Becoming Disabled: The Odds Are Higher Than People Think
by Bruce Shutan
Contributed by Matthew McAnaney, Regional Director, The Guardian Life Insurance Company of America

It’s no secret that long-term disability (LTD) insurance is a low priority for many consumers. This is evident in individuals routinely underestimating the possibility of becoming disabled and running the risk of incurring serious debt from such an occurrence.

Consider that upwards of 375,000 Americans become disabled every year. A 35-year-old’s chance of missing 90 days or more of work before age 65 is 50%, while one in seven of those individuals can expect to be sidelined for five years, according to the ProtectYourIncome.com Web Site.

The U.S. Bureau of Labor Statistics’ national compensation survey also found that roughly 70% of working Americans have access to medical care, 52% life insurance and 46% dental care, compared with just 30% for an LTD product.

Moral imperative

The Guardian Life Insurance Company of America is doing its part to spread awareness about the need for affordable and flexible LTD benefits that help consumers with financial peace of mind, particularly among small and midsize employers.

“Insurers have a responsibility to help people understand what their risks are and provide ways for them to protect themselves against those risks,” observes Craig Guiffre, vice president of the carrier’s Group Life and Disability Strategic Business Unit.

The loss of a working spouse in dual-income households can be devastating. Even just one individual missing work in a relatively small family business, law office or medical practice that lack HR and financial resources to adequately manage claims and shift work from one location to another can pose significant problems, particularly if there’s highly specialized knowledge or machinery involved.

In most cases, they will be sidelined by heart disease and back problems – the two leading causes of disability. While the latter may not always be so preventable in a workplace where accidents will happen, the former appears to be well within the control of may people.

“If you’re engaged in heavy lifting at work or involved in a car accident, then a back injury isn’t all that surprising.” Guiffre says, “But for something like cardiovascular disease, most people sadly don’t realize they have a problem until they have a heart attack.” The same generally holds true for diabetes, blood disorders, cancer and asthma.

There’s a tendency to play down the effect of an injury or illness, as well as overestimate one’s ability to find employment after becoming disabled, or to receive government assistance. Many employees do not realize that benefits-eligibility requirements relating to the disability portion of Social Security benefits have substantially tightened in the past decade.

“You pretty much need to be unable to do anything,” he says, “and, in fact, it’s now at the point where many (Social Security) claims are denied up front when cases are reviewed on the first pass. Individuals often require multiple levels of appeal to secure benefits.”

Vendor benchmarks

When selecting a disability carrier, there are several key areas for employers and brokers to consider along the road to building a formidable partnership. The most important, of course, is working with a financially solvent and credible organization than can pay claims in full and on time. Others include:

• Social Security claims assistance. As previously noted, this process can get complicated and there are numerous forms to fill out. But it also involves preparation for the possibility of having to appear before a disability assessment team at the U.S. Social Security Administration’s nearest branch office or file an appeal with an administrative law judge, which may even be partially paid for by the insurer.
• Rehabilitation services for early return to work. To help claimants remain as highly functioning as possible, what’s needed is an evaluation of the individual’s workplace and recommendations for accommodations or various treatment options that may include physical or occupational therapy.
• Role of clinicians in evaluating disabilities. Medical professionals employed by the insurer who are not only able to intelligently converse with claimant’s physician, but also are up to date on new treatment options, will vastly improve disability management, especially if there’s a difference of opinion or unusual condition with a number of co-morbidities.
• Claims reviewer caseloads. The issue is to ensure the right level of attention is paid to fully and fairly evaluate each claim, secure all the benefits to which claimants are entitled and provide any necessary follow-up assistance.
• Integrated approach to absence management. Multiple vendors handling everything from STD, LTD and workers’ comp to behavioral health and family and medical leave absences must be willing to work together and coordinate care on behalf of each claimant.

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