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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Cigna denied my disability claim. Can I appeal?
You opted into your employer’s long-term disability (LTD) insurance plan with Cigna for the peace of mind it provided. You thought it would cover you and help your family if you had to take significant time off of work due to an injury or illness. However, your LTD claim was denied, and you don’t know where to turn. Fortunately, it may be possible to appeal Cigna’s denial.
Cigna Is Known for Denying Claims in Ohio
As an insurer for companies like Honda, Cigna is a big player in the Ohio insurance game. Unfortunately, it doesn't always follow the rules. According to a recent study, Cigna and its subsidiaries deny more long-term disability claims each year than any other insurer, and not always for valid reasons. In the last ten years, there have been at least 62 bad-faith court cases filed against Cigna. So if Cigna denied your LTD claim, you're not alone.
What You Should Do If Cigna Denies Your Claim
If your employer provided your Cigna long-term disability insurance, it's probably governed by the Employee Retirement Income Security Act (ERISA). If you have to file an administrative appeal, be prepared for a difficult battle. Your first steps should be to:
- Review the denial letter. You first need to understand why your claim was denied. Under ERISA, Cigna must provide a detailed explanation for the denial and tell you about your right to appeal.
- Gather evidence. Given Cigna’s reason for denying you, the next step is to gather evidence to counter their claims. This might include witness statements, medical records, employment records, and statements from vocational experts.
- Call an ERISA attorney. Not every attorney is equipped to handle ERISA claims. You'll need to find an attorney who is willing to take on Cigna within the constraints of ERISA law.
It’s important to understand you don't have to face Cigna alone. You should have an attorney help you with an appeal.
Monast Law Office Accepts ERISA Appeals
If Cigna denied your long-term disability claim, contact my office in Upper Arlington. I'll review your denial letter and help you launch a successful appeal. To learn more about ERISA claims, request a free copy of my book, Don’t Go it Alone: How Insurance Companies Sabotage Disability Claims.
What is an adverse benefit decision on a long-term disability claim?
If you file a long-term disability (LTD) claim on your employer-sponsored policy and the insurance company denies or terminates your application, pays less than the claim is worth or says you're only entitled to limited benefits, that means they have issued an “adverse benefit decision.” As soon as this happens, you have necessary rights to act on.
But unless you talk to an attorney who handles ERISA claims, you'll have a hard time exercising those rights. Let me explain what I’m talking about.
ERISA Grants You This Important Right
The Employee Retirement Income Security Act (ERISA) is a complicated piece of legislation that protects both employers and employees in situations involving various kinds of benefits, including long-term disability insurance policies. Under ERISA, if you receive an adverse benefits decision, you may get a copy of your claim file to see the information the insurance company used to make the adverse decision.
Now, it won’t just voluntarily hand over the claim file. You'll have to request it in writing and, even though the carrier is required by law to give you the record, it might still deny your request.
How Can You Protect Your Rights?
Maybe the claim manager isn't aware of the law that compels the company to hand over the file, or it could be more intentional than that. Either way, without an ERISA attorney advocating for you, it's unlikely you'll get access to the file, even though the law is on your side. Even if you're able to get the file, it will be difficult, if not impossible, for you to wade through the data and figure out if you have a case for an appeal.
However, an experienced ERISA attorney such as myself has the knowledge and resources to review the file—which could be thousands of pages long—and determine if you have reason to appeal.
Trust Monast Law Office With Your LTD Appeal
As I said before, ERISA protects both you and your employer. While it might grant you some rights, it also limits what you can do with those rights to protect the employer. Your best bet is to call our office when your LTD claim is underpaid or denied. Leave the complicated ERISA laws to us—we’ll make sure your rights are protected. If you want to learn more about ERISA, request a copy of our free book, How Insurance Companies Sabotage Disability Claims.
Why was my short-term disability claim denied?
You opted into short-term disability insurance because you were worried about how bills would get paid if you could not work for several months. You thought you were doing the responsible thing to protect your family if an illness or injury prevented you from earning a paycheck. However, when the worst happened, and you had to make a claim, you were denied. How can this be?
It’s All in the Fine Print
Employers in Ohio aren't required to offer short-term disability policies to their employees, but some do. With this coverage, people unable to work for several weeks or months due to a non-work-related injury or illness can file a claim to recover some lost income and additional compensation while temporarily disabled. The conditions covered and the time you're insured depend on the terms of your specific policy.
Some short-term disability policies offer as little as 30 days, while others cover you for a year. However, no policy covers illness or injury caused by your job, because those circumstances fall under the umbrella of workers’ compensation.
Why Was Your Claim Denied?
Short-term disability claims are usually denied for one of these reasons:
- The condition isn't covered. You have to understand the terms of your policy before you apply for benefits. Some policies cover time off for childbirth by C-section, for example, and others don't.
- You didn't provide adequate medical evidence. Even though your disability is only expected to be temporary, you still have to provide medical proof that you're unable to work. If the insurer doesn't think the evidence is sufficient, it will deny the claim.
- The insurer thinks you're lying. Insurance adjusters check out your social media, follow you around, and even talk to your friends and coworkers to find a reason to deny your claim. If they think your behavior contradicts your application for disability, they could deny it.
If you paid your premiums and are legitimately disabled, get the insurance benefits you deserve. If you're denied, you can file an appeal, but need the help of an attorney who handles these kinds of cases. Employer-sponsored benefits are governed by the Employee Retirement Income Security Act (ERISA) and are subject to strict regulations.
Contact Monast Law Office With Your ERISA Claim
As a dedicated workers' comp attorney for over 30 years, I'm honored to provide winning strategies for clients denied an employee benefit covered by ERISA, including short-term disability. Contact our office in Columbus to discover if we can help. To learn more about ERISA and the appeals process, request a free download of our book, Don’t Go It Alone: How Insurance Companies Sabotage Disability Claims.
How long do I have to file an appeal of my LTD denial, considering the restrictions imposed under the COVID-19 pandemic?
In March 2020, the world as we knew it changed almost overnight. Most of us were told to shelter in place, work from home, and only go out for essential purposes. Many businesses came to a standstill, at least while everyone adjusted to the changes, and any medical, legal, and government problems not related to COVID-19 were pushed aside or put on hold.
Were you facing a denial of your long-term or short-term disability benefits as this went down, you're probably wondering when you'll be able to continue pursuing an appeal.
Among all the bad news around us these days, one bright spot is that the U.S. Departments of Labor and Treasury unprecedentedly decided to loosen some of the restrictions imposed by the Employee Retirement Income Security Act (ERISA).
What Does This Mean for Your ERISA Appeal?
While ERISA gives you the right to appeal denials of your employer-sponsored long-term disability (LTD) insurance, it does so with fairly rigid restrictions, including a short, 180-day time limit from the date of denial. If you received a denial in the last six months, you were probably just figuring out what to do about it when COVID-19 hit.
Whether you were affected by the pandemic and let the claim slip your mind, or you've been unable to get help because of the restrictions, you might be panicking that your time is running out. To file an appeal, you must see your health providers to get medical reports. If you've been unable to leave your home or your doctors’ offices were closed, you haven't been able to get the evidence you need to support your appeal.
However, given the National State of Emergency issued on March 13, the 180-day time limit has been lifted. On May 4, the following rule change was announced:
“All group health plans, disability and other employee welfare benefit plans, and employee pension benefit plans subject to ERISA…must disregard the period from March 1, 2020, until sixty (60) days after the announced end of the National Emergency or such other date announced by the Agencies in a future notification.”
As of June 1, the National State of Emergency had still not been lifted, so this means that the period from March 1 to an indefinite date cannot be counted against the 180-day time limit for your LTD appeal.
Monast Law Office Is Open for Business and Ready to Discuss Your LTD Appeal
Appealing an LTD denial is difficult in the best of times, and it's especially difficult now. As a board-certified workers’ comp attorney for over 30 years, I'm dedicated to providing people the guidance and representation they need to get the long-term disability benefits they deserve. Contact our office in Columbus to discover how we can help! To learn more about ERISA and the appeals process, request a free download of our book, Don’t Go It Alone: How Insurance Companies Sabotage Disability Claims.
Will I have to pay income tax on my ERISA long-term disability settlement?
You had a long-term disability insurance policy through your employer, but when you were injured and needed the benefit, your claim was denied. You sued under the Employee Retirement Income Security Act (ERISA) and won. You agreed to a lump-sum settlement amount and hoped that was the end.
However, be aware that you probably owe federal income tax on the settlement for the year you received it. Why is this? We look here.
Some Lump-Sum Settlements Are Taxable
The U.S. Tax Code is about as easy to decipher as the Rosetta Stone. Tax laws regarding disability settlements are no exception.
Generally, if the long-term disability (LTD) policy was provided by the employer as a fringe benefit, the payments you receive—or the lump-sum settlement in an ERISA lawsuit—would be taxed as income. This rule applies even if your disabling injuries are purely physical, despite the tax law that says disability payments for physical injuries are not taxed. That rule only applies to self-funded long-term disability policies.
Several U.S. Tax Court rulings over the last several years have upheld that ERISA lump-sum settlements are subject to federal income tax.
How to Avoid Losing Settlement Funds to Taxes
While there’s no way to get around federal tax laws, you may ease the pain by choosing monthly payments of your long-term disability benefits instead of a lump-sum settlement. When you work with an ERISA attorney to appeal your long-term disability denial, tax implications will be considered along with your right to the benefits you deserve.
Monast Law Office Welcomes ERISA Long-Term Disability Appeals
If your employer-sponsored group LTD claim was denied, I can help you sort through your options for filing an appeal that preserves the settlement. 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 the Monast Law Office today and get off to the right start with your appeal.
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.