Long Term Disability (LTD) insurance benefits pay you if you become disabled and can no longer work. It is income replacement. Amputation is defined as a surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger.
As with any other medical condition, in order to receive LTD insurance benefits you must prove you are unable to work because of the limitations caused by the amputation.
Applying for Long Term Disability Insurance Benefits After Amputation
Workplace functions affected by amputation include:
The specific impairment depends on which limbs were amputated.
- One or both hands
- A lower limb above the ankle (tarsal region), further complicated with medical conditions that prevent you from using a prosthetic device to help you walk
- Loss of one hand and one lower limb above the ankle
- Loss of an entire leg at the hip or pelvic region, or both legs
- One or more fingers
These are just a few examples. No matter what limb was amputated, you have to prove your ability to perform work has been permanently affected. It is important your medical records and other documentation (such as functional capacity exams) discuss why you can’t use prosthetic devices to help you perform work duties.
Your medical records and documentation also need to show any and all restrictions resulting from your amputation.
Whether such impairments qualifies for disability depends on the type of work you previously did, and language of your policy.
Own occupation vs any occupation in LTD amputation claims
Some policies will define disability as “own occupation.” This means, if you can show you are unable to perform the duties of your current occupation, you qualify for disability benefits. If your policy defines disability as “any occupation,” this means you have to prove you cannot perform the duties of any occupation.
For example, let’s say your current job requires a lot of walking, pushing, and other physical activities. If you have both legs amputated, that might make it very difficult or impossible to perform those duties. But you can still sit at a desk and perform the duties of a sedentary job. You would qualify under “own occupation” policies, but if your policy requires “any occupation” disability, then your application would likely be denied.
ERISA Claim for Long Term Disability Benefits for Amputation Denied
If your application for LTD benefits is denied, you must act quickly. If your LTD insurance policy was provided by an employer, it may be covered by ERISA, a federal statute that covers employee benefits. If it was provided by an employer, you normally only have 180 days to appeal the denial. This time limit varies, but 180 days is most typical.
This is very important because if you do not appeal within the time limit set by your policy, you lose the right to do anything else. You can’t appeal later. You can’t file a lawsuit. You are stuck with their decision and may lose your rights forever.
Appeal in ERISA LTD claim is your last chance to introduce evidence
Also important is the fact that your appeal is the last chance you have to introduce any records and evidence.
If you filed a timely appeal and it is denied, you can file a lawsuit in federal court. However, the judge will only consider the evidence already contained in the administrative file. You cannot introduce new information. That means, all of the evidence submitted in the appeal or earlier, will be considered. But nothing else will be (outside of extraordinary circumstances).
So, you need to stuff the appeal with as much compelling medical evidence as you can. It is your last chance.
Your LTD Amputation Case
If your amputation long term disability claim is denied or terminated, you should consult with an ERISA LTD Lawyer right away. They can assist you with your claim, ensuring deadlines are not missed, and providing the necessary medical evidence in your appeal. Give the Disability Legal Center a call right now to schedule your free denial letter review at (858) 999-2870.