Top 5 LTD Benefits Questions
- 1What is ERISA?The Employee Retirement Income Security Act of 1974 (ERISA) is a federal statute that was designed to protect participants of employee pension plans and other benefit plans offered by employers, such as Long-Term Disability benefits. Unfortunately, in its current legal state, ERISA offers more protection to insurance companies than to the participants it was intended to protect. If your Long-Term Disability benefits are governed by ERISA, or if you’re unsure if ERISA applies, you should contact our team today. Under ERISA, plan participants may seek relief for breaches of fiduciary duty, denial of benefits, or failure to disclose plan terms or benefits changes. However, if state law applies, then you could have a claim for insurance bad faith. Determining whether ERISA applies to your claim is a question of law best assessed by one of our attorneys. The insurance company will often misclassify benefits as governed by ERISA when, in fact, they are subject to state law.
- 2What is the Appeals Process?In an ERISA case, you’re generally required to exhaust the administrative appeals process before bringing a lawsuit. This means you must appeal directly with the insurance company or claim administrator and submit evidence in support of your claim. You also have a right to all relevant documents used in your claim, so that you can “perfect” your claim. Currently, the Department of Labor is reviewing ERISA claims regulations, so the rules for appealing may change. Unlike other areas of the law, the evidence you are allowed to present in court on an ERISA matter is often limited to the evidence you submit during your appeal. If you do not appeal, or fail to do so timely and carefully, you could forever lose your right to benefits. Because of the question as to applicable law, relevant regulations, and the overall importance of submitting appeals, you should consult one of our attorneys. Submitting the best evidence possible is critical to your success on appeal.Beware of online resources offering advice on appealing your denial of disability benefits. These resources often give incorrect advice about appeals and vary, depending on where you live. If you have questions about appealing a determination on your Long-Term Disability benefits, contact our team for a free consultation today.
- 3Why Was I Denied?Insurance companies deny or terminate claims for many reasons. One common reason is the purported failure to meet the definition of “disability.” Many Long-Term Disability policies have changes in the definition of “disability” after 24 months of benefits, requiring you to be disabled not just from your “own occupation,” but from “any occupation.” The insurance company will frequently “cherry pick” your medical records, even retaining an “independent” medical reviewer to build evidence against you, despite the fact that you’ve never been personally evaluated by that reviewer.Although the road ahead can seem difficult, don’t give up on your right to your disability benefits. Insurance companies often count on you not fighting your benefits, thus saving them from paying you for the months – and often years – of benefits to which you’re entitled.
- 4Should I Resign from my Job?No. Don’t resign, enter into a severance agreement, or make any retirement decisions without first consulting your plan documents. Better yet, contact one of our attorneys, Erin or Kevin, who specialize in plan document review. Any resignation or severance agreement may impact your eligibility for disability benefits, and there are ways to end employment while still protecting your disability benefits.
- 5Should I Apply for Social Security Disability?In most circumstances, the answer is yes. Under most employer sponsored disability plans, you’re required to apply for Social Security Disability benefits, assuming you are eligible under Social Security’s rules. Most plans and group disability policies allow the insurance company to reduce your monthly benefits amount by the amount you receive in Social Security Disability benefits. This is so the insurance company can reduce its financial liability and the amount it pays you each month. There is little downside to applying for Social Security Disability benefits if you are qualified; doing so can protect your retirement and qualify you for Medicare. But, if you don’t apply for Social Security Disability benefits, just know that the insurance company may have the right to reduce your Long-Term Disability benefits by what you would otherwise receive in Social Security Disability benefits.