As for a qualifying disability, the administration defines disability as “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
You can apply online or by visiting a Disability Determination Services (DDS) field office in either Phoenix or Tucson. We can assist you with the filing process to help make sure you cross all the T’s and dot all the I’s. Remember, the first-time success rate is low for those who file without assistance.
Qualifying Through Your Insurance Company
Most of the largest insurance companies provide private long-term disability policies. Household names like Unum, Aetna, Liberty Mutual, The Hartford, John Hancock, and many others all underwrite LTD policies. You may have purchased one through work or on your own.
The one thing these companies all have in common is that they aim to protect their bottom line, so they will no doubt make it difficult for you to qualify. The application process for each company may differ a bit, but just as you would for SSDI, you must provide proof of your disability, which requires medical documentation.
Your insurer may also require you to qualify for SSDI before they provide any funds in the form of an offset from whatever SSDI provides. For instance, if your policy promises $2,000 in disability payments and SSDI is providing $1,000, the insurer may pay only $1,000 as an offset.
Remember, insurance companies rely on adjusters to determine your eligibility for any claim you file. The last thing you want while suffering from a disability is for you or a loved one to have to deal with these adjusters, either by phone, in person, or by mail. Let an experienced disability insurance attorney deal with the whole process, including filing and answering questions from the adjusters.
Appealing a Decision vs. Filing a Lawsuit
If you are turned down or later have your benefits reduced or rescinded for whatever reason, your appeals process will largely be governed by whether you’re under a group plan or an individual plan. Group plans such as those offered by employers are covered by the Employee Retirement Income Security Act (ERISA), which established certain appeal rules and standards that can stretch out the appeals process.
Individual, non-group plans can be appealed directly or taken to court if need be, to obtain a court order mandating the payments.
If the Arizona DDS denies your claim, you have 60 days to file for reconsideration. If that’s denied, you can request a hearing. If the administrative law judge at the hearing denies your appeal, you have 60 days to appeal to the Appeals Council. If that fails, you must file in federal district court.
In Arizona, 28% of new disability applications are approved, compared to 35% nationwide, A reconsideration appeal is successful 11% of the time (13% nationwide), and judges side with the appellants 55% of the time (45% nationwide). However, the average wait for a hearing in Arizona is 19 months, compared to the nationwide average of 17 months.
Group and private insurers may try to offer you a lump-sum buyout. Generally, this will favor the insurer over the insured, but in some cases, it may represent a better deal for the insured. If you are offered a lump-sum payment, you must run it by your attorney to have a benefit analysis conducted.
As you can see, there are legal and procedural hoops and hurdles involved in any type of disability claim, whether from the government or a private insurer. Your best recourse is not to go it alone but to get the help of those experienced with filing — and appealing — disability insurance claims. Remember, whether applying or appealing, don’t sign anything without running it by an experienced disability insurance attorney like our team at Arnett & Arnett, PC.