The first step to understanding your long term disability benefits is to obtain a copy of your insurance policy. The policy is a contract that sets forth, among other things:
- the amount of your benefits
- when benefits will begin
- how often benefits will be paid
- when benefits will end
- how disability is defined (must you be disabled from any occupation or just your own?)
- whether there are certain disabilities that excluded from your coverage (such as pre-existing and self-inflicted conditions)
- whether there are certain conditions for which you will be paid limited benefits (such as mental illness, substance abuse, chronic fatigue, “self-reported” or “neuromusculoskeletal” conditions, and other types of disabilities)
- the claims process and, if you are denied, the deadlines to appeal or file suit
If you bought your disability insurance from an agent, broker, financial institution, or directly from an insurance company, you can request a copy of your policy from whoever sold it to you. If you do not remember how you purchased the policy, look for your most recent premium invoice. Call the customer service number or mail a written request for a copy of your policy to the address on your bill. The insurance company may charge a small fee to mail you a copy.
What if you did not purchase your own long term disability policy?
The vast majority of working adults in the US have group long term disability coverage through their employer or union. If you received yours as part of your employee benefit plan and your policy is governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), then you have the right to receive a free copy of your policy. ERISA § 104(b)(4), 29 U.S.C. § 1024(b)(4) states, “The administrator shall, upon written request of any participant or beneficiary, furnish a copy of the latest updated summary, plan description, and the latest annual report, any terminal report, the bargaining agreement, trust agreement, contract, or other instruments under which the plan is established or operated.”
Requesting your group long term disability policy if you have already filed a claim
If you are already disabled and have filed a claim, then look for the name and address of the person or company administering your long term disability benefits. Usually, this will be an insurance company.
Write a letter to the insurance company requesting a copy of the long term disability policy in effect as of the date you became disabled. Employer-sponsored benefits can change every year, so make sure you specify the date of your disability in your request.
Keep a copy of your letter and proof of the date you mailed it. Most people send this request via certified mail. ERISA § 502(c), 29 U.S.C. § 1132(c) provides penalties for a plan administrator’s refusal to supply required information within 30 days.
Requesting your group long term disability policy if you have not yet filed a claim
If you have not yet filed a claim, your best bet is to ask your employer or union representative for a copy of the policy.
- If your company has a web portal for employees, you may be able to download your employee benefit information, including your long term disability policy.
- If you do not have access to your policy on-line, ask your supervisor or employer's human resources department for a copy of your current long term disability policy.
- If your employer or union representative does not have a copy of your long term disability policy, ask for the Summary Plan Description. This may be a booklet or a single sheet of paper outlining of your disability insurance coverage. The Summary Plan Description will also give you the plan administrator's name and address.
- Once you have the plan administrator’s address, write a letter to the plan administrator requesting a complete copy of your long-term disability policy. Keep a copy of your letter and proof of the date you mailed it. If your employer's plan is governed by ERISA, the Plan Administrator must provide you with a copy of the plan documents within 30 days of your written request.
What to do when you receive a copy of your long term disability policy
Insurance policies are notoriously difficult to read. If you decide to tackle this task yourself, be sure to read the entire document. Remember, “the big print giveth, the small print taketh away.” If you need help interpreting your long term disability policy, consult an experienced long term disability lawyer. The best disability lawyers will offer free policy analysis and free initial consultations.