Disability Benefits After an Accident

Unexpected and severe injuries can happen to anyone. A car accident or a serious injury at work may cause anything from a temporary impairment to a permanent disability. Medical bills, time off work, and rehabilitation can affect your life and your family’s situation.

According to the Social Security Administration (SSA), one-quarter of workers will experience a disability before reaching retirement age. For those who suffer from injury or illness and can’t work, disability insurance can provide an essential source of income.

In this section, you’ll find resources to help you deal with issues related to disability insurance. You can learn about different definitions of disability, how to apply for benefits, and what to do if your disability claim gets denied.

Dealing with disability insurance can be challenging, given the technical, legal, and medical issues involved. The requirements of insurance policies and the possibility of denial also make it difficult. You may want to discuss any questions or problems with a disability law attorney. 

Types of Disability Benefits

There are several types of disability benefits to help with your financial needs while you’re out of work due to injury or disability. Eligibility for coverage depends on the kind of benefit, your age, whether your injury happened at work, and the severity or longevity of your injury or illness.

How you apply for disability benefits will vary depending on the type of coverage you have. About 30% of workers have long-term disability benefits through their employer. This disability insurance is heavily regulated by federal law.

Workers’ Compensation

Workers’ compensation often covers a work-related injury. All states, except Texas, require employers to provide workers’ compensation benefits to salaried employees. These benefits usually include partial salary compensation and payment of medical bills and rehabilitation therapy. A private insurance company manages these benefits, and the requirements vary by state. Check with your state’s workers’ compensation board for more information.

Short-term Disability Insurance

Short-term disability coverage protects you when injured or temporarily disabled by a non-work-related event. This coverage is a benefit you elect and pay for through your job or a private company, though a few states offer this coverage for workers. Short-term disability generally begins paying out for a personal injury claim quickly, but as the name suggests, your benefits are for a limited time.

Long-term Disability Insurance

Long-term disability insurance is also a benefit offered by an employer. You elect and pay for the coverage. Long-term disability won’t begin paying for at least six months after your injury or illness. But, it can pay out much longer, with some policies covering you until retirement age.

Social Security Disability Insurance (SSD or SSDI)

If your injury has kept you from work for one year, you could qualify for Social Security disability benefits. SSDI benefit eligibility has a disability and work history criteria. You can meet the work credit rule if you work for five to 10 years and have paid into Social Security. Meeting the disability is more complicated. There is a “blue book” list of injuries and illnesses that generally qualify automatically. You are also eligible if you show that your disability prevents you from working. The SSA will enroll you in Medicare after getting benefits for two years.

Supplemental Security Income (SSI)

The SSI program provides monthly benefits to qualifying applicants. SSI is a need-based program available to blind or disabled people whose disability will affect their ability to work for more than a year or will result in death. To be eligible, you must meet specific criteria, such as age or disability. You must have limited income and meet asset limits. You can check your SSI eligibility on the Social Security Administration website.

How Do I File a Disability Claim Through Work?

You may have disability insurance through your employer as part of your employee benefits package. These offerings are regulated under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA establishes strict requirements for processing and responding to claims.

Step One: Reviewing Your Disability Benefits Plan

Before applying for benefits, review the summary plan description (SPD) for your benefits plan.

This document provides a detailed overview of:

• How your disability benefit plan works
• What benefits your plan provides
• How to file a claim

Step Two: Make Sure You Meet Your Plan’s Requirements

Before filing a claim, carefully review the details of your plan. Make sure you meet all the requirements for coverage under your plan.

Pay particular attention to:

• Time limits and deadlines
• The plan’s definition of disability
• Exclusions

Typically, only non-work-related injuries qualify for coverage. Work-related injuries, in contrast, might render you eligible for workers’ compensation benefits.

Step Three: Sending in Your Claim

Your summary plan description (SPD) will describe the steps to follow when filing a claim for benefits. The SPD must include information on:

• Where to file
• What documents to file
• Who to contact with questions about your plan

Support your claim with as much medical evidence as possible. While your insurer will investigate your records, don’t trust the insurance company to do all the work. Consider asking your doctor to write a detailed report discussing your medical history and current medical issues. Your medical records and the determinations of your doctor are the most critical parts of your claim.

Consider sending your claim via certified mail. This way, you can be sure your claim has been received.

Step Four: Getting a Decision on Your Claim

Disability claims must be decided within 45 days after being received. Your plan may delay making a decision by another 30 days. Your insurer must notify you in writing of all delays.

If more information is requested, you’ll have 45 days to supply it. Once you provide the additional information, the insurer must then make a decision within 30 days (with another possible 30-day extension). Any additional delays will require your consent.

Disability Benefits Outside of an Employer Plan

If you don’t have private disability insurance or you’re completely unable to work for at least a year due to a serious injury, you may be eligible for SSDI or SSI benefits. Specific legal requirements govern all aspects of SSD and SSI. These include filing claims and challenging a denial to qualify for benefits. 

Whether you seek benefits through your employer’s disability insurance or Social Security for your car accident injuries and impairments, your situation may require legal expertise from a disability lawyer.

Qualifying for Other Disability Benefits

For SSDI and SSI, you must meet the Social Security Administration’s definition of disability. Not all disabilities or injuries will make you eligible. You need medical proof of your condition, that you cannot work, and that you meet other requirements of each program. For example, you must meet work requirements to get SSDI benefits. For SSI, you can’t exceed $1,913 per month, pre-tax, wages, self-employment income, or $2,827 monthly for a couple.

If you file a lawsuit over a personal injury that left you disabled, you should know that any personal injury settlement amount can affect your SSI payments or Medicaid eligibility.

Applying for Other Disability Benefits

Processing a disability claim can take a long time. File your application early to get SSDI or SSI payments as soon as you’re eligible. The SSA has compassionate allowances, which remove waiting times for certain conditions, giving you access to your benefits sooner. Examples include specific cancers or Lou Gehrig’s disease (ALS).

If you are applying for SSI or SSDI, you must provide detailed information about your disability. Before you begin your application, ensure you have:

• Your medical care providers’ names and phone numbers
• A list of your medications
• A list of medical tests given
• Your Social Security number
• Information about your last two years of employment
• Banking account details

You can apply for SSDI or SSI benefits online or at your local Social Security office.

Appealing a Claim Denial

If your disability claim is initially denied, it can feel discouraging. While employer plans may involve a claim denial lawsuit, Social Security claims follow a specific process.

Certain conditions generally qualify for SSDI benefits. SSI should be approved if you meet the criteria honestly and have not tried to hide assets. Social Security disability insurance and SSI allow you to appeal a denial several times.

The SSA has four levels of appeal:

1. First, you should request reconsideration of the SSA’s decision. You can fill out a request online or at your local SSA office.
2. If you disagree with the SSA’s follow-up response, request a hearing with an administrative law judge.
3. If denied again, request that the Appeals Council review your case and a judge to review it.
4. Finally, you may file a federal district court action in the appropriate U.S. District Court.

Pay attention to why the SSA rejected your claim. Provide any supporting information required to improve your case. During your appeal, make sure to note important deadlines and other requirements. Consider seeking legal advice during the appeal process. Find a local legal clinic or law school to locate low- to no-cost legal representation.

How an Attorney Can Help

Disability benefits are an important lifeline for those who can’t work due to illness or injury. An experienced disability attorney can work with you to assemble the strongest case before you file a claim. Your attorney can also determine if extra medical testing will benefit you. Seek legal advice if the SSA denies your claim or your benefits get lowered or terminated. A disability lawyer can help you avoid financial hardship and get the coverage you deserve.

If your disability is the result of another person’s negligence, speak with a personal injury attorney right away. A personal injury lawyer can evaluate your situation. Your attorney can help you fight for a settlement if you have a personal injury case.