Does Long Term Disability cover an eye surgery (necessity on one eye, not on the other) that is not done perfectly and therefore makes it where you are unable to work?

This type of surgery would replace a lens in one eye due to cataract w/a lens that is not cloudy but also corrects vision. Lens on other eye would also be replaced only b/c your vision in each eye would be so drastically different, you couldn’t live that way.

  1. 406 POINTS
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    Coby Higgins
    Licensed Independent Agent, Texas Insurance Alliance, Little Elm, TX
    If you're thinking about filing an LTD claim, you should first consult the summary plan description in your long-term disability policy (or ask your employer's human resources department) for the policy's precise definition of "disability." Generally, you will be found "totally disabled" if you're unable, due to illness or injury, to substantially perform the duties of your occupation. If your LTD policy provides for "partial disability," you may qualify for benefits if you can no longer work full-time at your own occupation, even if you're capable of working full- or part-time at another job.

    Many policies state that you cannot file an LTD claim if you are still on your employer's payroll.

    As in Social Security disability cases, the most important factor in proving your disability in an LTD claim is the opinion of your treating doctor. As part of your application for LTD benefits, your doctor will be asked to complete a form or write a statement regarding his or her opinion on your condition. Your physician's opinion is critical, but the claims administrator will also want objective proof of your disability. Therefore, the administrator will also request all the medical records related to your disability, including relevant clinic notes, lab results, x-rays, MRIs, exam findings, and surgical reports.

    To show that your disability is ongoing, you should continue to receive treatment from your doctor while your LTD claim is pending, and even after you are approved for benefits. Failure to continue treatment may be grounds for the insurance company to cut off your benefits.
    Answered on April 20, 2017
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    Larry GilmorePRO
    Agent Owner, Gilmore Insurance Services, Marysville, Washington State
    A disability policy depends entirely on the definition of disability. The best policies keep it short and sweet because basically anything past the first sentence takes away from the policy. The best definition, which is now hard to find is "unable to perform your occupation." If two eyes are important to your occupation and damage means you can no longer perform your occupation, you can file and collect on claim. Even if you can do another occupation. It is hard to find this simple sentence anymore because as you can see, it's really good.

    When reviewing a disability policy, always read the definition first. Then review the features. Is there a residual rider? Is there a COLA rider? A disability policy's value isn't the price, it's the words that define disability.
    Answered on December 30, 2017
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