Insurance policies can be hard to understand. Nevertheless, if you or a family member has recently become disabled, whether related to an accident or not, you may be entitled to Long Term Disability benefits (LTD) through a policy typically purchased on your behalf by your employer. These are typically group plans, just like with your health insurance coverage, and probably controlled by ERISA.
What Are The Types Of Disability Insurance Policies?
Each type of disability policy may have its own unique definition of “total disability.” There is not necessarily any uniformity between how disability contracts are written when comparing one company to another. However, most of these types of policies typically have a two-year “own occupation” clause. This type of policy pays long-term disability (LTD) Insurance benefits to you for two years only if you are disabled in the actual occupation in which you were working at the time you became disabled. In other words, whatever job you had on the date of disability, if you can’t perform in that specific job, you will only be paid for two years. After that, you will only be entitled to benefits if you Long term disability lawyer cannot perform “any occupation” of any type. This second type of clause, “any occupation,” is very favorable to the insurance company.
If you purchased your disability policy privately, i.e., not a group plan, it is possible that the definition of disability may be more favorable to you. A privately purchased LTD policy may or may not have the limiting “any occupation” clause. This does not mean that your disability insurance company will make it easy for you when it comes time to pay your disability claim. Disability policies are generally very restrictive.
What Are The Drawbacks of Long Term Disability Insurance Policies?
We find that folks think they have long-term disability coverage since it was purchased by their employer on their behalf and as part of a group plan. However, they often do not realize that the coverage has limited value. Below are some facts about most long-term disability policies that may surprise you.
- Wage loss coverage only goes to age 65
- Wage loss coverage only up to 60% of the insured’s earnings
- LTD insurance company pays only if you cannot perform each and every material duty of your occupation that you claim you can’t work at anymore
- Denying a claim for “lack of a sufficient record of disability” established in the claim process
Check with your HR department. Ask for a copy of the long-term disability policy, and go through it. Most employers don’t really know that they purchased lousy coverage for themselves and their employees. At Carpey law we know how to evaluate these policies and litigate them on behalf of our clients. We can help you understand these kinds of policies. Some policy sections give you rights, and some policy sections take away your rights. It is important to understand how these various sections overlap before you put in a claim for LTD benefits.
What Is ERISA?
ERISA is the Employee Retirement Income Security Act of 1974. This federal law was originally enacted to protect retirement pensions. Over the years it has been extended by the courts to govern every aspect of employee benefits, including health insurance and disability insurance paid for by the employer and not the employee, even if you contributed to the payment of your insurance premiums.
How Does ERISA Affect My Ability To Get My Disability Insurance Benefits Paid?
ERISA has specific timeframes for filing disputes with your insurance company and how the disputes are handled in the court system, as well as appeals of those disputes. Typically, the various rules governing ERISA benefit the insurance company and not the employee seeking disability benefits.
You should be aware that handling the claims process without an attorney puts you at a disadvantage when facing the insurance company. They know the ERISA rules and so do their attorneys. The reason insurance companies are in business is to make a profit for their shareholders. They really do not care about your needs or your family’s needs when it comes to paying a disability or health insurance claim.
Choose an Experienced Long Term Disability Lawyer to Fight for You
Stuart A. Carpey, who has been practicing as an attorney since 1987, focuses his practice on complex civil litigation which includes representing injured individuals in a vast array of personal injury cases.