As our video explains, a wrongly denied individual disability income claim is not fettered by federal ERISA law. If your disability insurance policy is one you bought and paid for yourself, things are much more in your favor. You have many more legal remedies available to you when there is a dispute.
Also referred to as individual disability insurance (IDI), disability income protection and private disability insurance, these policies are not part of an employee benefits package. They are purchased independently from an insurance broker by self-employed professionals such as doctors, dentists, architects, executives – any lucrative profession where an employer or professional association does not provide group disability coverage.
An employee under a group plan may also purchase a private disability policy as supplemental coverage for added income protection.
Individual Disability Income Claims vs. Group LTD Claims
Private disability insurance claim disputes are handled quite differently than group claims. Individual policies are regulated by your state’s insurance contract laws, tort laws and consumer protection laws – all of which are much more beneficial and supportive for claimants than ERISA law.
In stark contrast to group long term disability plans, individual policies have nothing to do with groups of employees, and everything to do with protecting you exclusively.
Private policies offer much more versatility in the coverage you receive because they are written to meet your specific circumstances. You supplement your policy by adding specific riders (options) such as portability, occupation-specific (own-occupation) coverage, or cost of living protection. As a result of the customized coverage, IDI policies have higher premiums than group plans.
Under ERISA law the opposite is true. Group disability plans typically define disability in the context of being unable to perform any occupation, with general and even vague job descriptions, and other characteristics befitting a collective plan.
Here’s everything you need to know about how group and individual insurance plans differ.
You Have Better Options When Fighting Individual Disability Income Claim Denials
If your claim is wrongly denied, you have many legal remedies to bring into play which are not allowed under ERISA. Depending on the state of residence and terms of the policy, the protections and damages that are available to you in a dispute over a private disability claim include:
- You may appeal a claim denial to the insurance company at the administrative appeals level, or you may be able to fail a lawsuit as soon as your claim is denied.
- Your case is heard by a judge and jury in state court; decisions are based on a jury of your peers (as opposed to a federal judge reading your previously established case file).
- You may call on expert witnesses to authenticate your claim.
- You may introduce new, supporting evidence during the trial process.
You may be able to sue for
- Breach of Contract and Bad Faith Insurance Practices
- Deceptive Trade Practices Act Violations
- Insurance Code Violation claims
- Emotional distress
- Loss of credit
- Tortious interference with contract
- You may also sue to recover contractual compensatory damages and/or punitive damages
- Attorney fee reimbursement
Disability Insurance Attorneys Fighting for You
Whether your claim is under an individual LTD policy or a group plan, our law firm is here to help you fight back when the insurance company unfairly denies benefits.
Come to us with your questions. At Marc Whitehead & Associates law firm, your initial case evaluation is free and without obligation.