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Short-Term and Long-Term Disability Benefits:

Many individuals have short-term disability and/or long-term disability insurance coverage through their employer, or purchase it on their own.

Short-term disability (STD) insurance pays a percentage of an individual’s salary if the person becomes temporarily disabled, meaning that the person is not able to work for a short period of time due to sickness or injury (excluding on-the-job injuries, which are covered by workers compensation insurance). The exact benefits will depend upon the plan. Generally, STD benefits cover up to 26 weeks away from work and pay between 55 and 100 percent of an individual’s wages. Some plans start immediately, while others have a waiting period before benefits start. Long-term disability (LTD) coverage generally picks up when STD coverage ends, or requires a longer waiting period in order to obtain the benefits.

An individual must go through an application process in order to obtain STD and/or LTD benefits and, if denied, an appeals process. Many insurers make little or no effort to impartially evaluate disability claims. In addition, the application and appeal processes are often designed to frustrate individuals by requiring complicated forms, making unreasonable document and medical record requests, and possibly requiring examinations by “independent” doctors.

Jeselskis Law Offices assists individuals with the process of applying for short-term and/or long-term disability benefits and with any appeals process that may be required. If all appeals processes are exhausted without an award of benefits, Jeselskis Law Offices also determines whether litigation is feasible.

Social Security Disability Benefits:

There are two disability programs offered by the Social Security Administration (SSA):

  • Social Security Disability Insurance Benefits (SSDI) – These benefits are extended to disabled workers whose work history has allowed them to obtain sufficient “credits” to be eligible for benefits.
  • Supplemental Security Income (SSI) – This program is intended for the elderly, blind, or disabled whose incomes and assets are very low.

While the eligibility criteria differ under the two programs, many of the standards and procedures required in determining disability are virtually identical in both programs. An individual applying for SSDI or SSI benefits is required to meet one standard of disability. Under both programs, an individual is disabled if he or she is unable to “engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which:

  • can be expected to result in death, or
  • has lasted or can be expected to last for a continuous period of not less than 12 months.

To meet this definition, an individual must have “physical or mental impairment[s] of such severity that they are not only unable to do their previous work but cannot, considering their age, education, and work experience, engage in any other type of substantial gainful work existing in the national economy.” Disability is determined using a five-step sequential evaluation process conducted by the SSA. If, at any point, an individual is found not to be disabled, the evaluation process terminates and the claim for disability benefits is denied.

If the disability evaluation requirements have been met and the disability has been proven, disability payments will begin after a five-month waiting period. Benefits are payable starting with the sixth month after the onset of the disability and continue through the second month after it ends. Benefits continue until the disability improves or the recipient returns to substantial work.

Appealing unfavorable decisions by the SSA involves a three-step appeal procedure, after which a dissatisfied applicant or benefits recipient may sue in federal court. Each step concludes with written notification of the outcome and includes a 60-day period during which the individual may file for further review. Following are the three steps of the appeal process:

  1. Reconsideration. A reconsideration is a review by the SSA of its initial decision. A social security representative who was not involved in the original application or decision conducts the review. The representative may also review any new evidence submitted by the claimant.
  2. Hearing. An administrative law judge conducts a hearing.
  3. Appeals Council Review. The Appeals Council of the SSA does not review all hearing decisions. For decisions it does review, the Council will either render a decision or return it to the administrative law judge for further review.

Jeselskis Law Offices represents individuals with SSDI and SSI claims at any stage in the process.