then file a lawsuit seeking the benefits due, along with the attorneys’ fees and costs incurred in litigation.

Please refer to the following blog article for more detailed information regarding the disability insurance benefits claim process: What Should I Expect When I File a Disability Insurance Claim?

How Do You Qualify for Disability Insurance Benefits?

You will typically be eligible for short-term disability (STD), long-term disability (LTD), or individual disability insurance (IDI) benefits if you suffer from a severe illness, injury, or mental health condition that impacts your ability to work. If you are disabled and cannot work in any capacity, you may qualify for total disability benefits. On the other hand, if you have a disability, but can still work in a limited capacity, you may qualify for residual disability benefits. In that case, you will be paid a percentage of the total disability benefit amount you would otherwise be eligible to receive, which will be calculated based on the extent of your disability and loss of income.

Some disability benefits plans will define disability based on whether you can continue to perform your regular occupation, while others will include an any reasonable occupation standard. It is also very common for LTD benefit plans to include an “own occupation” standard initially, but have the definition of disability transition to an “any occupation” standard after a set period of time (typically between 12 to 36 months).

To qualify for disability insurance benefits, you will also need to meet certain requirements, including ensuring:

• Your disability coverage remained active and in force when you ceased working or reduced your work schedule;
• You are under the regular care of a doctor or other medical professionals with the appropriate specialty to treat your condition;
• You can provide documentation of how your medical or mental health condition results in work-related restrictions and limitations; and
• Your condition does not fall into an exclusion under the plan, such as for pre-existing conditions or self-inflicted injuries.

What Medical Conditions Qualify for Disability Insurance Benefits?

You can qualify for disability insurance benefits based on various medical and mental health conditions. Common mental health conditions that may cause a disability include, but are not limited to:

• Depression
• Anxiety
• Borderline personality disorder
• Bipolar disorder
• Schizophrenia
• Post-traumatic stress disorder (PTSD)
• Substance use disorders

While most disability plans pay benefits for as long as you remain unable to work until you reach normal retirement age, disability benefits for mental illnesses and substance use disorders are often limited to a shorter payment period up to a maximum period of typically 24 or 36 months. Please refer our Mental Health Disability page for more information on mental health disabilities.

Common types of medical conditions that may qualify for disability insurance benefits include, but are not limited to:

• Cancer
• HIV/AIDS
• Stroke
• Multiple sclerosis (MS)
• Spinal impairments
• Arthritis
• Chronic pain
• Chronic fatigue syndrome
• Fibromyalgia
• Sleep disorders
• Vision impairments

Many people also qualify for disability insurance benefits based on cognitive disorders, which may be classified as either a mental health or medical condition depending on the terms of your plan.