Can I Claim Long-Term Disability Benefits?

May 20, 2010

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What exactly is “long-term disability?” Does your employer-provided insurance cover long-term disability? How do you file for those benefits in Kentucky?

These are all very important questions, especially when you’re sick or injured, and may be unable to work for a long time.

Long-term disability is defined as the inability of an employee — due to sickness or injury — to engage for more than 12 calendar months in any occupation for which he or she is qualified by education, training or experience.

Many Kentucky employers provide long-term disability coverage as part of their employee benefit package. And, it’s that insurance contract that determines how much and for how long a disabled employee will be paid.

Most insurance contracts require that a medical doctor examine the sick or injured employee to determine whether he or she qualifies for these benefits. And, once the person filing the claim is declared disabled, the doctor is usually required to re-examine the employee periodically, and confirm that his or her condition remains severe enough to prevent a return to work.

Another factor that affects who pays a disabled employee is how and where they became sick or were injured. If the employee was disabled at the workplace or as the result of action taken by a third party, other liability coverage might “offset” what the employee’s long-term disability carrier must pay. These offsets include, but are not limited to:

  • Social Security disability payments
  • Worker’s Compensation payments, awards and/or settlements
  • Payments, awards and/or settlements from other disability plans covering the employee
  • Damages or settlements recovered from the third party

Most insurance contracts pay a disabled employee their full base salary (less offsets) for a defined number of months, then pay a percentage of the base salary through the remainder of the coverage term (usually one calendar year). Many Kentucky employers also offer Supplemental Long-Term Disability coverage which employees can purchase at group rates.

Making sure that you have the right long-term disability coverage is a complex task — one you should complete before you get sick or are injured. Ask your company’s human resources department what you have and what your options are.

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