Our Long-Term Disability & ERISA FAQs
You may have thought it would be easy to file a claim for long-term disability with your employer’s group policy, but you were shocked to find out your claim was denied. Get questions about why claims are denied and how to file a successful appeal answered in our long-term disability and ERISA frequently asked questions. Our attorney provides reliable information here.
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What's the difference between long-term disability insurance and Social Security disability?
People use the word “disability” to refer to many kinds of insurance programs. If someone says they’re “on disability,” they may mean they're collecting veteran’s disability, supplemental security income, Social Security Disability Insurance (SSDI), or private long-term disability (LTD) insurance.
These are vastly different programs that all do the same thing—provide financial assistance when the claimant cannot work due to a disabling condition. You should know which programs apply to you and how they work together.
SSDI Is a Government Program, While LTD Insurance Is Optional
If you worked and earned a paycheck in the United States, you have most likely paid into the Social Security system. The Old-Age, Survivors, and Disability Insurance tax is deducted from your paycheck each month. If you become disabled, you can apply to receive these benefits, regardless of your assets and income. You'll have to meet fairly stringent criteria, including having enough work credits and meeting the Social Security Administration's (SSA) medical standards of disability.
If you purchased long-term disability insurance through your employer, you could also claim benefits on this policy. These employee benefits are governed by the Employee Retirement Income Security Act (ERISA). An attorney who handles ERISA cases can help you understand this coverage or if your application is denied. Generally, it's easier—and faster—to get approved for private LTD benefits than it is for SSDI.
How the Two Programs Work Together
This is the tricky part. Some LTD policies require that you also apply for SSDI within a specific timeframe and, if approved, will lower their payments to you. This is a way LTD policies shift their disability payment burden to Social Security.
Likewise, when the SSA notices that you're collecting on an LTD policy, it will consider that income and reduce payments to you. If your LTD claim is approved before your SSDI claim, but you're eventually awarded SSDI benefits, your LTD insurer may require you to reimburse them some of what you've collected so far.
Confused? Contact ERISA Attorney Jim Monast Today!
If you have long-term disability insurance through your employer and were denied—or your insurer is demanding that you pay it back after an SSDI approval—contact Monast Law Office. We handle ERISA cases and can help get the benefits to which you are entitled. To learn more about the long-term disability application process, request a free copy of our book, How Insurance Companies Sabotage Disability Claims.
I was told I need an ERISA attorney to help with my long-term disability denial. What does that mean, and where can I find one?
For many people, the perks of employer benefit packages are almost as important as the salary they earn. Medical insurance plans, retirement savings accounts, pensions, life insurance, and disability are just some benefits your employer may offer.
While you may have to opt into some plans and pay premiums, it's usually at a significant discount over what you would pay if you enrolled as an individual.
However, these benefits are subject to federal law and, when something goes wrong, you may need to hire an attorney who's familiar with the Employee Retirement Income Savings Act (ERISA).
How to Find an Attorney Who Takes ERISA Claims
If you submit a claim for long-term disability (LTD) with the company group plan and are denied, you may appeal. However, the process—which is established by ERISA—is complicated, and favors the insurance company that denied your claim.
Because these appeals aren't like other insurance claims, not every attorney is qualified or willing to take them. You want a disability attorney who is:
- Familiar with the law. Appeals of long-term disability claims governed by ERISA follow specific processes, and the time for filing an appeal is limited. An attorney with insight on how appeals work under ERISA can work quickly and efficiently to file a strong appeal.
- Experienced with ERISA claims. The more ERISA appeals an attorney has handled, the better prepared he or she will be to manage your application.
If an attorney doesn't advertise his services as an ERISA attorney, he's probably not well-versed in the process, even if he's willing to take your appeal. Try to find an attorney who wants these claims and will work hard to file a strong appeal.
Monast Law Office Welcomes ERISA Long-Term Disability Appeals
When your employer-sponsored group LTD claim is denied, call my office in Upper Arlington to learn more about my expertise for handling these claims. As a workers’ compensation attorney with over 30 years of experience, I know what it takes to build a strong disability claim, and I understand how the ERISA process works. Time isn't on your side with a denied LTD claim. Contact Monast Law Office to get off to the right start with your appeal.
How do I file a claim for long-term disability?
You’ve had the policy since you started in your current job, but hoped you’d never need it. Unfortunately, an illness or injury has left you unable to work, and you think it’s time to file a claim. By understanding your policy and the application process, you may be able to save yourself time and aggravation.
As a workers’ compensation and long-term disability appeals attorney, I help clients who are struggling to get approved for the benefits they deserve.
What Does Your Policy Cover?
The first thing to do is to read and understand your policy. Each policy defines what the insurance carrier considers a qualifying disability to be, so you'll have to make sure your illness or injury meets those specific standards. Disability under your policy may be defined as a condition that prevents you from performing your current type of work, or it may require you to be unable to perform any work.
Your policy also outlines time limits for applying for benefits and any exclusions, such as pre-existing conditions and specific medical issues that aren't covered. Ensuring that you meet the requirements of your policy before applying can save you a lot of trouble down the road.
Supporting Your Claim With Medical Evidence
Whatever the specifics of your policy might be, the carrier will require you to provide medical evidence to prove you're disabled. This evidence includes records from your treating physician, lab test results, hospital records, and MRIs, or other scans.
Also, ask your doctor for a detailed description of your medical history and the physical limitations you're experiencing because of the illness or injury. The space allotted on the insurance company’s form might not be sufficient to provide these details, so a separate statement may be necessary.
What If You're Denied?
Even if you understand your policy and submit a complete application, you might be denied. In some situations, you may be able to file an appeal, but this is often a complicated process. If you have long-term disability insurance through your employer, the appeal process is probably subject to the rules established by the Employee Retirement Income Savings Act (ERISA). These rules are complicated, and not many attorneys are willing to help with an ERISA appeal.
However, my team at Monast Law does accept these claims and would be happy to take a look at your application to determine if an appeal is an option for you. Contact our office in Upper Arlington to find out if we can help.
Why was my long-term disability claim denied?
You opted into your employer’s long-term disability (LTD) insurance plan thinking it would protect your family if something happened to you that prevented you from working. Now that your fears have come true, you're shocked to discover that your claim for LTD benefits is denied. You’ve paid your premiums reliably for years—how could this happen? We look at common—and often petty—reasons LTD claims are denied.
Insurance Adjusters Are Paid to Deny Claims
The first thing to realize is that insurance companies only make money on the claims they deny, so their adjusters will look for any undotted "i" or uncrossed "t" to throw out your claim. You may not even be given a reason when your claim is rejected, but it's probably for one of these reasons:
- Small print in your policy. You must meet the terms of your specific LTD policy, including its definition of a disability. Most policies exclude pre-existing conditions, so if the claims adjuster believes your condition isn't new, you'll be denied.
- Lack of evidence. You must include evidence of your medical condition and your physical limitations. Medical evidence includes doctors’ reports, scans, and lab tests, which have to be dated within the period of eligibility. Statements and evaluations from doctors and occupational experts attesting to your inability to perform work must also be included.
- Application errors. Incomplete applications, or forms with even minor mistakes on them, will likely be rejected immediately.
- Missed deadlines. You must meet strict deadlines when applying for LTD benefits. If you miss a deadline, your application won't even be read.
- Evidence of duplicity. An approved LTD claim means a hefty payout by the insurance company, so it may go to great lengths to prove your claim is fake. Tactics such as monitoring your social media, spying on you in public, and speaking to friends and co-workers aren't beneath adjusters instructed to find any reason for fault. They won't hesitate to misconstrue perfectly innocent actions as being evidence of fraud.
If you're denied for any of these reasons, or have no idea why your claim was denied, you may be able to file an appeal helped by a long-term disability attorney.
But Not Just Any LTD Attorney
Employer-sponsored long-term disability insurance policies are regulated by the Employee Retirement Income Security Act (ERISA), a set of complicated federal laws originally intended to protect workers’ retirement savings. ERISA now also includes provisions that dictate how LTD claims and appeals should be handled.
Because these cases are complex and time-consuming, few attorneys take them, but I do. As an experienced Columbus workers’ comp attorney, I understand the frustration of a denied LTD benefits claim. Call the Monast Law Office to discuss the possibility of filing an appeal. We'll take a look at your claim and let you know if we can help you navigate the difficult ERISA process.