In fact, this is the very reason many people opt for disability coverage through their employment. Others even choose their industries, professions, and career roles based on the benefits package offered by their employers. The question is, will your long-term or short-term disability insurance carrier abide by the policy terms and pay your claim?
Understanding your insurance policy terms, your rights and obligations when filing a claim, and the insurance company’s common denial tactics can mean the difference between obtaining the benefits you deserve and a denied claim. Contact our skilled ERISA insurance claims attorneys today to pursue the best possible outcome for your unique disability circumstances from the start.
Frequently Asked Questions For Our Accident Death & Dismemberment Claims Attorneys In Fort Lauderdale, Florida
What Does Disability Insurance Do?
Most people consider a disability to be a permanent affliction, leaving them out of work and preventing them from enjoying their lives going forward.
What most people do not consider are the most common reasons for disability claims may include pregnancy, mental health issues, and cancer — conditions that might not be top-of-mind when considering their insurance coverage options.
Disability insurance is designed to replace a portion of the policyholder’s income when they are unable to work because of a serious illness or injury and pays benefits directly to the policyholder, so they can cover their expenses with no limitation on how the money can be spent.
What is the Difference Between Long-Term and Short-Term Disability Insurance?
Short and long-term disability insurance serves specific purposes and has different coverage lengths, which can be incredibly helpful to those who suffer from an injury or illness that keeps them out of work.
The biggest difference between short-term and long-term disability insurance is the amount of time the individual will receive the benefits if they are unable to work called the “benefit period.”
As the name indicates, short-term disability insurance is intended to cover the policyholder for a short time following an illness or injury that keeps them out of work. While insurance policies vary, short-term disability coverage lasts for a term between 3-6 months, and typically covers a greater percentage of income than its long-term counterpart — sometimes up to 70%.
Long-term disability insurance is intended to provide benefits for a longer period, which is usually stated in years: 5, 10, 20, or even until retirement age, depending on the plan, and typically covers 40-70% of the individual’s income.
What is ERISA?
ERISA is a federal statute that provides extremely strict deadlines and guidelines for claimants and insurance companies to abide by in the processing of a claim, submission of an appeal, and ultimately the determination of eligibility for benefits under a long-term or short-term disability insurance policy.
ERISA creates an unequal claims process, placing strict obligations on individuals pursuing benefits that make maneuvering a claim difficult and frustrating for unaware claimants at a time when they should be focusing on their recovery. For most, the process is mysterious and often confusing. What you do not know and what your insurance carrier will not tell you can be fatal to your claim.
If you are applying for benefits under an ERISA-governed plan, you should be aware of your obligations in proving your claim and the strict deadlines under which you are working.
Navigating the ERISA Insurance Claim Process
The ERISA insurance claim attorneys at Disability Insurance Law Group are dedicated to leveling the playing field for our clients. We use our experience in managing these complex legal cases to guide our clients through the process and vigorously fight to protect our clients’ rights.
If you are unsure of whether your disability benefits plan or insurance policy is ERISA-governed, you should proceed with caution and seek clarification. The laws that govern each type of benefit plan and insurance policy, and your legal rights and obligations under each, are vastly different.
Can I Appeal a Denied ERISA Insurance Claim?
When a claim for disability benefits governed by ERISA is denied, the claimant MUST submit an administrative appeal directly to the insurance company that originally denied the claim. If you do not, you may be barred from pursuing your claim further.
When we prepare an appeal, we make sure that all the necessary information is added.
Often, this will include expert testimony, independent medical opinions, testimony from co-workers and/or family members, and statements from your treating physicians. The insurance companies understand that we will not hesitate to expend the time and resources necessary to properly prepare our clients’ claims and aggressively represent their rights.
What most people do not understand is that the appeals process may be your LAST opportunity to provide proof of your claim in or out of court. If your insurance company upholds its denial of your claim following the submission of all mandatory appeals, you may then file a lawsuit. Typically, the only information that you may present at trial is the information gathered during the application and appeals process.
Accordingly, we MUST essentially prepare your long-term or short-term disability trial before the final denial of your claim and before you even have a right to file a lawsuit. If you leave out any evidence, including medical records, testimony, or expert reports, the judge will likely never consider it if a lawsuit is necessary.
Most individuals would not think about preparing for and facing their insurance company and its lawyers without legal counsel. However, in submitting an administrative appeal unprepared, this is exactly what they are doing.
Claimants in ERISA-governed disability claims do not have a right to a jury trial. Instead, you must present your case to a single judge. Typically, at trial, the goal is not to prove that you are disabled, but that the insurance company acted unreasonably or in its own financial self-interest when it made the decision to deny you benefits. As such, ERISA places a much higher burden on claimants in a lawsuit.
Moreover, insurance companies understand the burden that claimants are facing, and claims examiners are well-versed in how to prepare a denial to make it appear reasonable. For this reason, it is essential that claimants put all the necessary information in their applications and appeals. We can help. Contact our experienced ERISA insurance claims attorneys today.
We Protect ERISA Policyholders Throughout the U.S. Inside and Outside of the Courtroom
Our ERISA insurance claims lawyers understand the importance of the appeals process and prepare our clients’ appeals accordingly. Because of our experience and reputation with insurance companies and benefits administrators, they understand that if an unreasonable denial of benefits is not overturned, we will aggressively pursue our clients’ rights in a court of law. They further understand that with a well-prepared appeal, we will have the ammunition needed to defend our clients’ rights in court.
These cases are highly technical, and companies spend millions of dollars per year scrutinizing and defending against these long-term and short-term disability insurance claims. It is essential that you choose an attorney with the knowledge and experience necessary to oversee these complex legal issues.
Contact Us for Individualized, Experienced ERISA Insurance Claims Representation
The ERISA insurance claims attorneys at Disability Insurance Law Group encourage you to contact us if you are:
- Planning to file a long-term or short-term disability insurance application.
- Have filed and are experiencing a delay in payment.
- Have been denied long-term or short-term disability insurance benefits.
- Having difficulty managing your ongoing benefits claim.
Contact our skilled ERISA insurance claims denial attorneys in Florida today by calling 954-989-9000 or contact us online to schedule a completely free and confidential case assessment, so we can put our over 50 years of combined experience to work for you.