• If My Short Term Disability Claim Is Denied Do I Need To File A Separate Long Term Disability Claim?

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

Questions About Hiring Us

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.

Dell & Schaefer Client Reviews   *****

Bert M., DDS

I was referred to Dell & Schaefer thru a network group of top clinicians who gave them a very positive recommendation. I was not disappointed. Dell & Schaefer’s organisation, confidence and direction proved invaluable during a very frustrating and emotional period. We were fortunate to get them onboard at onset of my medical problems, and their help was pivotal as the demands of my illness and the claims procedure became very challenging. I can’t say enough positive things about Stephen Jessup, Greg Dell and the many valuable members of their team. They possess unique knowledge and experience critical for success in this field, and demonstrate a sincere commitment to success for their client. These are highly skilled professionals who provided outstanding guidance and personal support through the processing and management of my professional disability insurance claim.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

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