855-551-1019

Long-Term Disability Benefits Attorneys

Home Practice Areas Government Long-Term Disability Benefits Attorneys

Long-Term Disability Benefits Attorneys

When you’re young or feel fine, it’s hard to imagine being unable to work for any reason. The unfortunate truth for 20-year-olds is that more than 1 out of 4 of them can expect to miss at least a year’s work due to a disabling condition before they reach retirement.

What makes the numbers so alarming is that more than 50 million adults in the United States are without disability insurance and nearly half of all American adults don’t have enough savings to cover three months of living expenses if they can’t work.

That’s why many people have opted to get long-term disability insurance to help in the event of a tragic accident or disability. Unfortunately, insurance companies will do everything in their power to deny legitimate claims of long-term disability benefits.

Find out more about long-term disability settlements and how an attorney can help.

What is Long-Term Disability Insurance?

Long-term disability insurance is a policy that protects a worker from financial ruin in case he or she is unable to work for an extended period of time due to a disability.

This type of insurance usually kicks in after short-term disability insurance has run out, typically between three and six months. Long-term disability pays out a portion of a person’s salary. The exact numbers depend on the policy, but the percentage of income paid out ranges from 50 to 70 percent.

Long-term disability insurance is usually offered by employers as part of a package of benefits. The policies come from major insurance companies like Aetna, Metlife, Prudential, and others. Individuals can also purchase this type of insurance, but the costs are often exorbitant.

Workers’ compensation is different than long-term disability. Those who are hurt on the job are not covered by long-term disability and must pursue claims of workers’ compensation.

What is ERISA?

When an employee starts a new job, their biggest concern is whether they’ll have enough income to set aside for retirement, as well as having easy access to the money. In the early 1970s, the Employee Retirement Income Security Act (ERISA) was enacted. It provides private employers, as well as insurance and pension companies, with specific guidelines on how employee benefit plans should be administered.

Health plans established for church employees and governmental entities are not covered by ERISA. Workers’ compensation or unemployment, which are both related to state laws, are not covered either. Private employers are not required to have pension plans under the ERISA definition, but for those that do, it provides the minimum standards.

The scope of this act has broadened the amount of information that’s being conveyed to employees. It has expanded upon the reporting guidelines to the government, and also acts as a healthcare plan enforcement that requires employers to exclusively manage funds for people who participate in healthcare plans, while keeping their best interests in mind.

Disability Insurance

American disability law is complex and it is recommended that you consult an experienced ERISA attorney or long-term disability lawyer. It is important to understand why representation should be secured from an experienced ERISA insurance lawyer or long-term disability attorney. You need to figure out what kind of disability insurance you qualify for, in order to find the right lawyer to help you. It depends on your injury or illness and how it affects your job, your income, and the state you’re working in.

There are three main types of disability insurance. These include:

  1. Private Disability Insurance

State and federal disability insurance plans have high standards that must be met in order to receive disability benefits. Most Americans who suffer from a debilitating injury or illness will need to rely on private employer-sponsored or individual disability benefits.

If someone has been unjustly denied long-term or individual disability coverage, a general attorney might mistakenly attempt to file a breach of contract claim on their behalf. ERISA prohibits anyone from filing a breach of contract against a group disability insurer, which is why you must submit a thorough, comprehensive, and timely administrative appeal before you file an ERISA-related complaint in federal court.

  1. State Disability Insurance

Only a small number of states, including Rhode Island, New York, New Jersey, Hawaii, and California have passed specific disability insurance requirements. New York and Hawaii have required some level of employer-sponsored disability coverage in their states, while others offer benefits funded by the state. Some disability laws that have been passed, depending on the state you live in, either contradict or differ from federal case law in a federal circuit court or in federal disability statutes.

If your state requires employers to provide disability insurance or mandates it, you need to hire an experienced ERISA attorney or long-term disability lawyer who understands how long-term disability insurance from your employer might conflict, or interact with, your group coverage under state law. Disability insurance lawyers already understand these legal pitfalls if they’re well-versed in long-term or individual disability insurance law. They will be able to help you avoid serious claim mistakes that an inexperienced attorney may not be aware of, if they don’t have any past experience working with disability insurance claims.

  1. Federal Social Security Disability Insurance (SSDI)

If, based on your age, you have enough “work credits” to claim disability, you have paid enough money into SSDI, or you’re entirely disabled and cannot work, you may be eligible to receive Social Security disability benefits. By definition, “work credits” are how the federal government determines if you’ve worked long enough to obtain SSDI benefits.

For instance, if you are 35 years of age and you have suffered a traumatic brain injury, you must have paid into federal SSDI between the ages of 25 and 35 for 5 full years and have made enough income during those 5 years to qualify for benefits.

Long-Term Disability Benefits

The benefits of long-term disability insurance depend on the insurer and the policy.

The terms of the package will often lay out just how much of an employee’s salary it will cover. It can be capped at a certain amount per month. The duration of the benefits also vary. Benefits can last for a set period of time — 5 years, for example — or until the age of 65.

Some insurance companies have requirements employees must meet in order to receive benefits. For example, an employee may need to work full-time at 30 hours a week or more. Certain insurance companies will also put limits on the types of injuries that qualify. In many cases, pre-existing conditions or specific diseases that cause disabilities can be excluded.

Most benefits can be offset against the benefits received for Social Security benefits. This means Social Security benefits can be used as part of payments for long-term disability benefits.

Filing a Long-Term Disability Claim

If you have become injured, you must file a long-term disability claim before receiving any benefits. There are a few things to note, however.

The process can be long and complicated. It is important to obtain a copy of your policy in order to read it over thoroughly. There may be deadlines or limitations that can affect your chances of getting benefits.

Once you’ve read everything over and understand all the policy, you can usually request an application from your employer’s human resources department. The application will involve the disclosure of medical records, detailed information about your condition, statements from employers and doctors, and other evidence to support your claim.

Upon approval, there is a waiting period that usually coincides with short-term disability so there is no disruption in benefits.

Reasons for Long-Term Disability Denial

Applications for long-term disability claims get denied all the time, especially when the application is completed by an individual without in-depth knowledge of the policy.

In some cases, a policy is denied because the individual does not meet the policy’s definition of disability. There are specific criteria that must be met in order to be approved. If there is insufficient medical evidence to support the claims or a person is only partially disabled but still able to do some of the work duties, they will be denied.

Insurance companies will also try to prove that people can still work or are exaggerating symptoms. This could manifest itself as following an individual around to see if they are faking injuries or finding additional doctors who disagree with the individual’s initial diagnosis.

These factors, along with missed deadlines or disqualified diseases, can all result in claim denials.

What is a Long-term Disability Settlement?

Sometimes, an insurance company will reach out to the insured with a settlement proposition for their long-term disability claims.

This means the insurance company wants to settle the long-term disability claims by paying the insured a lump sum for the entire length of the policy period rather than paying monthly for years.

A company will calculate the value of a claim with their best interests and take a few factors into consideration. These factors include whether you will live to the end of your policy, whether a carrier thinks it will have to pay the entire period of the policy, and the value of the claim in today’s money.

Working with a Long-Term Disability Lawyer

If you are unable to work due to an illness or injury, and you are denied benefits through your long-term disability insurance company, you would be wise to hire an attorney. Unlike disability claims for Social Security disability through the federal government, there is no impartiality among long-term disability insurance companies. These types of insurers have a vested interest in the overall outcome of these claims. If a high number of disability claims are approved and paid out to policyholders, the company’s bottom line suffers financially as a result. Their profit margins tend to be higher when fewer long-term disability cases are approved.

Your claim may be unfairly delayed or denied by a long-term disability insurance company. This means the company is acting in bad faith.

Here are some examples of this:

  • Requiring duplicate, unnecessary, or excessive information
  • Delaying claims for unusually long periods of time
  • Denying valid claims for benefits for unacceptable reasons
  • Paying claimants lower disability payments than what was stated in the long-term disability policy

Most insurance companies don’t always play fairly, which is why it is important to have legal representation for your long-term disability claim. You should also have a disability lawyer by your side before your scheduled hearing concerning your claim status. Long-term disability companies will never tell their policyholders that their records will be “closed” by the time an administrative hearing is held regarding their claim. The reason they never tell them this is because if they did, claimants would try to include any and all medical evidence pertinent to their claim in their file prior to the hearing, and they would also ask their doctors to submit supporting documentation on their behalf.

How Long-Term Disability Attorneys Are Paid

Attorneys who deal with long-term disability suits work under contingency fee arrangements. This means that they will only ask for a fee if they help you win your case. Long-term disability attorneys charge contingency fees that are a certain percentage of the proceeds of your settlement. Not many disability claimants can afford to hire a lawyer on a flat-fee or hourly basis, which is why they often choose the contingency fee option. It allows attorneys to work on their case without charging any up-front fees, while disabled individuals receive the quality representation they need to win a fair settlement.

If you successfully win your case and the insurance company issues you a lump-sum settlement, your attorney will collect a portion of it according to the agreed-upon terms in your contingency fee contract.

When You Should Hire A Lawyer

It’s never too late or too early to hire a long-term disability attorney to represent you in your case. You should contact a lawyer the moment you become unable to work. They will advise you on your next steps going forward.

While some workers who file for long-term disability benefits tend to wait until their claim has been denied before speaking with an attorney, this is not recommended. Hiring an attorney to assist you with your initial application will protect your interests.

Unrepresented workers make the following common mistakes when they try to file a long-term disability claim on their own:

  • Filing for disability benefits after quitting their job – If you terminate your relationship with your employer, coverage through your long-term disability policy will end as a result.
  • Transitioning into a lower-paying position or a job that is less demanding – Employees will attempt to make efforts in good faith to continue working regardless of their impairments. What they don’t realize is that this could unintentionally harm their long-term disability case. Changing occupations can also make it more difficult to win an “own occupation” claim, and accepting a lower-paying position could decrease the amount of money you would receive for long-term disability.
  • Making mistakes on your benefits application – Insurance companies deliberately design their paperwork to provoke answers from you that could possibly disqualify your claim. Disability attorneys are aware of these tricks and traps that are used by insurers to deny benefits and will be able to alert you to these pitfalls before you submit your application.

How a Long-Term Disability Benefits Attorney Can Help

Throughout the entire process, an insurance carrier will do everything it can to deny your claim or give you the least value possible. A missed deadline at the very beginning, failing to gather the correct information, and low settlement offers are all used to cheat someone out of important funds that will help cover daily expenses.

The experienced government benefits attorneys at The Eichholz Law Firm can help navigate the complex legal language of long-term disability insurance policies and negotiate with insurance carriers who are trying to give you the least amount of money possible.

Contact The Eichholz Law Firm today to find out more about the process of filing a long-term disability claim.

References

Please seek the advice of a medical professional before making health care decisions.
Menu