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If I am approved for Social Security does that mean the disability insurance company must approve my disability claim?



Disability attorney Stephen Jessup discusses how an approval from Social Security for beneifts relates to a claim for disability insurance benefits.

Just because the Social Security Administration has approved you for benefits under their standards, it’s not a guarantee that you’re going to get your long-term disability situation. There’s different standards, there’s different ways in which they evaluate a claim. Obviously, we’ve discussed on recent episodes how courts are looking more and more into making sure the insurance companies are reviewing their files, Social Security claim files; however, it’s not carte blanche meaning you’re going to get your benefits. Social Security may have, for instance, approved you for a mental health condition but your policy may only have a two-year limitation so they could cut you off after that point. Or, your policy through your employer or something you purchased on your own, there might be an exclusion to certain conditions, or you might have a pre-existing condition which wouldn’t make you eligible under your group disability policies. So although Social Security can be a strong piece of evidence to the total picture of your disability and your claim, it doesn’t mean that just in receiving those benefits that you’re going to be approved for your long-term disability. If you have any questions regarding this situation, please, by all means, give us a call and we’ll see if there’s anything we can do to help you out.

There are 14 opinions so far. Add your comment now.

John:

Stephen, I am an Iraq combat vet diagnosed with PTSD, depression and anxiety. I am receiving 100% VA disability and SSDI for it. I also have a private LTD policy with Guardian, and I’ve been on claim now for over 3 years. But, I sometimes worry that they are going to start being overly critical of my claim, as they were in the initial stages of establishing it. They did an exhaustive investigation of my claim and took 8 months before finally reaching a decision. I had IME examinations with Social Security, the VA, and even their own insurance company doctors who confirmed everything.

Anyway, I guess my question is how likely is the insurance company going to continue to scrutinize my claim and/or terminate benefits if I am already receiving SSDI and VA disability for the same illnesses?

Attorney Greg Dell:

John,

Good question. It is very helpful for your claim that you have two other entities stating you are disabled. Guardian is a private entity so they have different powers. Guardian is one of the better disability companies so you should be in good shape. You need to continue treatment and always assume you are being watched by them.

R. Shampo:

I was getting disability from Unum, got approved for SSDI, now Unum sends paper saying they want overpayment, I said no, sent to attorney, they said double dipping is illegal and that’s why I would have to pay back, double dipping is not illegal in Wisconsin, Unum stopped making payments to me all together, even though I have two doctors saying I am disabled, what do I do??

Attorney Greg Dell:

R,

If your policy has an offset provision for SSDI payments, then it is likely that Unum is entitled to the overpayment they seek. If your benefits have been denied, then you need to file an appeal within 180 days of the day of the denial.

Kelly J.:

If they approved my SSI, does this mean I will get benefits?

Attorney Stephen Jessup:

Kelly,

Receipt of SSDI benefits is not a guarantee that you will receive benefits under a private or group disability insurance policy.

Shirley Massey:

I was approved disability in August 2014 but denied any back pay. I have appealed that and it has been over 3 months and they say it is at the payment center. What does that mean? Thank you.

Attorney Stephen Jessup:

Shirley,

I am unsure. Who approved you for disability? A private carrier or the SSA? If it is the latter, then you would need to consult with a social security attorney as to any questions you may have.

Abbey:

I filed a claim for LTD with a disability insurance. They don’t wont me to file for SS benefits yet. Is it to my advantage to ignore their advise and file for SS benefits? Thanks

Attorney Stephen Jessup:

Abbey, if your disability policy is an employer provided disability policy then one almost always has to file for SSDI. Private policies do not require it. I do not see where there would be a disadvantage for filing.

Sue:

I had Guardian life with my former employer, went out on disability 3 yrs ago. Back in July I was approved for social security disability, and payments from Guardian stopped. I also had a life insurance policy with them, also though my former employer. They are constantly calling, sending mailings telling me if they don’t have information from my doctors they will stop my life insurance policy, that it is only good as long as I am disabled. Otherwise I have to pay the premium on it. I hadn’t been able to see doctors last year, as I had no insurance, plus was going with my husband (who has cancer) to his treatments of both chemo and radiation. Then last summer I received insurance from Medicaid, and was able to see a new Doctor,which I continued to see all summer. Then my husbands cancer came back and worse then before, this time they only gave him 6 months to a year to live. I am disabled and will be for the rest of my life. Why this constant harassment on their part?

So again I traveled with my husband to his treatments, which was a hour and a half drive each way.

Again I am getting calls (even though Guardian knows my circumstances, as to why I had to cancel my own doctors appointments. Again their telling me they will be canceling my life insurance policy, because of no doctors proof I am still disabled. I am under so much stress full of anxiety, and constantly having panic attacks over these threats and the health of my husband. Saw a doctor today, which told me this is harassment, that they should not be calling and threatening me this way. Is this treatment they are putting me though illegal?

My doctor thinks it’s totally illegal for them to keep doing this to me constantly. I realize they do not want to have to pay my life insurance, but is there anything I can do to make them stop the harassment?

Attorney Stephen Jessup:

Sue, unfortunately, under the waiver of premium provision of the policy Guardian has the right to request information to verify ongoing disability. Typically, the reviews are only every 6-12 months under the Life insurance policy. Why did your LTD benefit stop? Was your claim denied?

Brent:

My husband was approved for SSDI but his LTD company (principal) are denying him. They say that thier independent doctor claims he’s fit for work. His a 100% disabled veteran who has nerve damage preventing him from doing his job. They are telling he has to have a letter from a doctor before he can appeal. He has several doctor’s saying he shouldn’t be working based on his medications alone. SSDI sent him to 2 doctors that both said he shouldn’t be working. Do they have legitimate grounds to deny him?

Attorney Jay Symonds:

Brent, SSDI and Principal make separate independent decisions regarding disability. The fact that one approves benefits does not mean that the other must approve. That said, the fact that SSDI has approved him and there are, presumably, two favorable physician evaluations in the file is certainly strong evidence of disability that Principal must address. You should certainly request his complete SSDI file for submission as supporting evidence with your appeal to Principal. I also suggest you contact our office and speak with one of the attorneys.

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