Public Service Announcement: Know your LTD coverage BEFORE you need it.

brandy1017, ASN, RN · Oct 24, 2011

On another website I read MetLife has been notorious for denying people LTD when there was no doubt they were disabled! What I read said even judges had limited ability to help people with their disability claims.

roser13, ASN, RN · Oct 24, 2011

On another website I read MetLife has been notorious for denying people LTD when there was no doubt they were disabled! What I read said even judges had limited ability to help people with their disability claims.

Yes, under ERISA, that is true. It is not true for private disability policy holders.

FancypantsRN · Oct 24, 2011

Thanks for the food for thought roser. I have always just automatically elected for employer LTD coverage. I thankfully have never needed to use it, but just assumed it would take care of whatever without hassle if I did need to cash it in. It never occurred to me that it could be denied.

defyinggravity2009 · Oct 24, 2011

Before going back to school for nursing, I spent a few years working as a Disability Claims Manager for a very large and well-known insurance company, however I worked only in the Short Term Disability aspect (absences lasting

While insurance companies get a bad rap for denying claims, there are a lot of justifiable employment suits that result when a person transitions from short term to long term disability: these usually arise from the disagreement between how long a company can hold a position for an employee who may or may not be able to return to work after they have exhausted their (federally funded) family medical leave/short term disability period. You can usually request a leave of absence from your HR department, and it is often honored if there is some sort of reasonable estimated duration for an absence's extension. But if that estimated return to work date is left open-ended, the employer is often able to deny this request in the interest of the business.

So look into your personal disability options - I often dealt with patients who had AFLAC, and they had good things to say about them (not a plug - just an observation from time in the field). You are your own best advocate, and it's a lot easier to take care of yourself financially before there is a problem, rather than waiting until your bills are piling up and you are at the mercy of the insurance company.

Thanks to the OP for posting this thread!

theantichick · Oct 25, 2011

Thanks for the heads up. I was NOT aware that LTD was governed by ERISA. My research into ERISA with a medical claim that was denied has me convinced that ERISA is the law that allows easily 90% of the insurance abuses to occur, and has resulted in untold deaths and disabilities.

I'll definitely be looking into purchasing my own.

Esme12, ASN, BSN, RN · Oct 25, 2011

No one thinks they'll ever need it. It's not like health or life insurance: we all need medical care and we all die. We may or may not become disabled.
As nurses, we should be hyper-aware of our potential need for LTD coverage. We all know how physicially demanding our jobs are. A few words to the wise (from one who has been in the trenches and survived):
Does your employer offer LTD coverage? If so:
1) Are you aware that if you pay your premiums with after-tax dollars, your LTD benefit will be tax-free?
2) Are you aware of ERISA (Employee Retirement Income Security Act) and how it can impact your ability to claim a benefit in a fair and equitable manner? The vast majority of employer-provided LTD policies are governed by ERISA. Under ERISA, you may not claim any damages against the LTD company for bad faith. If your LTD claim is denied, the burden will be upon you, the claimant, to prove otherwise. The only penalty against the LTD company that can be awarded (no matter how egregious the LTD company's behavior) is backpay of the claim plus interest. Occasionally, a paltry per-diem penalty is allowed when the LTD company misses mandated deadlines.
3) Have you obtained a copy of the Disability Policy, read it, and understand that any other income (SSDI, private LTD policy, VA benefits, etc.) may (likely will) be offset (taken out of your disability payment)?
4) Are you aware that you can decline your employer's coverage and purchase your own private disability policy, which will NOT be subject to ERISA?
After 10 years and 3 federal lawsuits, my husband and I are experts on this subject, much to our dismay. We wish that we had paid more attention before needing disability coverage. I hope that we can serve as a cautionary tale to all of you. These are all details that I wish I had known before unexpected disability visited my family.

Ahhh...another fallen victim to the innocence of trusting your employer.....I personally feel your pain and financial strife.....:redpinkhe

xtxrn, ASN, RN · Oct 25, 2011

I've been very fortunate with my LTD coverage. They have done what they said they would. When I was eligible, the only thing they asked was that I also apply for SSDI, which I did, and got approved on the first application; after that, the LTD paid the difference between my 66% of my prior wages (per the LTD I had- paid for the upgrade), and SSDI. It was a good thing for the LTD company, but I didn't care- I was getting the same.

It ends when I'm 62 (so several more years to go)..... the only BIG issue is having no savings for after that, and not being able to afford to move someplace cheaper - though having in-apartment laundry and a garage is also very important in this climate and my mobility issues.

I was fairly cut and dry about my ability to work.... I hear that it's MUCH more difficult for the majority of people. But I definitely recommend getting LTD....nobody plans on not being able to work.

But YES-- look into LTD. Get it :)