What Happens When an Employee Goes on Long-Term Disability?

A prolonged disability coverage serves as a critical lifeline for employees who are unable to work due to a severe illness or injury. When facing this situation, their primary concern is often understanding how they will maintain financial stability, protect their job, and access the necessary benefits. So, what happens when an employee goes on long-term disability, also known as LTD? Below, we will dive into a detailed step-by-step, exploring legal protections and what to expect regarding their employment status and benefits.

At Dyer, Garofalo, Mann & Schultz, we assist Ohio employees in navigating the complexities of these claims, ensuring their rights are protected and can receive the benefits they deserve.

what happens when an employee goes on long-term disability

What’s Considered Long-Term Disability?

It refers to a situation in which an employee cannot work for an extended period due to a serious medical condition. Unlike short-term disability (which typically ranges from several weeks to a few months), LTD covers more severe health conditions that prevent the employee from working for months or even years. Insurance often provides a percentage of the employee’s salary, usually 50-70%, to help them manage their finances during this period.

The duration of the coverage varies based on the policy but can last several years or until the employee reaches retirement age. For instance, if you are eligible for Social Security Disability Insurance (SSDI), LTD may provide financial assistance until SSDI takes over or until you retire. Employees must review their policies to thoroughly understand the specific benefits available. You can learn more about LTD eligibility by visiting the Social Security Administration website.

In Ohio, state-specific protections complement federal laws, adding layers of support for workers facing this injury. That’s why residents should familiarize themselves with their employer’s prolonged impairment policies and state regulations to better overcome the process.

What Happens When an Employee Goes on Long-Term Disability?

When an employee experiences an enduring disability, LTD insurance replaces a percentage of their salary, but their employment status and health coverage may also be affected. Many workers mistakenly believe that this limitation guarantees job protection. However, insurance primarily provides financial compensation, not job security.

While some companies may continue to offer health benefits during the process, it’s not a requirement. Organizations might extend health coverage for a limited period, but it often depends on their specific policies. If your company discontinues your health insurance, you may need to explore options like COBRA (Consolidated Omnibus Budget Reconciliation Act), which allows you to maintain your coverage for a limited time—though you will be responsible for the full premium. Another alternative is purchasing insurance through the Affordable Care Act marketplace.

Besides, many employees also worry about losing their jobs while in this condition. Though the Family and Medical Leave Act (FMLA) guarantees 12 weeks of unpaid, job-protected leave for medical reasons, once that period ends, there is no automatic employment security. Your employer may be allowed to hire someone to replace you if you are unable to return to work. Despite this, they cannot terminate you solely due to your disability. In this situation, working with a law firm like Dyer, Garofalo, Mann & Schultz – Ohio Tiger can help ensure your rights are upheld throughout the process.

For the employees of this state, Ohio Legal provides further details on benefits and protections.

What Are the Labor Consequences After Going Into Disability?

This event can significantly impact your employment status, health benefits, and future job prospects. While LTD offers financial support, it does not come with guarantees about your job being held open for an indefinite period. After your FMLA leave is exhausted, employers may legally fill your position if you cannot return to work.

This means that, even though you might still receive benefits, there could no longer be a job waiting for you to return to. Some companies have more flexible policies, allowing employees to return to their jobs when they can work again, but this varies greatly depending on the employer and the specific industry.

Additionally, some benefits tied to employment, such as retirement contributions and life insurance, may be affected if you’re no longer actively employed. As such, it’s essential to review your company’s specific policies before going on leave, so you fully understand what to expect.

If your job status or benefits are impacted by going on LTD, you may be able to explore legal avenues for recourse. Seeking legal advice is highly recommended if you believe your employer is infringing upon your rights while you are on long-term disability.

What Are the Laws That Protect Me?

Several federal and state laws protect employees facing these difficulties, ensuring they are not discriminated against due to their medical condition. The most notable protection is the Americans with Disabilities Act (ADA), which requires employers to provide reasonable accommodations. Under this law, employers cannot fire, refuse to hire, or prejudge against an employee simply because they have a disability, as long as they can still perform their job with suitable modifications.

Likewise, the Family and Medical Leave Act (FMLA) grants employees the right to take up to 12 weeks of unpaid leave each year for medical reasons, including a serious health condition. That being said, FMLA does not protect your job beyond the 12-week mark, and once the leave is exhausted, your employer is not obligated to keep your position open.

If you believe your rights under the ADA or FMLA have been violated, consulting with an experienced law firm can help you understand your legal options and protect your employment rights.

What Are the Requirements to File for Long-Term Disability?

You must meet specific requirements outlined in your LTD policy to file a process. These requirements generally include:

Employment Length: Typically, you must have been employed for at least 6 months to 1 year before being eligible for LTD benefits. The exact duration can vary by policy, so it’s vital to review your employer’s specific terms to know when eligibility begins.
Medical Certification: Provide documentation from a licensed doctor confirming that your medical condition prevents you from performing your job duties for an extended period. Make sure the documentation is detailed, as incomplete medical records can lead to claim denials.
Waiting Period: Most policies have a waiting or “elimination” period of 60 to 180 days, during which you must be continuously disabled before LTD benefits start. This period helps insurers verify the legitimacy of the disability.
Exhaustion of Other Benefits: Before LTD benefits kick in, short-term disability or sick leave usually must be fully utilized. If you have other employer-provided benefits, like vacation or PTO, you may also need to exhaust those first.
Proof of Income: You will usually need to provide proof of income, such as recent pay stubs, W-2s, or tax returns, to help calculate the benefits you are rightfully entitled to.
Long-Term Disability: Your condition must be severe enough to prevent you from working for a prolonged period, generally lasting at least 12 months, although this may differ by policy.
Ongoing Treatment: To maintain eligibility, you must provide proof of ongoing medical treatment for your disability, such as regular doctor visits or therapy. This confirms the condition’s severity and your efforts to recover.
Job Function Impact: Initially, LTD benefits require that you are unable to perform your specific job. Nevertheless, after two years, this may shift to whether you can perform any job you’re qualified for, based on your skills and experience.
Deadlines: Filing within the policy’s deadlines is crucial, often ranging from 30 to 90 days after the onset of the disability. Missing these deadlines can jeopardize your eligibility for benefits, so act promptly and provide all required documentation.

Filing for this benefit requires thorough documentation. Be sure to submit all the necessary forms, including medical records, proof of employment, and any other relevant documents your insurance provider needs. To avoid delays or denials, file your claim as soon as possible after the commencement of your disability. Visit Social Security to find additional guidance on how to file.

What to Do If My Claim Is Denied?

If your allegation is denied, there are several steps you can take to appeal the decision. First, carefully review the denial letter to understand why it was rejected. Common reasons include incomplete medical documentation, failing to meet the policy’s definition of “disability,” or missing filing deadlines.

Once you understand the reason for the denial, gather additional documentation or correct any errors in your application. Most LTD policies offer an internal appeal process, and it’s important to follow the insurer’s instructions carefully. Keep in mind that there are strict end dates for filing an appeal, often 180 days from the date of denial.

In some cases, it may be necessary to seek legal assistance. An experienced Social Security disability lawyer can help you gather the necessary evidence, go through the appeals, and represent your interests if further action is needed.

Ready to Secure the Long-Term Disability Benefits You Deserve? Contact Us Today!

Long-term disability can present numerous challenges for both your financial stability and employment status. Knowing your rights and the processes involved can alleviate much of the stress associated with LTD claims. Whether you are filing for the benefits or appealing a denied claim, staying informed and proactive is of the utmost importance.

At Dyer, Garofalo, Mann & Schultz, we are specialized and dedicated to helping Ohio employees secure the long-term disability benefits they are entitled to and guiding them through the complexities. If you need assistance with an LTD claim or appeal, contact us at 1.937.222.2222 or fill out a form to learn more about how we can help guarantee that your rights are protected.

Before establishing Dyer, Garofalo, Mann & Schultz L.P.A., Doug Mann, a top Ohio Injury Attorney served as a bodily injury claims adjuster at a major insurance firm. With over 40+ years of experience, Doug’s background has proven invaluable in securing maximum cash settlements for his clients swiftly. Since leaving the insurance industry, Doug has devoted his entire legal career to assisting injured clients during their times of greatest need.