Employment Law Attorneys Serving South Florida and Other Areas
What is Long Term Disability Insurance?
Exactly as it sounds, long term disability insurance is for those who become disabled due to injury or sickness (often including mental disorders), where the disability expects to last more than just a few months. It is considered an income substitute because its goal is to replace your lost wages. It typically pays you 60 to 80 percent of what you were making while working on a monthly basis.
This insurance often starts after you have been unable to work for six months. It can remain paying you monthly benefits until you are no longer disabled, or reach the age of 65 (or beyond depending on your policy).
If you have become disabled due to sickness or injury you should immediately determine if you have a long term disability policy. A large majority of employers offer their employees this insurance as one of the standard employee benefits. Most employees never expect to become disabled, and even forget they have this employee benefit. Unfortunately, the U.S. Census Bureau estimates that one out of five of us will become disabled (at least temporarily).
Ten (10) Things for Employees to Know About ERISA Disability Insurance Benefits
Long Term Disability Insurance Denials and the Importance of the Appeal
If you have become disabled you should immediately apply for this insurance. When completing the claim forms, be sure you are diligent in the information you provide to your insurer. Attach supporting documentation so as not to allow the insurance company an easy denial.
If you have submitted a claim and been denied-the next steps are critical. It is important that you retain an attorney almost immediately after a denial. This is because you will have strict deadlines on appealing the decision. You will also want to preserve your right to sue (and not submitting a timely claim can sometimes cutoff your legal remedies). Many people lose their benefits at this step because they don't do everything needed to prove their benefits.
In addition, the appeal is your opportunity to put in your claim file all the evidence you have to show a judge that the insurer acted in bad faith by denying you. Failure to properly submit evidence can lead to denials and cutoff certain evidentiary rights you have during any later lawsuit.
Likewise, before you sue, you will want to "exhaust your administrative remedies." While not always a bar to bringing a lawsuit, the law that governs an employee's disability benefits often requires you go through this appeal process as a good faith attempt to settle your dispute out of court. If the insurer has simply made a mistake, this is the time to point it out, not just file a lawsuit.
What Law Covers My Long Term Disability Insurance?
If your disability insurance comes from your private employer, it is almost always governed by the Employee Retirement Income Security Act of 1974, better known as "ERISA." One of the most convoluted and difficult areas of the law, this federal legislation is designed to protect the pension and other employee benefits of the American workers. Debate is out on whether it succeeds in its mission, but the fact remains you will need to file a federal lawsuit. This is because ERISA allows insurance companies to interpret plan terms and sets forth a difficult burden shifting standard, however, if successful, you are entitled to make a claim for your attorney's legal fees.
Should you need to file a claim against the insurance company that denied your employee benefits, you want to make a federal claim for violation of ERISA Section 502(a)(1)(B) (a claim for benefits due under the terms of the plan), and often a claim for violation of ERISA Section 502(a)(3) (breach of fiduciary duty). At Feldman Morgado we have attorneys that have spent years litigating under ERISA. Our firm can help you in seeking a denial of your employee benefits.