Work accidents often lead to severe complications for those involved. In many cases, the victims are left with permanent or long-term disabilities that could affect their ability to work and earn a living for long periods or the rest of their lives.
Luckily, there is an established workers’ compensation insurance system that allows injured workers to receive monetary support to take care of their medical expenses and lost wages to help them survive after a work injury. If you are dealing with such a long-term disability due to a work injury, you may also get long-term disability benefits if you subscribe to a long-term disability insurance plan.
But the question remains: can you get both workers’ compensation and long-term disability benefits, or does one cancel out the other?
Our team of experienced lawyers at the Dressie Law Firm is committed to helping clients obtain compensation for their occupational injuries and disabilities. Below, we discuss the compensation system for long-term disabilities due to work accidents to help you understand your rights and take the necessary steps to maximize the amount you can get.
Please read on to learn more.
What Is Long-Term Disability?
Long-term disability is any severe impairment that prevents an employee from working or adversely affects their earning capacity for an extended period, usually months or years. This level of disability is usually caused by work-related Construction Accidents or dangerous work conditions.
It is not restricted to the loss of a bodily function or a body part, such as an amputation, vision, or hearing loss. But it could include any illness or conditions that make your previous work schedule unbearable or impossible, such as
- Breathing difficulties or other respiratory conditions
- Herniated discs
- Chronic back pain and other back injuries
- Concussions.
The critical point here is not the nature of the disability but how long the disability lasts and the extent to which it affects your ability to earn a living.
To qualify for long-term disability benefits, several factors come into play. Firstly, the worker must demonstrate a disabling condition that prevents them from performing their usual job for an extended period, typically exceeding 90 days. This period is known as the “elimination period,” and no benefits are paid during this time. It’s essential that the worker has been paying into a long-term disability insurance plan, either privately or through their employer, before the injury occurs. Coverage must be active at the time of the injury or illness.
Medical documentation plays a critical role in proving eligibility. The worker must provide detailed reports from licensed healthcare providers that outline the diagnosis, treatment, and prognosis. Conditions that are often covered include severe back injuries, mental health disorders, and chronic illnesses. However, certain conditions may be excluded from coverage, such as pre-existing conditions if the employee was aware of the ailment before obtaining insurance.
Another key factor is the definition of “disability.” Many policies differentiate between “own occupation” and “any occupation” definitions. Under “own occupation,” the worker is deemed disabled if they cannot perform the specific job they were hired for. Under “any occupation,” the worker must be unable to perform any job for which they are reasonably qualified by education, training, or experience to be eligible for benefits. This distinction can drastically affect eligibility and payout duration.
Long-term disability insurance may also require that the worker actively participate in rehabilitation programs to remain eligible. Failing to comply could lead to termination of benefits.
Ordinarily, your long-term disability claim should not affect your workers’ compensation claim and vice versa. However, in certain cases, your employer’s workers’ compensation provider may be entitled by law to recover a portion of your disability insurance payments. Generally, this happens if
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The employer funds a part or the entire long-term disability insurance policy
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The employee is entitled to or has received payments for disability benefits under the workers’ compensation law.
In such cases, the employer or their insurance company may recover or deduct the amount paid under the insurance policy from the workers’ compensation amount to avoid double payment by the employer, thereby reducing the amount of workers’ comp benefits you can get.
You may be entitled to other public benefits, such as Social Security disability benefits. Such benefits could also affect your workers’ comp claim and disability insurance. If you intend to claim them, it is important that you consult a personal injury attorney who can help you understand the implications of each benefit on the other and how you can maximize the available benefits for the best possible outcome.
The Dressie Law Firm, LLC Can Help You
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