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Los Angeles Disability Attorney

If you are facing challenges with your disability benefits, don’t hesitate to reach out to Aegis Law Firm. Our dedicated Los Angeles Disability Attorneys are here to help you navigate the complexities of disability claims and secure the benefits you deserve. Contact a Los Angeles workers’ compensation attorney today for a free consultation and let us fight for your rights and your future.

How is Long Term Disability Received?

In California, long-term disability benefits can be received through several avenues:

  • State Disability Insurance (SDI): A program administered by the state to provide short-term disability benefits, which can extend into long-term benefits in certain cases.
  • Private Disability Insurance: Policies purchased individually or provided by employers that offer long-term disability coverage.
  • Social Security Disability Insurance (SSDI): A federal program providing benefits to individuals who are unable to work due to a disability expected to last at least one year or result in death.
  • Employer-Sponsored Plans: Benefits provided through employer-sponsored disability insurance plans, often governed by the Employee Retirement Income Security Act (ERISA).

Qualifying for Long-Term Disability

To determine eligibility, insurers and government programs evaluate specific criteria related to your health, work history, and ability to perform job duties. Here is a detailed overview of what typically qualifies someone for long-term disability benefits.

Medical Condition

  • Severity of the Condition: Your medical condition must be severe enough to significantly impair your ability to perform work-related tasks. This usually involves chronic illness, mental health disorders, or serious injuries. 
  • Duration of Disability: Your disability must be expected to last for an extended period, typically at least 12 months, or result in death. Short-term conditions usually do not qualify for long-term benefits.
  • Medical Evidence: You must provide comprehensive medical evidence to support your claim, including medical records of diagnoses, treatments, and ongoing care; statements from your healthcare providers outlining your condition and how it limits your ability to work; and assessments that objectively measure your physical and mental capabilities in relation to job duties.

Most LTD policies and programs require that you were working full-time when you became disabled. Part-time workers might have limited eligibility, depending on the policy terms.

Policy Terms

Eligibility depends on the specific terms of your long-term disability insurance policy, whether it is provided by your employer or purchased privately. Key factors include:

  • Coverage Start Date: You must be covered by the policy at the time your disability begins.
  • Exclusions and Limitations: Policies often have exclusions for pre-existing conditions or specific types of disabilities.

State and Federal Programs

In addition to private insurance, you may qualify for government programs such as:

  • Social Security Disability Insurance (SSDI): A federal program that provides benefits if your disability is expected to last at least one year or result in death and you have sufficient work credits.
  • State Disability Insurance (SDI): In California, SDI provides short-term disability benefits that can transition to long-term benefits under certain conditions.

Work History

For SSDI, you must have earned enough work credits based on your age and the number of years you have worked. Generally, you need to have worked for a substantial part of your adult life.

Long vs Short Term Disability Insurance

Long-term and short-term disability insurance both provide financial support when you’re unable to work due to illness or injury, but they serve different needs and timeframes. 

Short-Term Disability Insurance

This insurance typically covers a portion of your salary for a limited period, often ranging from a few weeks to six months, and is designed to help you during temporary periods of disability. Short-term disability insurance is generally less expensive due to the shorter benefit period and higher likelihood of claim resolution within a few months. It is also often simpler and faster to apply for, with fewer medical documentation requirements. 

Long-Term Disability Insurance

Long-term disability insurance, on the other hand, kicks in after short-term benefits are exhausted and can provide coverage for several years, up to retirement age, or even for life, depending on the policy. While short-term disability helps with immediate financial needs during recovery, long-term disability offers sustained support for more serious, long-lasting conditions that prevent you from returning to work. As a result, this type of insurance is typically more expensive because it involves potentially higher claim payouts.

What Common Conditions are Covered?

Here are some common conditions covered by disability insurance:

Short-Term Disability Insurance

  • Illnesses:
    • Severe Flu or Pneumonia: Conditions that require extended bed rest and recovery time.
    • Gastrointestinal Disorders: Severe cases like acute pancreatitis or Crohn’s disease flare-ups.
    • Respiratory Issues: Severe asthma attacks or bronchitis.
  • Injuries:
    • Fractures and Sprains: Injuries requiring significant recovery time, such as broken bones.
    • Post-Surgery Recovery: Time needed to recover from surgeries like appendectomies, gallbladder removal, or minor orthopedic procedures.
    • Accidents: Injuries from car accidents, falls, or other mishaps that lead to temporary disability.
  • Pregnancy and Maternity Leave:
    • Childbirth: Recovery period post-delivery.
    • Pregnancy Complications: Conditions like preeclampsia, severe morning sickness (hyperemesis gravidarum), or gestational diabetes requiring bed rest.
  • Mental Health:
    • Severe depression, anxiety attacks, or stress-related disorders requiring temporary leave.

Long-Term Disability Insurance (LTD)

  • Chronic Illnesses:
    • Cancer: Especially when treatment involves chemotherapy, radiation, or surgery that impacts the ability to work.
    • Heart Disease: Conditions like congestive heart failure, severe coronary artery disease, or after major heart surgeries.
    • Multiple Sclerosis (MS): Especially during flare-ups or as the disease progresses.
    • Severe Arthritis: Rheumatoid arthritis or severe osteoarthritis that limits mobility and functionality.
  • Mental Health Disorders:
    • Severe Depression: Major depressive disorder that severely impacts daily functioning.
    • Bipolar Disorder: Especially during manic or depressive episodes that prevent working.
    • Anxiety Disorders: Severe cases of generalized anxiety disorder, panic disorder, or PTSD.
  • Serious Injuries:
    • Spinal Cord Injuries: Injuries leading to partial or complete paralysis.
    • Traumatic Brain Injuries: Injuries resulting in cognitive impairments or significant physical limitations.
    • Amputations: Loss of limbs affecting the ability to perform job duties.
  • Neurological Disorders:
    • Parkinson’s Disease: As the disease progresses and affects motor skills.
    • Epilepsy: Severe cases with frequent, uncontrolled seizures.
    • Alzheimer’s Disease and Dementia: Early-onset cases impacting memory and cognitive function.
  • Autoimmune Diseases:
    • Lupus: Especially during severe flare-ups.
    • Fibromyalgia: Chronic pain and fatigue syndromes.
    • Chronic Fatigue Syndrome: Severe, long-term fatigue impacting daily activities

How Can a Disability Lawyer Help?

A Los Angeles Disability Attorney can provide invaluable assistance in navigating the complexities of disability insurance claims. They can help you understand your policy’s terms and conditions, gather and present the necessary medical evidence, and ensure all paperwork is accurately completed and submitted on time. If your claim is denied, a Los Angeles employment law lawyer can represent you in appealing the decision, leveraging their extensive legal knowledge to build a strong case. Additionally, they can negotiate with insurance companies on your behalf to secure the benefits you deserve. Overall, having a trusted disability lawyer by your side can significantly improve your chances of a successful claim, reducing stress and allowing you to focus on your health and recovery.