Long-Term Disability Insurance Claims

Long-Term Disability Claims Scenarios

Scenario 1:

Tim works in Massachusetts as a technician. Tim was in a motor vehicle accident 10 years ago and has a long history of low back pain as a result.

Tim goes out of work on February 15^th. Tim’s back condition has caused him to undergo surgery to help alleviate his pain. He’s already let his manager and coworkers know about his absence.

After 8 weeks out of work, Tim files a Long-term Disability (LTD) claim with MetLife. Tim is advised by his Agency Coordinator that since he likely will not return to work within 90 days from the surgery date, Tim should proactively file for LTD with MetLife.

After Tim calls MetLife to file his claim, Tanya, a MetLife LTD Claims Specialist (CS), begins working with Tim on the LTD process. Tanya is assigned as the CS on Tim’s claim and will be Tim’s main point of contact as he recovers from surgery. Tanya discusses Tim’s medical condition, gathers appropriate doctor contact information and will assist Tim in attempting to gather supportive medical documentation to help approve Tim’s claim. Tanya also emails Tim’s Agency Coordinator to validate Tim’s last day worked and to understand the details of Tim’s normal job.

After gathering all pertinent claim information from Tim’s physicians and Agency Coordinator, Tanya approves Tim’s claim for LTD benefits. Tim will begin receiving monthly LTD benefits from MetLife on May 15^th after satisfying the 90-day Elimination Period. Tanya continues to monitor Tim’s progress as he begins undergoing physical therapy.

After 6 months out of work, Tim is nearly fully recovered. Tim and Tanya work together to ensure that Tim’s physicians, Agency Coordinator and MetLife have all key information to facilitate a safe return to work, and on August 20^th Tim returns to work full-time, back to his normal job. Tanya confirms with Tim’s Agency Coordinator that he has returned to work and closes Tim’s LTD claim as of August 19^th.

Scenario 2:

Michelle has worked as an administrative assistant for 12 years and is suffering from bilateral carpal tunnel syndrome.

Various treatment methods for the condition were utilized. Her physician advised that because conservative treatment had failed that surgery on both wrists was recommended. Surgery was performed on both wrists on June 11^th, which is also the first day Michelle was out of work.

Michelle’s condition was deemed to be related to her work activities. In discussions with her physician it was advised that the ongoing repetitive motions and keystroking that Michelle’s job entails was the main cause of her condition. After advising her Agency Coordinator of this, Michelle filed a worker’s compensation claim.

A return to work was anticipated in mid-July, however slower than normal recovery delayed this. Knowing that she was getting closer to satisfying the 90-day waiting period for Long-term Disability benefits, Michelle filed a new LTD claim with MetLife in mid-August for potential benefits as she continued with her recovery.

Steven, a MetLife LTD Claims Specialist, contacts Michelle to discuss LTD. Steven receives notification of Michelle’s new LTD claim and reaches out to discuss all pertinent claims information and educates Michelle on the LTD process. During this conversation Michelle explains that this is a work-related condition and she is currently receiving worker’s compensation benefits due to the injury.

Michelle remains out of work. Michelle’s recovery is slowly progressing, but she is not quite ready to return to work by the time her LTD waiting period ends, which is as of September 9^th. Steven gathers all relevant claim information, including Michelle’s worker’s compensation benefit information and adjusts the LTD benefit accordingly based on the worker’s compensation payments being made.

Michelle’s LTD claim is approved. Michelle is approved for monthly LTD benefits beginning on September 9^th. Her LTD benefit of $1,500 per month is reduced by the $1,000 that she receives per month for her worker’s compensation claim, so she will receive a monthly benefit of $500 since she continues to meet all criteria to remain on LTD.

All parties work together to facilitate a return to work. Michelle begins working part-time per the recommendation of her physician, for 4 hours a day. Steven helps facilitate the partial return to work between the physician, Michelle and her Agency Coordinator to ensure that Michelle is safely able to return back to work. Michelle returns to work part-time on October 1^st and after 3 weeks of partial duty, she is released to full time work as of October 21^st, with her LTD benefits ending as of October 20^th.