A recent court decision from another state makes a few important points that Wisconsin workers can benefit from. The plaintiff in the case suffered from chronic fatigue syndrome, a medical condition we discussed in our June 2 post. Unable to work, the plaintiff filed for and received long-term disability insurance benefits.
Her employer decided to terminate her benefits, regardless of her ongoing disability. She sued, and she prevailed. The federal court said the employer’s decision to terminate her coverage was “illogical.”
The truth of the matter is that filing a claim for long-term disability insurance benefits is not always easy. An insurance company can take months to make a determination, and even then, as in the case above, the decision may not make any sense. Employee advocates and insurance insiders alike recommend filing an appeal as soon as possible if the claim is denied. And, advocates urge workers and their families to stay on top of their claims.
It is not impossible that you or your spouse could be among the 30 percent of American employees that will suffer a short- or long-term disability during their working lives. Disability insurance can help to bridge the income gap caused by an absence from work, and employees should review that coverage annually.
Disability benefits can come from a government program, like Social Security, or from insurance. Insurance can be paid for by the employer or the employee, or both. Short-term disability insurance generally kicks in after an employee uses all of his sick leave; the benefits last for about six months. Then long-term disability insurance kicks in.
A disability can be an injury that heals, like a broken leg, or a chronic condition like chronic fatigue syndrome. Insurance companies may have their own definitions of what a qualifying injury or condition is, which can lead to more confusion — and an appeal.
Alan Olson practices employment law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here.
: KJRH.com, “Disability insurance termination ruled illogical,” Ed Greenberger, June 16, 2012