As a law enforcement officer, navigating your disability insurance policy and understanding all the nuances of your claim as well as things that may influence your decisions – such as workers’s compensation – may feel a little overwhelming. Long-term disability insurance claims for law enforcement officers have their own specifics, and it’s important to have all the right information at your disposal to make sure your claim is successful.
Here at Dell Disability Law, several of our lawyers are former prosecutors, and we have extensive experience working with law enforcement from police officers to DEA agents and beyond. Having represented hundreds of law enforcement officers across the country, we have a deep understanding of the challenges they face when dealing with long-term disability insurance claims.
Law enforcement is an interesting dynamic in terms of own occupation: most of the insurance policies for this sector are ERISA-exempt, which means the police officers and law enforcement are not stuck with the inability to have a jury trial if their claim is denied. However, they still usually have group employer-provided disability policies that may not have the best language because they did not buy the policy on their own.
In this article:
- Understanding the Language of Your Disability Policy
- What Can Offset Long-Term Disability Benefits?
- Issues Develop If You Have a Worker’s Comp and Long Term Disability Claim
- How Long Do Long Term Disability Claims Last for Law Enforcement Officers?
- How Long Do Disability Insurance Lawsuits Take?
- What Settlement Can You Expect from a Disability Insurance Lawsuit?
Nationwide disability insurance attorneys Gregory Dell and Alexander Palamara provides some tips for law enforcement officers that are either considering applying for disability benefits, have been on claim, or had their claim denied, and talk about some helpful pointers to protect your long term disability benefits. We help law enforcement officers nationwide and we encourage you to contact us for an immediate free phone consultation.
Understanding the Language of Your Disability Policy
Every disability insurance policy is a little bit unique, but it is important to understand that most disability insurance policies have a definition of disability that changes after 24 months of payments. This means that for the first two years, in order to prove to the insurance company that you are disabled, you have to prove that you can’t do the material and substantial duties of your own occupation. In most group policies, after the initial two-year mark, it becomes a bit more difficult to qualify for benefits: at that point, you have to prove that you can’t do any occupation for which you’re qualified based on your training, education, and experience.
Let’s say you’re a police officer. After two years, the insurance company might suggest that you can now go be a security guard because of your background, training, and history as a police officer. In their eyes, you can be a security guard as long as that security guard position pays a certain income level and requires different physical skills than your pre-disability job. Under most policies, the alternative job must pay at least 60% of what you were earning pre-disability.
However, while most insurance policies will have this change in definition of disability, there may be ways to get around this language to prove that you are still disabled. Depending on their disabling conditions and the proof they have for those disabling conditions, there are certain ways to get around the 24-month limiting language or the 24-month change in definition of disability.
A lot of these policies also have mental health limiting language where they will only pay disability benefits for a mental health condition for 24 months. And in this day and age, being a law enforcement officer is harder than ever; there are mental health claims to be made just because of the challenges that many police officers are dealing with on a regular basis. However, you have to keep in mind that mental health claims can be limited to 24 months under most policies because of the language in the policy. Even if you have anxiety, depression, or PTSD, which is very common with law enforcement, there could be limitations in the policy you need to be aware of.
What Can Offset Long-Term Disability Benefits?
Often, law enforcement members’ disability claims are unique because a significant number of officers have had on-the-job injuries. This makes it somewhat complicated, because if an officer is injured on the job, they also end up with a workers’ compensation claim which is often an offset to long-term disability coverage. However, workers’ compensation doesn’t last forever: it only goes for a certain period of time, whereas the long-term disability policy can last to age 65 or your Social Security retirement age, which could be 67 or 68. Despite that, as long as you’re continuing to get workers’ compensation, the insurance company may offset that amount. Potentially, workers’ compensation offset may only be for wages, and it shouldn’t be for medical, which can help increase the value of the long-term disability policy.
Disability insurance policies typically pay 60% of your prior monthly earnings. Let’s just say you’re making $100,000 a year; they should be paying you $60,000 a year, divided by 12 months, which is about $5,000 a month in this scenario. However, if you are getting workers’ compensation, workers’ comp pays fairly high. Sometimes, it can pay even higher than a disability insurance policy on a monthly basis. In that scenario, your disability insurance policy might end up paying you a minimum benefit amount per month, which might be something minimal like $100 or up to 10% of your gross monthly benefit. And typically, workers’ compensation ends around two years, or there may be a settlement prior to the two-year mark.
At that point, your long-term disability should kick in and pay you the gross monthly benefit, unless there are other offsets such as pension claims or social security disability. Any other benefits that you could be receiving would be an offset to your disability insurance claim, and it would lower the amount of money that the insurance company has to pay you per month.
Issues Develop If You Have a Worker’s Comp and Long Term Disability Claim
Another issue for law enforcement officers is the change in definition from own occupation, which means inability to do the duties of a law enforcement officer, to any gainful occupation based upon experience, education, and training; it may also have an income component, that is, the insurance company may say you have to be able to do a job that will pay you 60% of what you used to make. The challenge here is that you may be treated by a workers’ comp doctor, and they may confirm you are unable to do work in law enforcement. However, they may not be limiting you to do any other gainful occupation. If the workers’ comp doctor won’t support inability for any gainful occupation and only supports inability to do law enforcement, then, after 24 months, you may get denied for your long-term disability.
Workers’ comp doctors typically have a high volume of patients, aren’t well-compensated, and often, they’re not interested in working with the claimant against the insurance company. Because of this, it’s worth considering going above and beyond that treatment and going to other doctors. The only way you can prove your claim for disability insurance benefits is with well-documented proof. Depending on your disabling conditions, you have to go to the right specialist so you can document exactly what you’re suffering from in a way that will prove your disability to the insurance company.
Remember, proof is everything to your claim. Whether it’s objective testing you can have done, whether it’s a functional capacity evaluation, X-rays, MRIs, whatever it is to prove your disabling condition, it’s best to go and get it done, because insurance companies love to deny claims if there isn’t sufficient proof. So be sure to see the appropriate health providers, the appropriate specialist, and get those records to the insurance company. Instead of being stuck with a workers’ comp doctor who isn’t going to support you, you need to think proactively, even if it’s difficult or costly because it could be a small price to pay once every few months in order to keep the benefits going, which could potentially be couple of thousand dollars every month. Sometimes, you have to invest into your own claim: if you invest $1,000 every couple of months for the doctors’ appointments or tests that will support your claim, at least you’re going to be getting five-fold that in your monthly benefits.
It’s crucial to understand that the claim is only as good as it is documented on paper. Not only that, but the quality of the proof is important, so it’s not enough to just go to the doctor. You have to make sure that all your complaints and symptoms are on the record. If you’re having pain, that has to be in the records. If you’re limited in how long you could sit, how long you could stand, how long you could walk, reaching, bending – things like that have to be documented.
We often suggest that people keep a symptom log or a pain log where they document things that were difficult for them on a daily basis or what were they limited in and sharing that information with the doctor and letting the doctor say, “I was presented with a daily symptom log and I documented in this log the following things”. Then it’s in the records, because, once again, if it’s not in the records, it doesn’t exist in the eyes of the insurance company.
How Long Do Long Term Disability Claims Last for Law Enforcement Officers?
Most disability insurance companies say that on average, a claim lasts for 34 to 36 months. You may be on disability for three years, as an example, and the insurance company may then try to cut the claim. We often see people who are denied from day one, or they get denied a couple of months in, or they get denied at that change in definition of disability. A lot of the time, they may go a little beyond the 24 months; sometimes, some policies have a 36-month change in definition of disability. But generally we see that most claims do not last 36 months, unless lawyers get involved, at which point the claimant may be able to get back on claim with an appeal or by filing a lawsuit and litigating the case to the end.
How Long Do Disability Insurance Lawsuits Take?
If a lawsuit is filed for a disability insurance denial, you still have to maintain your records constantly and always see the doctor and submit your claim forms and attending physician statements in a timely manner. Because law enforcement policies are not subject to ERISA, mostly, it would probably be in state court (unless there was greater than $75,000 in controversy), and then it could go in federal court. Our lawyers represent law enforcement officers nationwide in every state or federal court.
A typical time frame for these lawsuits from start to finish could be as high as two years, depending on what court you’re in. Some courts have a fast track, but a trial could be six months or as many as twelve months away. Typically, however, 18-24 months is the average time frame where a case will actually come to trial from the day you file your lawsuit. However, not all cases go to trial: most, in fact, end up settling. The great majority, probably 90% of cases, usually settle.
The fact that these policies are not governed by ERISA is a significant advantage, because you have a right to a jury trial, the standard of review is different, and proof that is required is different.
What Settlement Can You Expect from a Disability Insurance Lawsuit?
When a lawsuit is filed, the cause of action is called a breach of contract. This is because, as an insurance policy holder, you bought (or got it as an employee benefit) a contract where the insurance company said, if you meet this qualification, we will pay you this benefit each month that you remain eligible. Because it’s a contract and there’s a set monthly benefit amount, when you go to trial, it’s not your typical personal injury trial where you’re asking for pain and suffering or damages that are of an unknown number; there are clearly defined values involved.
For example, if the policy pays $5,000 a month amounting to $60,000 a year and there are 10 years left, then we know it’s worth $600,000. That’s the defined value, and because of it, 90% of these cases often settle with a lump-sum settlement as the disability insurance companies typically put some kind of an offer on the table.
If the case is worth $600,000 and they hypothetically offer $300,000, then the claimant needs to make a business decision at that point and say, if my upside is $600,000 and they’re guaranteeing me $300,000 right now, do I want to go through a trial to try to double my money? It’s that plain and simple, and it becomes a pure business decision.
Often, it’s hard for claimants to set aside their emotions of feeling like they have been taken advantage of by their disability insurance company. At this point, they have potentially waited nine months, a year, or more to even get to this point, and it’s understandably tough to make this decision.
Ultimately, your lawyer is your navigator, but you are the pilot. Your lawyer can tell you that the right move is to turn right, but if you want to turn left, that’s your decision. We provide you with the best information available, explain to you the case law, our history, what we’ve done in past cases and your chances of success at a trial so that you can make the best decision for yourself and, ultimately, for your family.
If you are a law enforcement officer, no matter what stage your claim is at, even if you haven’t even filed yet or you’ve been denied, feel free to contact us. Any of our disability lawyers will immediately answer your call or your email when you reach out to us, and we will provide you with an immediate free consultation.
We also encourage you to search our website where you can look up other cases involving law enforcement disability cases around the country. You can search by your medical condition or, alternatively, you can search specifically by your insurance company which is always a great idea because we want you to know how your disability insurance company thinks. The more you can start to think like your disability insurance company, the better position you’re going to be in to protect your disability benefits.
Finally, we welcome you to subscribe to our YouTube channel so that you can continue to get useful tips that will help you to secure and protect your disability benefits. We look forward to the opportunity to speak with you, should you need us in the future.