my family dr has diagnosed me with a disability not work related. can i collect on my ltd policy for this condition while recieving workers comp for work injury?
Total Comments: 5
Posted: Mon Aug 30, 2010 02:53 pm Post Subject:
Possibly . . . but it depends on the language of your LTD policy. Most have exclusionary language that reduces your policy's benefit by the amount of other benefits you receive (such as worker's compensation or state disability benefits). The provision is sometimes known as "integration of benefits."
You'll have to read your LTD policy to know for sure. And you'll also have to fit the definition of disability in your contract -- it will either be "OWN OCCUPATION" (cannot do the work you were doing at the time you became disabled) or "ANY OCCUPATION" (any perform the duties of any job you are qualified to do, with your disability, based on education, training, or prior experience).
The whole point is this: few LTD policies are going to allow you to be disabled and collect more money than you would if you were working normally. If they did, you might choose to never get better.
Posted: Tue Aug 31, 2010 10:09 am Post Subject:
Well Max, perhaps you may clarify my doubts to some extent. Can he really collect workers comp for work injury even when his disability is not work related?
Posted: Thu Sep 02, 2010 10:48 pm Post Subject:
I was injured at work and recieve comp for that injury.
I recently saw my family doc and was diagnoised with an entirely different disabilty that is not work related. Just wondering if I should apply for ltd for the non work related disabilty. The non work is advanced and will not get any better.
Posted: Fri Sep 03, 2010 02:48 am Post Subject:
Can he really collect workers comp for work injury
Of course. That's the purpose of Workers' Compensation Insurance.
even when his disability is not work related?
No. That's not a Workers' Comp claim. But it could be paid for by a personal disability income policy. And he/she could be paid for both.
Here's a possibility: Jane breaks her arm falling down a flight of stairs at work. Workers' Comp claim. Employer tells Jane she cannot be at the workplace while in a cast. Fine, she's off work for 4-8 weeks, paid for by WCI.
While recuperating at home, with one week left to go before the cast comes off, she begins to experience unrelated aches and pains. Goes to her private physician, who diagnoses her with West Nile virus, the result of a mosquito bite, and needs to be hospitalized. Not a workers' comp claim, but if it results in her being off work the required amount of time (might be 7 - 14 - 30 or more days), her personal disability income policy will cover her lost time.
But while hospitalized, her orthopedist determines that her arm has not fully healed, and she needs to be in the cast another 4 weeks. Workers' comp continues to pay for that time off, even though she hospitalized for something totally unrelated. The reason . . . her employer will not allow her to work as long as her arm is in a cast.
But her personal disability policy will not pay a full benefit. It will be reduced $ for $ for every penny she collects from Workers' Comp. If her WCI benefit is greater than her personal benefit, she won't collect any of that as long as she's on the WCI claim.
Sure, this sounds bizarre, but it would be perfectly legitimate, and things like this have happened. Employees who are off work due to a WC injury have been more severely injured when involved in a traffic collision while driving to a WC doctor's appointment.
There are as many possibilities as there are employees on claim.
Posted: Fri Sep 03, 2010 02:51 am Post Subject:
Just wondering if I should apply for ltd for the non work related disabilty. The non work is advanced and will not get any better.
If your particular disability is not excluded by your LTD policy's language, then by all means file a claim. It does not guarantee that you'll collect a benefit, because you'll have to meet the definition of disability in your policy.
Posted: Mon Aug 30, 2010 02:53 pm Post Subject:
Possibly . . . but it depends on the language of your LTD policy. Most have exclusionary language that reduces your policy's benefit by the amount of other benefits you receive (such as worker's compensation or state disability benefits). The provision is sometimes known as "integration of benefits."
You'll have to read your LTD policy to know for sure. And you'll also have to fit the definition of disability in your contract -- it will either be "OWN OCCUPATION" (cannot do the work you were doing at the time you became disabled) or "ANY OCCUPATION" (any perform the duties of any job you are qualified to do, with your disability, based on education, training, or prior experience).
The whole point is this: few LTD policies are going to allow you to be disabled and collect more money than you would if you were working normally. If they did, you might choose to never get better.
Posted: Tue Aug 31, 2010 10:09 am Post Subject:
Well Max, perhaps you may clarify my doubts to some extent. Can he really collect workers comp for work injury even when his disability is not work related?
Posted: Thu Sep 02, 2010 10:48 pm Post Subject:
I was injured at work and recieve comp for that injury.
I recently saw my family doc and was diagnoised with an entirely different disabilty that is not work related. Just wondering if I should apply for ltd for the non work related disabilty. The non work is advanced and will not get any better.
Posted: Fri Sep 03, 2010 02:48 am Post Subject:
Can he really collect workers comp for work injury
Of course. That's the purpose of Workers' Compensation Insurance.
even when his disability is not work related?
No. That's not a Workers' Comp claim. But it could be paid for by a personal disability income policy. And he/she could be paid for both.
Here's a possibility: Jane breaks her arm falling down a flight of stairs at work. Workers' Comp claim. Employer tells Jane she cannot be at the workplace while in a cast. Fine, she's off work for 4-8 weeks, paid for by WCI.
While recuperating at home, with one week left to go before the cast comes off, she begins to experience unrelated aches and pains. Goes to her private physician, who diagnoses her with West Nile virus, the result of a mosquito bite, and needs to be hospitalized. Not a workers' comp claim, but if it results in her being off work the required amount of time (might be 7 - 14 - 30 or more days), her personal disability income policy will cover her lost time.
But while hospitalized, her orthopedist determines that her arm has not fully healed, and she needs to be in the cast another 4 weeks. Workers' comp continues to pay for that time off, even though she hospitalized for something totally unrelated. The reason . . . her employer will not allow her to work as long as her arm is in a cast.
But her personal disability policy will not pay a full benefit. It will be reduced $ for $ for every penny she collects from Workers' Comp. If her WCI benefit is greater than her personal benefit, she won't collect any of that as long as she's on the WCI claim.
Sure, this sounds bizarre, but it would be perfectly legitimate, and things like this have happened. Employees who are off work due to a WC injury have been more severely injured when involved in a traffic collision while driving to a WC doctor's appointment.
There are as many possibilities as there are employees on claim.
Posted: Fri Sep 03, 2010 02:51 am Post Subject:
Just wondering if I should apply for ltd for the non work related disabilty. The non work is advanced and will not get any better.
If your particular disability is not excluded by your LTD policy's language, then by all means file a claim. It does not guarantee that you'll collect a benefit, because you'll have to meet the definition of disability in your policy.
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