If possible, ask your employer for a copy of the employer’s short-term and long-term disability plan documents, including any Summary Plan Descriptions and Certificates of Insurance. You have a right to these documents under ERISA. They may be on your employer’s benefits portal or an intranet, or you may need to contact Human Resources. If you have not been covered by the Long-Term Disability policy for at least 1 Year, read the provision on Pre-Existing Conditions and Schedule a Meeting with Bartolic Law to plan to avoid your claim being excluded, if possible.

You must immediately notify your employer. Communicate that the reason you will not be at work is due to symptoms of your injury or illness, and you want to initiate FMLA and Disability leave. Communicate you do not know how long you will be out, and that you will update the employer following your next doctor appointment. DO NOT immediately communicate you will be permanently absent. Often during short-term disability, doctors will certify your need to be off work until the next office visit. It may take a few visits for your doctors to feel comfortable certifying your long-term disability, especially if you recently established treatment with them. Ask for any forms necessary to initiate FMLA and disability leave.

You must give the long-term disability notice of the claim and proof of claim (or proof of loss). Most policies require you have given the notice and proof of claim as soon as possible, and no later than 90 days after when Long-Term Disability benefits would begin. Long-term disability benefits begin at the end of an “elimination period,” which is the amount of time you must be disabled and have the required earnings loss before benefits begin. However, the best practice is to notify the long-term disability insurer 60-90 days before the end of the elimination period, so the insurer has time to review your claim and hopefully approve it with no interruption of your income. Sometimes the LTD insurer also administers the short-term disability and FMLA, so it will already have noticed when you claim short-term disability.

Often insurers will ask seemingly odd questions designed to give a basis to deny your claim. They may ask “do you use a computer?” Say exactly how, as insurers often use a simple yes to determine you are qualified for any kind of technical occupation that involves specialized software or support. They may ask “can you carry a gallon of milk?” A gallon of milk weighs approximately 10 pounds, and if you say “yes,” the insurer will likely conclude you can meet the lifting and carrying requirements for sedentary work. If you haven’t done it recently, say you aren’t sure. Or if it hurts to do so, say when you do you are in pain.

Don’t say you can’t lift anything if it isn’t the case. Don’t say you can’t sit at all if it isn’t true. If you exaggerate, insurers will have a basis to call your credibility into question, and think you exaggerate everything, or place you under surveillance. Surveillance showing you do something you said you cannot do is a case killer.

Anything you say online can be discovered, and can be used against you, even if your profiles are set to “private.” Investigators have tools to get past privacy settings, and your insurer can demand you share what you post as part of proof of claim if there’s a reasonable basis to suspect there’s evidence there that is inconsistent with your claim. For instance, if you have a profile picture on vacation or being active taken at a time you say you’re disabled, the insurer will want to investigate further, causing delay at the least, and possibly denial.