There are two types of long-term disability insurance: individual plans and ERISA. Employer-provided plans are governed by the Employee Retirement Income Security Act or ERISA. ERISA plans most often define disability as being unable to perform any job. On the other hand, some group plans define disability as being unable to do your job. Usually, the definition changes to “any job” after two years. The insurance company is essentially trying to terminate benefits. Terminations can be appealed, and the employee needs a Long Term Disability Attorney to help.
Restrictions on Benefits
ERISA and individual plans have restrictions on what they cover. There is often a limit on how long people with certain conditions receive benefits. These conditions include mental or nervous disorders and substance abuse issues. The insurer sells policies without restrictions at a higher premium.
Long-term disability insurance substitutes for a paycheck when one is disabled. However, ERISA and individual policies pay less than the regular paycheck. Further, there is a cap on the monthly benefits.
The Disability Claim Is Denied
A Long Term Disability Attorney steps in when claims are denied. Claims are often denied for insufficient medical evidence. The claimant must be making regular visits to a physician that are documented. Likewise, if the claim is based on a psychiatric condition, the claimant should be seeing a therapist monthly. Additionally, the claim may be denied because the insurer has incomplete medicals. The attorney will try to get the treating physician to write a letter attesting to the claimant’s disability. This is the best tool to use.
It’s not unusual for the insurer to put the claimant under surveillance. They want to obtain video proof that the individual is not disabled. If this occurs, benefits may be terminated. Lawyers are required to ask for an administrative review of an ERISA claim before a lawsuit is filed.
The Appeals Process
Claimants with individual policies may sue in state court for breach of contract, negligence, and bad faith. Further, these claimants have the right to a jury trial. ERISA claimants must file their lawsuit in federal court. The case will be heard by a judge because a jury trial is not allowed. For more information, visit chrisrichardattorney.com.
