To prevail in a long term disability claim dispute, one of the first things to identify is the law that will govern your disability insurance appeal. There is a great difference between appealing a disability claim that is under group coverage, as opposed to individual, or private coverage.
Our video talks about ERISA law. The acronym ERISA stands for the Employee Retirement Income Security Act and is the federal law that governs group disability insurance plans. Group coverage is typically provided by your employer, or in some cases through professional associations and trade groups.
Group LTD coverage is a “one size fits all” form of insurance.
Group disability plans have to cover many individuals of varying ages and health. Therefore, group plans limit the way disability is defined, restrict the percentage of salary you can collect per month, and impose a stringent process to be followed, called the administrative appeal, if your claim is denied. As the video explains, a group disability insurance appeal must adhere to the insurance company’s rigid guidelines and time frames.
Be prepared for an insurance company to do all it can to delay and deny the claim. What happens if you appeal and the insurer still denies benefits? Only after you exhaust the insurance company’s appeals process, are you allowed to file a lawsuit.
Meanwhile, rigid ERISA laws govern ensuing litigation. The process is very limiting for you, the insured, and more lenient towards the insurer. You are not able to engage in discovery or add new information or evidence to support your claim. The final case is reviewed and decided in federal court by a judge with no jury.
At this stage of the game in a group LTD claim, if you prevail, the best you can expect to recover in a lawsuit are the benefits you are waiting to receive. You are not allowed to seek compensatory and punitive damages.
A private, or individual disability insurance appeal differs greatly.
In contrast, individual disability insurance offers versatile income protection and flexibility of coverage. The policyholder pays the premiums. Accordingly, it is more expensive. Purchased directly through an agent, these policies are written to meet your individual needs and customized through policy add-ons called riders.
For example, you decide how “disability” is defined in your policy, and you have options for the percentage of salary you can collect each month. You can even make the policy portable, and take it with you if you change jobs.
If your claim is denied by the insurance company, the laws protecting you are fair, not confining. Breach of contract law, bad faith insurance laws, and other legal options govern private disability insurance claim denials. When disputes cannot be resolved, and your insurance carrier still denies benefits, you may bring a lawsuit swiftly and are entitled to a jury trial. You may also engage in evidence and discovery, as well as seek compensatory and punitive damages depending on your state’s laws.
Your Best Bet for Any Disability Insurance Appeal
Appealing a disability claim denial can be tough, especially for someone already struggling with physical or mental impairments. Our disability attorneys work closely with our clients in ways that many law firms do not. See how we make it easy through skilled and compassionate representation.