An employee filed an LTD claim. What's my role as employer?
Mostly administrative. The carrier handles the claim adjudication; the employee files the claim and provides medical documentation. The employer's role: confirm employment, salary, and dates worked; respond to carrier requests for job descriptions and accommodation discussions; and continue the employee on the policy until the claim is resolved. Don't communicate directly with the employee about claim merits — that should go through the carrier and (where applicable) defense counsel. Disability discrimination claims often arise out of how the employer responded to the disability, not the underlying disability itself.
- Category
- Employee Benefits
- Audience
- For existing clients
- Topic
- Employee Benefits
Related FAQs
Can I use a Professional Employer Organization (PEO) or association plan instead?
Sometimes. **PEOs** (TriNet, Justworks, Insperity, Sequoia, etc.) bundle health, retirement, and HR services for small businesses — they pool employees across many client businesses to access large-group pricing and richer plan options. For some NY small employers (especially those with younger/healthier workforces), PEO pricing beats community-rated small-group. But PEO arrangements have implications for tax, payroll, ERISA compliance, and unwinding can be complicated. **Association Health Plans** (AHPs) are restricted in NY — DFS regulates them tightly and they're far less common…
Read answerDo I have to offer health insurance to my employees?
Federal law (ACA employer mandate) requires "applicable large employers" — generally those with **50+ full-time equivalent (FTE) employees** — to offer affordable, minimum-value health coverage to full-time employees, or pay a penalty. Below 50 FTEs, federal law does not require coverage. NY does not impose its own coverage mandate beyond federal rules. That said, most healthcare practices and professional services firms offer coverage as a recruiting and retention necessity — the labor market makes it functionally non-optional even when legally…
Read answerDo voluntary benefits coordinate with major medical?
No — and this is the main feature, not a bug. Voluntary benefits pay cash directly to the employee, regardless of what major medical paid. There's no coordination of benefits, no offset, no reimbursement claim. The cash can be used for anything: deductibles, copays, lost wages, transportation, childcare, household expenses. This is why voluntary benefits are so frequently paired with HDHP medical plans — they fill the high-deductible gap with non-coordinated cash.
Read answerDo voluntary benefits cost the employer anything?
Generally no — premiums are 100% employee-paid through payroll deduction. Some employers pick up a portion of premium as a richer benefit (especially for groups looking to differentiate). The administrative cost of offering voluntary benefits is real but small: enrollment communications, payroll integration, claims questions handling. Most carriers in this space provide turnkey enrollment platforms and call center support to make administration light.
Read answerDPPO vs. DHMO — what's the difference?
**Dental Preferred Provider Organization (DPPO)** plans operate like a medical PPO: members can see any dentist but pay less in-network. There's typically an annual deductible ($50–$100), an annual maximum benefit ($1,000–$2,500), waiting periods on major services (6–12 months for crowns, 12–24 months for orthodontia), and coinsurance percentages by service tier (preventive 100%, basic 80%, major 50%). Strongest coverage breadth. **Dental Health Maintenance Organization (DHMO)** plans require employees to pick an in-network primary dentist, who refers to specialists. Typically: no annual…
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