I Left Work And Made A Disability Claim, What Else Do I Need To Do?

If you have been injured or become ill, and have had to leave work, the first thing to do is to make a disability claim. You need to understand your disability benefits, whether they are available to you via government plan, or by your employer, or if you have purchased an individual policy for yourself.

However, if you have left work due to disability, you need to fully understand what happens to your other benefits, such as health, life and pension benefits, in order to determine your rights and obligations regarding these benefits. I am often contacted by individuals asking to retain me to assist them in submitting their disability claims. While I am in the business of fighting with insurance companies over benefit claims, I very frequently tell potential clients that there is no reason to pay me or any other attorney to submit their disability claim. The process can typically be completed without having to pay an attorney. I tell them to wait to see if the claim has been denied to retain me. That being said, it is penny wise and pound foolish not to retain an expert to explain to you how to protect your health, life and pension benefits. A denied disability claim can be contested. But health, life or pension benefits may be lost forever if not properly protected within a short time after you leave work.

There are endless scenarios which might occur, as there are an infinite number of different plan provisions impacting individuals who are on disability. It is impossible to discuss them all in a short blog. However, generally speaking, there are a number of things you need to consider:

Health Insurance:
If you employer was providing you and/or your family health insurance, what happens when you leave work? Some employers may continue paying all or some of your premiums for a limited period of time. Others may terminate your coverage immediately, and require that you go onto COBRA. Under COBRA, you will need to pay not only have to pay the premiums you were paying for your health coverage, but you will also have to pay the premiums your employer was paying on your behalf. COBRA has very stringent rules for when you have to sign up, and when you have to pay the first, and all subsequent premiums. If you decide that accepting COBRA is what is best for you, you need to make sure you understand how much you need to pay, and when it needs to be paid.

On the other hand, other forms of coverage may be a better option for you. If your spouse is employed, and can cover you and any other dependents, that is almost always a better financial option than would be accepting COBRA. Lastly, with the Affordable HealthCare Act, you may have other sources of coverage which will provide you with equal protection, at a lesser cost.

Life Insurance:
Employer group life coverage and privately purchased policies may have provisions which allow your premiums to be waived while you are unable to work. Some require that you be unable to work at your own occupation, while others require that you be unable to perform any type of work at all. Some policies require that you pay premiums for a period of time before the premiums are waived, while others waive premiums immediately. Some policies only permit the premiums to be waived if you are below a certain age when you become disabled. Not all policies allow for waiver of premiums. Some contain portability provisions, which allow you to take the coverage with you if you continue to pay premiums, while others require that if you want to keep your life insurance in force, you must “convert” your coverage to a different policy with different terms and higher premiums than you were previously paying. In any event, if your life expectancy is significantly shortened due to your disabling condition, continuing your life insurance may be of critical importance to you and/or your family. Don’t attempt to figure out for yourself what you need to do, or what your options might be. Either sit down with the Human Resources Department at your work, with your insurance agent, or with an attorney experienced in this area of law. Don’t be surprised if your H.R. Department doesn’t know any more than you do. They may not have dealt with your situation before, and are not sure of what to do. If you do meet with them, make sure to have your questions answered in writing. If they won’t provide written answers, you then do need to talk to a lawyer. Pay for an hour of an attorney’s time may save you or your family hundreds of thousands of dollars.

Pension Benefits:
Once again, no two pension plans are alike. However, in all likelihood, they will all have options as to how you take your pension if you are either retired or disabled. You might have the option of a benefit which pays you for the rest of your life, or a smaller benefit which pays a smaller amount, but pays until the later of your death, or your spouse’s death. Your decisions as to which pension to take may well depend on the nature of your illness. If you condition is not life threatening, and your spouse has his or her own pension, you might want to take the higher benefit. However, if you are in the unfortunate position of having a terminal illness, you might want to exercise the option which will likely provide the highest total payout. If you are not married, but benefits stop in the event of your death, you might want to look into taking a lump sum option. That would provide you with the greatest short term security, and also allow you to leave funds to your children if you pass away before expending all of the funds.

In summary, you should not take for granted that “things will work themselves out.” They won’t. If you are disabled, you need to be proactive and obtain the advice of an expert regarding your rights and obligations regarding not only your disability benefits, but also as to any other benefits to which you might be entitled.

Author: Glenn R. Kantor

Glenn Kantor is a founding partner of Kantor & Kantor, a 12 lawyer law firm in Los Angeles, California. For over 20 years, Kantor & Kantor has dedicated itself to protecting the rights of individuals with regard to their health, life, disability, pension, and long term care insurance and employee benefits.