Every LTD claim department has open and active claims that have not profited from a Social Security offset. Most likely, a Social Security Disability Insurance (SSDI) application was filed and was subsequently denied. It may have been that the denial was based on either lack of duration or lack of medical severity at the time a decision was rendered.

Often, the original impairment for which claim liability was established is adjoined by additional impairment(s) as other medical issues evolve. These LTD claims lacking a SSDI offset can become feasible candidates for pursuit of SSDI entitlement.

An additional area where opportunity may exist is with SSDI claims that were “technical” denials. Technical denials are those that did not have a medical decision rendered as they were denied for not meeting a requirement preceding a medical decision. One such requirement is that of being both “fully insured” and “disability insured”. Generally, that translates to having a minimum of forty Quarters of Coverage (QCs) to be fully insured and having worked five out of the last 10 years (20/40 QCs) to be disability insured.

The first 6 months of Sick Pay, Short-term Disability, or Long-Term Disability payments are FICA covered pursuant to IRS Regulations. These additional “earnings” for coverage purposes can either result in “insured status” being completed (Date First Insured), or extending the Date Last Insured (DLI). Described as “lag earnings”, they were simply not available on the earnings record when the decision was rendered.

Claims that have been branded as “Res Judicata” may be victims of “misinformation” from an official source. Misinformation is incorrect, incomplete, or misleading oral or written information that relates to the consequences of reapplying for benefits instead of filing an appeal.

Citizens Disability will support your risk management program by evaluating open and active LTD claims that do not have a SSDI offset. Through our feasibility assessments we identify claims that may have been improperly denied.