What Role Does My Employer Play in My Long Term Disability Claim?
- Matthew Maddox
- 15 hours ago
- 10 min read
Understanding the role your employer plays in your long term disability claim is crucial for navigating the claims process effectively. Whether you’re concerned about how your employer’s documentation might impact your claim, whether your employer can influence the approval or denial of your benefits, or what happens if your employer is uncooperative, it’s important to be informed.
In this article, we’ll addresses key considerations that can affect your long term disability claim and your employment status.
What Information Does My Employer Provide to My Insurance Company?
Your employer provides critical information to your insurance company through the Employer Statement Form, which is a key document in the processing of your long term disability claim.
Here’s the information typically included on this form:
Employer Information: This section covers details about your employer, including the name, address, and phone number of your employer. If applicable, they will provide details about any previous long term disability insurance provider, including your effective date with that carrier and the policy termination date.
Employee Information: This contains specific information about you, such as your full name, address, telephone number, and Social Security Number, your date of hire, the date you last worked, the number of hours worked on that last day, and your regular work schedule. Your employer may also provide information about the types of coverage you have with your insurance company, including short term disability, long term disability, life insurance, and any voluntary benefits.
Information About Your Occupation: The form asks your employer to provide details about your job, including:
Occupation Title: The title of your position, with a request to include a copy of your job description.
Primary Duties: A description of your main job duties on the date you last worked.
Pre-disability Work Status: Information about your work status before your disability, such as whether you were full-time or part-time and exempt or non-exempt.
Changes Due to Disability: Whether your job duties or hours changed due to your disability or medical condition before you stopped working. If there were changes, your employer must provide an explanation.
Return to Work Status: Information on whether you have returned to work, including the date and whether it was full-time or part-time. If your employment has been terminated, your employer must provide the termination date.
The accuracy and completeness of the data provided by your employer can significantly impact the outcome of your long term disability claim, making it crucial for your employer to fill out the form accurately.
To supplement the Employer Statement, your employer may also provide your insurance company with additional documentation, such as:
Official Job Description: A detailed description of your job duties, responsibilities, and physical and cognitive requirements.
Employment Records: Documentation of your employment history, including hire date, position, salary, and any relevant performance reviews.
Attendance Records: Information about your work attendance, including any absences or sick leave taken before your claim.
Medical Documentation: Any medical reports or notes from company medical examinations or occupational health services.
Accommodation Records: Documentation of any workplace accommodations made to help you perform your job despite your disability.
Your employer’s cooperation in providing this information is crucial for the insurance company to assess your long term disability claim. Without accurate and complete information, your claim could be delayed or denied.
How Does My Employer’s Documentation Impact My Long Term Disability Claim?
Your employer’s documentation has a significant impact on the outcome of your long term disability claim. The accuracy and completeness of the information provided can influence your insurance company’s decision regarding your eligibility for benefits.
Here’s how your employer’s documentation affects your claim:
Job Description: The job description your employer provides helps your insurance company determine whether you can perform the essential duties of your occupation. An accurate, detailed description is crucial, as it directly affects how your ability to work is assessed.
Employee’s Occupation and Duties: Information about your job title, primary duties, and any changes to your work responsibilities or hours due to your medical condition is vital. If these details are incomplete or incorrect, your insurance company may misinterpret the nature of your work and your ability to continue performing it. This information will help the insurance company determine the nature of your occupation for purposes of your disability claim.
Employment Records: The documentation of your employment history, including your date of hire, work schedule, and any changes in your job status due to disability, helps verify your eligibility for long term disability benefits. Discrepancies in these records could lead to delays or even denial of your claim.
Coverage Information: Accurate details about your insurance coverage, including the types of policies you have and their effective dates, are critical. Mistakes in this information could result in incorrect benefit calculations or challenges to your claim’s validity.
Attendance Records: Your attendance records, including the date you last worked and any periods of absence, provide evidence of the impact of your disability on your ability to work. These records can support your claim by showing a consistent pattern of health-related absences.
Accommodation Efforts: Documentation of any accommodations your employer made to help you continue working despite your disability can demonstrate whether all reasonable measures were taken before you stopped working. This information can be pivotal in proving that your condition genuinely prevents you from performing your job.
Termination or Return to Work: If your employment was terminated or if you returned to work, the documentation of these events, including specific dates, is essential. This information helps the insurance company understand the timeline of your disability and its impact on your employment.
Can My Employer Influence the Approval or Denial of My Claim?
Your employer can indeed influence the approval or denial of your long term disability claim, primarily through the documentation and information they provide to the insurance company. When your employer submits detailed and accurate records, such as your job description, employment history, and any changes in your work duties due to your disability, they help your insurance company get a clear picture of your situation. This information is crucial for the insurance company to determine whether you meet your policy’s definition of disability and whether you can continue performing your job’s essential functions. If the documentation accurately reflects the impact of your condition on your ability to work, it can strongly support your claim and increase the likelihood of approval.
On the other hand, if your employer provides inaccurate or incomplete information, it can have serious negative consequences for your claim. For instance, an outdated job description might lead the insurance company to believe that your job is less demanding than it actually is, which could result in a denial of benefits. Similarly, if your employer fails misrepresents the nature of your job duties, your insurance company might question the validity of your claim. These inaccuracies can create doubts about the severity of your disability and your need for benefits, ultimately jeopardizing the approval of your claim. Therefore, it’s essential that your employer provides thorough and accurate documentation to ensure that your claim is evaluated fairly and accurately.
How Does My Employer’s Human Resources Department Assist with the Long Term Disability Process?
Your employer’s HR department plays a crucial role in assisting with the long term disability process, helping to ensure that your claim is handled smoothly and efficiently. One of their primary responsibilities is to ensure that all necessary forms and documentation required from your employer are completed accurately and submitted on time. The HR department also gathers and submits critical information, such as your job description, employment history, and details about your insurance coverage, which are essential for the insurance company to evaluate your claim.
In addition to handling the administrative aspects, oftentimes your HR department can also provide you with a copy of your long term disability insurance policy. Having a copy of your policy is crucial because it outlines the specific terms, conditions, and definitions that govern your coverage, including the criteria for disability, the duration of benefits, and any exclusions or limitations that may apply. Understanding these details helps you navigate the claims process more effectively, ensures that you meet all necessary requirements, and allows you to advocate for your rights if there are disputes with the insurance company.
What Should I Do if My Employer is Uncooperative During the Claims Process?
If your employer’s HR department is uncooperative during the long term disability claims process, it can create significant challenges in securing the benefits you need. Uncooperative behavior can take various forms, such as delaying the submission of necessary forms, providing incomplete or inaccurate information, or refusing to communicate effectively with you or your insurance company. It’s essential to address these issues proactively to protect your claim.
Here are some steps you can take:
Communicate Clearly: If HR is slow to respond to your requests or avoids providing updates, document all your communications, including emails and phone calls. Written records can be critical if you need to demonstrate that you’ve made reasonable efforts to obtain the necessary cooperation.
Seek Legal Advice: If HR refuses to provide important documentation, such as a job description or records of workplace accommodations, consult with a long term disability attorney. An attorney can intervene on your behalf, ensuring that your employer fulfills their obligations.
Gather Your Own Documentation: If HR fails to provide accurate records, such as your work schedule or attendance, start collecting your own documentation. This might include pay stubs, emails, and any other records that can support your claim.
Taking these steps can help mitigate the impact of an uncooperative HR department and ensure that your long term disability claim is processed fairly. By staying organized, documenting all interactions, and seeking legal advice when necessary, you can protect your rights and increase the likelihood of a successful claim.
Does My Employer Have Access to My Medical Information During the Claim?
Your employer typically has limited access to your medical information during the long term disability claim process. The Health Insurance Portability and Accountability Act (“HIPAA”) and other privacy laws protect your medical records, ensuring that only specific, necessary information is shared with your employer.
However, there are some instances where your employer may have access to certain medical details:
Medical Certification: Your employer may receive general information about your medical condition through the forms you submit, such as a doctor’s note or medical certification required for leave. This information usually includes confirmation of your condition, the expected duration of your leave, and any work restrictions, but it does not include detailed medical records.
Job-Related Information: If your employer needs to make accommodations for you to continue working, they may receive information related to your ability to perform specific job duties. This could include details about physical or mental limitations, but not the underlying medical diagnosis.
Insurance-Requested Information: In some cases, the insurance company may request information from your employer to help determine your eligibility for benefits. This could include any medical documentation your employer already has, such as results from company medical exams or records of workplace accommodations.
Despite these exceptions, your employer does not have broad access to your medical records. The information shared is usually limited to what is necessary to manage your employment situation and ensure that the claim is processed correctly.
Can My Employer Terminate My Employment While I’m on Long Term Disability?
Yes, your employer can terminate your employment while you’re on long term disability, but there are important legal protections and considerations that come into play. Being on long term disability does not provide absolute job protection, and your employer may have the right to terminate your employment under certain circumstances. However, the termination must be lawful and not based on discriminatory reasons related to your disability.
Here are a few key factors to consider:
Job Protection under FMLA: If you’re eligible for the Family and Medical Leave Act (“FMLA”), your job is protected for up to 12 weeks while you’re on leave. After that period, your employer may not be legally required to hold your position open.
Job Protection According to Company Policy: Your employer may have a set medical leave policy, allowing employees to be out on medical leave for a set period of time -- typically six months to a year.
Business Necessity: Your employer may terminate your employment if they can demonstrate that your position is being eliminated due to legitimate business reasons, such as company downsizing or restructuring, and not because of your disability.
Inability to Return to Work: If you’re unable to return to your job after a reasonable period and no reasonable accommodations can be made, your employer may have grounds to terminate your employment.
Disability Discrimination Protections: Under the Americans with Disabilities Act (“ADA”), your employer cannot terminate your employment solely because of your disability. If you believe that your termination is based on discrimination due to your disability, you may have legal grounds to challenge the decision.
How Can The Maddox Firm Prove My Long Term Disability Claim?
Proving a long term disability claim can be complex and challenging, but The Maddox Firm can guide you through each step of the process. Our experienced team is dedicated to helping you navigate the intricacies of your claim and ensuring that you receive the benefits you deserve.
Here are a few ways The Maddox Firm can help:
We Examine Your Policy and Assess Your Claim: We start by thoroughly reviewing your disability insurance policy to understand the specific terms, conditions, and definitions that apply to your claim. This allows us to provide a clear assessment of your eligibility and the steps needed to secure your benefits.
We Handle All Communications with Your Insurance Company: Dealing with insurance companies can be overwhelming, especially when you’re focused on your health. We take over all communications with your insurer, ensuring that your rights are protected and that your claim is presented accurately and persuasively.
We Help You Obtain Evidence to Support Your Claim: Gathering the right evidence is crucial to proving your disability. We work closely with you and your healthcare providers to compile comprehensive medical records, expert opinions, and any other documentation needed to substantiate your claim.
We Handle Appeals and Litigation: If your claim is denied, you still have options. The Maddox Firm will handle all aspects of the appeals process and, if necessary, take your case to court to ensure that your rights are upheld and that you receive the benefits you’re entitled to.
A short term disability or long term disability claim can be a complicated process. If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse short term or long term disability decision, The Maddox Firm can help. The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim. Our New Jersey and New York long term disability attorneys help clients nationwide.