The Long-Term Disability Carrier Wants Me to Apply for Social Security Disability – Am I Required to Apply for Social Security Disability?
If you are currently receiving Long-Term Disability (LTD) benefits under a group sponsored by your employer, or if you are dealing with a claim that has been denied, the claim administrator (usually an insurance company funding the plan) has probably informed you that you are required to apply for Social Security Disability Income (SSDI). It is important that you review the insurance policy, specifically the “offset provisions” that describe what other sources of income the disability insurance company is entitled to subtract from your monthly LTD benefit.
What is an offset?
An offset is money that you are receiving from another source (i.e., State Disability, Workers’ Compensation Benefits, SSDI, a retirement benefit, etc.) that the policy subtracts from your monthly LTD benefit. The policy will identify all sources that it is entitled to offset from your monthly LTD benefit. SSDI is a common offset that you will see in disability insurance policies insuring a group disability plan.
Why Am I Required to Apply for Social Security?
If you are potentially entitled to receive an award of SSDI, the LTD policy will probably require that you actively pursue this benefit. If you chose not to apply for Social Security, and you have been approved for LTD benefits, the policy’s offset provision will typically entitle the claim administrator to estimate your monthly SSDI benefit and offset it from your LTD benefit. In other words, if you are receiving LTD benefits and you decide not to pursue SSDI, the LTD carrier may be permitted (pursuant to the terms of the policy) to subtract money from your monthly LTD benefit that you are not actually receiving (but were potentially entitled to receive). Therefore, it is generally not a good idea to forego applying for SSDI if the LTD policy requires that you apply for it.
One reason that you may want to delay the application for Social Security is that you do not have sufficient medical evidence to support your claim. You should consult an experienced Social Security lawyer about when it is proper to apply for SSDI.
What Happens if I Have Been Receiving LTD Benefits for Months or Years and
Then I Receive a Retroactive Award of SSDI.
If your LTD claim is approved before your SSDI claim has been approved, or before you apply for SSDI, the claim administrator on the LTD claim will decide how to handle the offset issue. If you provide the claim administrator on the LTD claim with proof that your SSDI claim is pending, they will generally pay the monthly LTD benefit without offsetting an estimated SSDI benefit. However, as indicated above, if you do not apply for SSDI, the claim administrator will ultimately be entitled to estimate your SSDI benefit and deduct it from your monthly LTD benefit.
If you have been receiving a monthly LTD benefit without offset, and then you receive a retroactive award of SSDI, it will create an overpayment situation. In other words, you will owe some or all the retroactive award from the Social Security Administration back to the claim administrator on the LTD claim. The reason that you owe the LTD claim administrator money back is because you were overpaid in each month that you have already received an LTD benefit and now have been paid SSDI retroactively. If you have been receiving LTD benefits for several months, or maybe years, without SSDI being offset, and now you have been awarded SSDI, it will be important for you to contact the claim administrator on the LTD claim after you receive your benefits from Social Security. If there has been an overpayment, you will owe some or all the retroactively awarded money received from Social Security back to the claim administrator on the LTD claim.
Can Being Approved for SSDI Help My LTD Claim?
If your SSDI claim has been approved, the claim administrator on the LTD claim will not be bound by the decision made by the Social Security Administration. Likewise, if your LTD claim has been denied on appeal and you sue the LTD carrier and LTD plan in federal court, the court will not be bound by the decision made by the Social Security Administration. Nevertheless, the decision by the Social Security Administration may be offered as persuasive evidence in support of your LTD claim at the administrative appeal stage (when the claim administrator is reviewing your appeal). Even if your appeal is ultimately denied, and you sue in federal court, you will want the Social Security Administration’s decision to approve your SSDI claim to be a part of the LTD claim administrator’s file (the administrative record) so that it can be referenced by the court in that case.
If you have been denied by the claim administrator on the LTD claim at a point where the “own occupation” definition of disability is applicable, the SSDI award could carry significant weight because the Social Security Administration uses a more stringent “any gainful occupation” standard as part of its criteria it uses for awarding disability benefits.
What If I Have Been Denied Social Security Disability Income Benefits?
On average, the Social Security Administration denies nearly 60 percent of first-time SSDI applications. If you have been denied, it does not necessarily mean that you are ineligible. It is an indication you need to provide the Social Security Administration with additional information to allow that agency to properly reevaluate your application. You should consult with an experienced Social Security lawyer who can assist with your request for reconsideration.
Why Was I Denied Social Security Disability Income?
If you have been denied SSDI benefits by the Social Security Administration, it could be for any one of several reasons. The reason for being denied could range from any of the following:
- You did not work enough quarters;
- Your condition was not deemed severe enough to prohibit you from working at your occupation;
- Your condition does not meet or equal one of the Social Security’s severe impairment listings;
- You are able to perform the important duties of another occupation, given your age, education, and job skills;
- You have an outstanding warrant for your arrest for certain felony crimes, you were convicted of a crime and will go to jail, or you violated your probation or parole.
You should consult with an experienced Social Security lawyer to review the reason(s) that your application for SSDI was denied. An attorney can assist you in filing an appeal and represent you on your request for reconsideration. You must request an appeal in writing within 60 days of the Social Security’s decision, so it is imperative that you consult with a Social Security attorney as soon as possible.
If you have any questions regarding your claim for LTD benefits, and/or how an award of SSDI benefits may affect your claim, call Law Offices of Kevin M. Zietz for a free consultation.
