If I File A Short Term Disability Claim With My Carrier And My Claim Is Denied, Do I Also Need To File A Separate Long Term Disability Claim?

An issue that comes up often during litigation of a claim for disability benefits is: After exhausting all of your administrative remedies for a clam for STD benefits, may a lawsuit be brought for LTD benefits as well? Insurance companies frequently move to dismiss claims for LTD benefits, claiming that the Plaintiff failed to successfully appeal the denial of the STD claim, therefore the LTD claim was never at issue.

However, in a recent case out of Kentucky, Basham v. Prudential (W.D. KY, Feb 21, 2014), the Court disagreed with Prudential’s argument to dismiss Plaintiff’s claim for LTD benefits arguing that the Plaintiff only filed a claim for STD benefits and never properly filed an LTD claim. In her summary judgment motion, Basham directed the Courts attention to a document found on Prudential’s website (www.prudential.com/mybenefits) entitled “Disability Claim Instructions” which sets out the requirements for the filing of an LTD claim. Prudential argued that this document should not be considered in this case as it was not part of the administrative record. The Court disagreed, stating although not contained in the administrative record, the document is properly considerable in determining whether Basham properly filed her LTD claim. Specifically, the document states in pertinent part:

…If you have both STD and LTD coverage with Prudential, and you have filed a claim for STD, there is no need to resubmit the statements noted above (Employee’s Statement, Attending Physician’s Statement and Employer’s Statement) for the LTD portion of your claim. Your claim for LTD benefits, in this case, will be considered filed, when you meet both of these two criteria: 1) We receive the Employee’s Statement, the Employer’s Statement, and the Attending Physician’s Statement; 2) The date is 45 days before the end of your LTD elimination period.

Prudential violated ERISA regulations by failing to render a decision on her LTD claim.

After finding that the Plaintiff had properly filed a claim for LTD benefits, the Court determined that Prudential’s failure to consider her LTD claim was in violation of ERISA. Since Prudential only addressed her STD claim and the Plaintiff never received notice of Prudential’s adverse determination of her LTD claim, the reasons therefore, or a request for additional material information necessary to perfect her claim, the Court found that Prudential violated ERISA and remanded the claim back to Prudential to conduct a full and fair review.

This is an important decision for claimants who have Prudential STD and LTD plans governed by ERISA. According to the Court in this case, it is possible that once a claimant files an STD claim for benefits with Prudential and they meet the two criteria set forth above, their LTD claim is also deemed filed. However, be aware that this may not be the case for plans with other insurance carriers. It is important obtain the procedures from your individual carrier to determine how to properly file a claim for STD and LTD benefits.

Leave a comment or ask us a question

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us