You shouldn’t have to fight for your disability insurance benefits when you’re already struggling to recover after an injury. Fortunately, a Los Angeles disability attorney can do the fighting for you.
Receive the Long-Term Disability Benefits You Deserve in Los Angeles, California
Serious injuries can be debilitating and life-altering in every facet of life, from the personal to the professional. After a severe accident, you may be unable to return to work. It’s an unfortunate truth, but many workers find themselves with injuries that can put them off the job for a few weeks. Some are even out of work for good.
When you began your job, you might have been provided or purchased disability insurance, but when your accident has left you injured and unable to work, how do you file a claim for those benefits? These benefits can help you keep going after a severe accident, but filing a disability insurance claim can be confusing and complicated, especially when you’re dealing with unfair claim denials.
California disability insurance rules are often strict, and when you have been hurt and left disabled, that can feel overwhelming. But with the help of a long term disability lawyer, you can get the help you need to handle your disability claim.
Quick Summary
Below is an overview of the critical points of this article.
- Disability occurs when someone has a physical or mental issue that makes it hard to do regular tasks. It can be temporary or long term, mild or very serious.
- After an accident, you must check what kind of disability insurance you have in Los Angeles. There are two main types: short-term, which covers you for a few months, and long-term, which can support you for life if your disability lasts more than six months.
- Long-term disability benefits pay a part of your income and can change. They might increase with the cost of living or decrease if you get other benefits.
- Social Security Disability Insurance (SSDI) benefits are meant for people who can’t work due to a severe injury or illness expected to last at least a year or result in death.
- To qualify for California Social Security Disability benefits, you must have worked in jobs covered by Social Security and have a medical condition that meets their disability definition.
- The key difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) is how you qualify and the benefits you get.
- Private disability insurance is offered by many companies in the United States. It’s usually obtained through group coverage at work or individual policies.
- Disability insurance often covers common conditions like substance abuse, pregnancy complications, multiple sclerosis, and Traumatic Brain Injuries.
- To qualify for Disability Insurance (DI) benefits, you must be unable to work for at least eight days due to a disability, have lost income because of it, and have earned at least $300 during your base period with SDI deductions.
- To file for disability in California, gather your documents and information, make an SDI account or get a claim form, fill out the forms or file online, have your doctor complete a certificate, send your application to the nearest EDD office, and wait for them to review your claim.
- To appeal a denied disability claim in California, fill out the form you received, send it back with any additional documents, wait for the EDD to review your appeal, review your hearing notice from the Office of Appeals, and attend your appeal hearing.
What is Disability?
Disability refers to a physical or mental impairment that limits an individual’s ability to perform certain tasks or activities considered normal for a person without such impairment. Disabilities can be temporary or permanent, and they can range from mild to severe.
Examples of disabilities include visual impairments, hearing impairments, physical disabilities, developmental disabilities, and mental health conditions. It’s important to note that disabilities are not the same as illnesses or diseases; they are not inherently negative or a sign of weakness.
Types of Disability Insurance in Los Angeles
After an accident, the first step is to determine what sort of disability insurance you have and what you need for your situation. There are two main types of disability insurance: long-term and short-term.
Your coverage will depend on the plan you choose through your employer or purchase through a private insurer, but there are a few key differences between the two.
Short-Term Disability Insurance
Short-term disability insurance refers to insurance that covers you for a short period. This insurance usually lasts three to six months, but your policy may last up to a year in California. These policies are less expensive, but they will not last as long as a long-term plan.
Long-Term Disability Insurance
Long-term disability insurance, however, can support you for a lifetime. If your disability lasts longer than six months, long-term disability should cover your needs for as long as your disability lasts.
Unfortunately, these policies can be significantly more expensive, and it is common to find yourself waiting for a few months before these benefits are available.
But there are often exclusions and limitations:
- Mental Health Issues. The most common exclusion in long-term disability insurance is for mental or nervous conditions. While some insurers don’t limit claims for these conditions, you’ll typically find this provision in your policy. These conditions can include stress, anxiety, depression, or dementia. The usual limit for benefits related to mental or nervous conditions is two years.
- Pre-Existing Conditions. A pre-existing condition is a health issue that insurance doesn’t cover because they think you had it before getting their insurance. For instance, if you had a heart attack and applied for disability, your insurer might check your medical records and discover that you had high blood pressure during a routine doctor’s visit in the relevant time frame. Your insurance company may use a preexisting condition clause to limit your benefits.
- Waiting Period. LTD policies often have a waiting period (elimination period) of three to six months, similar to short-term disability benefits, during which you are not covered.
- Duration of Benefits. Some policies pay LTD benefits until you turn 65 and can get Medicare, while others only pay for a few years.
How Much Does Long-Term Disability Pay Me?
Long-term disability benefits pay some of your wages and may change over time. They could go up with the cost of living or down if you receive other benefits like work or SSDI. Most long term disability policies pay between half and 80% of what you earned before you became disabled. There’s usually a maximum amount they’ll pay.
What Are Social Security Disability Insurance (SSDI) Benefits?
SSDI benefits differ from Social Security income people receive after working for a specific period. SSDI is designed to provide payments to individuals who are unable to work due to a severe injury or illness resulting in an impairment that is expected to last for at least a year or could lead to death within a year.
The amount of SSDI benefits a person receives is determined by their past earnings and is paid to both the individual and their dependents. The formula used to calculate the total disability benefit considers the worker’s income before their disability. Although it may not entirely replace the individual’s income, it can serve as a significant supplement.
Am I Eligible for California Social Security Disability Benefits?
Social Security Disability benefits are managed by the Social Security Administration (SSA). To be eligible for Social Security Disability Insurance (SSDI) benefits, you must:
- Worked in jobs covered by Social Security.
- Have a medical condition that meets Social Security’s strict disability definition.
- Social Security’s disability definition is different from that of other programs.
California residents may be eligible for SSDI benefits if:
- Cannot work or do substantial gainful activity due to a medical condition.
- Cannot do previous work or adjust to other work due to a medical condition.
- The condition has lasted or is expected to last at least one year or result in death.
What is the Difference Between SSDI and SSI?
The main difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) is how you qualify for them and your benefits. SSDI is for people with a strong work history who have paid into Social Security through taxes.
Benefits are based on earnings history and can also help certain family members. It’s for those who paid into the system and need help because of a disability. On the other hand, SSI is based on financial need, not work history. This makes the two programs different in how you qualify and what benefits you receive.
What Are Private Disability Insurance Benefits?
Numerous providers of private disability insurance offer services in the United States. People typically obtain long-term disability insurance through group coverage or individual policies. Group coverage is generally available through employer-sponsored insurance or professional associations.
Individuals who receive private disability insurance through their employer or association typically do not have to undergo the underwriting process. However, if a person obtains a private disability insurance policy on their own, it will typically require underwriting, and their eligibility and premium will be based on their personal health history.
Typically, the insurer will evaluate the person’s medical history over three to five years and may require a medical examination. Whether a person obtains private disability benefits through their employer or individually through a policy, they will be able to utilize the policy if they become disabled, up to the amount specified in the policy contract.
What Are the Most Common Conditions Covered by Disability Insurance?
Common injuries and illnesses that may be eligible for benefits include:
Substance Abuse
Certain disability policies may offer benefits if an individual seeks treatment for substance abuse. Depending on the specific plan, a 12-month rehabilitation program may qualify for short- or long-term individual or group disability benefits. If a person’s disability insurance policy does not cover illegal drug abuse, it may still provide coverage for addictions to prescription medication.
Additional time may be required to find effective alternative methods for pain management related to an underlying injury or illness. To avoid being excluded due to “self-inflicted” causes, it’s recommended to seek assistance from a Los Angeles long term disability lawyer who can help file a strong claim application.
Complications of Pregnancy
If you have experienced childbirth, you are likely aware of the numerous potential complications that may arise during pregnancy. Your doctor may advise bed rest in the early stages of pregnancy, or you may develop a post-surgical site infection after a C-section, or experience postpartum depression.
Even individuals in excellent health can encounter complications during and after childbirth. As an example, tennis champion Serena Williams faced life-threatening blood clots after giving birth to her daughter, and women are at a higher risk of developing blood clots during pregnancy.
Multiple Sclerosis
The immune system disorder referred to as Multiple Sclerosis causes interference with the communication between the brain and the rest of the body’s nerves. The physical symptoms can range significantly, including numbness, tingling sensations, loss of coordination, vision impairment, and even the inability to walk.
In addition to these physical symptoms, patients may experience difficulties in concentration, cognitive processing, and emotional regulation. While there are costly treatments available, there is currently no cure for this condition. Multiple Sclerosis may potentially prevent patients from continuing in any form of employment while burdening them with significant medical expenses.
Traumatic Brain Injuries
In modern times, athletes, particularly in football, are receiving significant attention due to the high prevalence of Chronic Traumatic Encephalopathy (CTE). While the condition is not yet fully comprehended, research suggests that it may result from recurrent concussions and other severe forms of Traumatic Brain Injury (TBI).
Nevertheless, even a single TBI, particularly those caused by vehicular accidents involving cars, trucks, and motorcycles, may result in long-lasting or permanent disability. Here are some more disabling illnesses and injuries that might qualify you for individual or group disability benefits:
- Malignant neoplasms, chemotherapy, and radiation
- Car accident injuries
- Spinal, cervical, and thoracic issues
- Surgical recovery
- Heart attacks, strokes, diabetes, COPD, and aneurysms
- Knee problems and knee replacements
- Other self-reported conditions include fibromyalgia, migraines, and chronic fatigue
- SLE and rheumatoid arthritis
- Diseases such as Crohn’s, IBS, and bowel dysfunction
What Are Disability Insurance Eligibility Requirements?
To be eligible for DI benefits, you must:
- Be unable to perform your usual or customary duties for a minimum of eight days.
- You have lost income due to your disability.
- Employed or actively seeking employment at the onset of your disability.
- During your base period, you earned at least $300, from which State Disability Insurance (SDI) deductions were deducted.
- You must be under the care and treatment of a licensed physician or practitioner or accredited religious practitioner for the first eight days of your disability. If your claim does not meet this requirement, the beginning date can be modified. You must continue receiving care and treatment to continue receiving benefits.
- Complete and submit your Claim for Disability Insurance (DI) Benefits (DE 2501) within nine days of your first day of disability, but no later than 49 days, or you risk losing your benefits.
- Have your doctor complete the medical certification portion of your disability claim.
How Can I File for Disability in California?
Below are steps to take to file for disability in California.
- Collect needed documents and information.
- Make an SDI online account or get a claim form.
- Log in and file a new claim or fill out the forms.
- Have your doctor fill out the doctor’s certificate.
- Send your application to the nearest Employment Development Department (EDD) office.
- Wait for the EDD to review your claim.
How Can I Appeal a Denied Disability Claim in California?
If you want to appeal your denied disability claim in California, here’s what you need to do:
- Complete the appeal form you got.
- Send back the form and any extra papers.
- Wait for the EDD to check your appeal.
- Look over your hearing notice from the Office of Appeals.
- Go to your appeal hearing.
Why Do I Need a Long Term Disability Lawyer in California?
If you have long-term disability (LTD) insurance, you know it protects your income if you can’t work due to a disabling health condition. You can get LTD through your employer or buy a private plan from an insurance company. When you need to file a claim, it can be overwhelming, especially if you’re also dealing with your health.
That’s when a Los Angeles long term disability lawyer can help. Legal help can be valuable when filing a claim or appealing a denial of benefits.
- They can review your policy.
- Help you understand complex laws.
- Can make sure the insurance company follows your policy’s terms.
- Help you avoid common mistakes.
- Can gather evidence for your claim.
- Can manage the long-term disability process for you.
Contact a Los Angeles Disability Attorney
When you’re injured and unable to work, disability insurance can help you get back on track or sustain you during a permanent illness or injury. Disability insurance is there to help you, and when you need that coverage, getting help with your claim is the best option.
Understanding disability insurance laws can be challenging—first, applications for disability coverage are often rejected. When this happens, you will likely need someone who understands the appeals process and can ensure you get the compensation you need to maintain your quality of life.
If you are having trouble with your disability claim or believe you have a case we can help with, call us. Our lawyers can assist you with Bad Faith Insurance, Property Damage, and Class Action Lawsuits. Schedule a free case review with us now.
