ERISA preempted long term disability insurance, Social Security Disability or Veterans Disability Compensation are the most common benefits available to help disabled workers. The legal standard of review is the criteria the courts look to in deciding whether to uphold or reverse the rulings of a lower court or in the case of most disability claims, the findings of an administrative proceeding. This post will explore the legal standard that the disabled worker must meet to prove their claim in court if they are denied during their administrative appeal.
Category: ERISA Disability Claims
Long Term Disability Insurance – The Definition of Disability
Long Term Disability (LTD) insurance companies are notorious for denying legitimate claims based on obscure disability definitions contained in the policy. There is no one legal definition of disability. Every insurance company, the Social Security Administration and the Veterans Administration all have different definitions.
Long Term Disability Insurance – What Did I Pay For?
Most People think that their long term disability insurance policy will replace their income if they are disabled. Most people are shocked to find how the insurance company has structured its policy to minimize the amount it has to pay to a disabled policyholder.
Disability Policies-Mental Health & Subjective Symptom Limitations
Most long term disability insurance companies try to limit benefits to the disabled by writing policies that have a mental health limitation. Usually mental health disability benefits are limited to only a short period of time, typically only 12 to 24 months. This means that benefits for mental health conditions such as depression, anxiety or bipolar disorder will only be paid for a limited time period. Many claimants develop depression secondary to chronic pain. The insurance company will try to classify the claimant’s impairment as mental, so that benefits will be paid for only 24 months. The insurance company may also try to classify a cognitive problem or side effects from narcotic pain medications as a mental impairment. Therefore it is very important to make sure the insurance carrier does not mischaracterize a claimant’s lifetime physical disability as mental.
Disability Insurance Policies – What type Do You Have?
The long term disability policy is the contract between a claimant’s employer and the insurance company. The language and provisions in the contract varies from policy to policy, so it is essential that a claimant get a copy of the policy from Human Resources.
Short Term Disability benefits (“STD”) are paid for a limited amount of time, anywhere from one week to six months, depending on your policy. Generally, STD is sometimes paid for by your employer and is usually 100% of your salary. Because STD is usually paid by the employer and is for a limited amount of time, it can be easier to get approved for STD than LTD.
What is ERISA and How Does it Apply to My Long Term Disability Claim?
What is ERISA and how does it apply to my long term disability insurance claim? ERISA stands for the Employee Retirement Income Security Act of 1974. ERISA is a federal law that regulates the handling of Employee Benefit Plans and the remedies of the beneficiaries of these Plans. ERISA applies to all employees benefit plans established or maintained by an employer engaged in commerce or by an employee organization representing employees engaged in commerce. Practically all long term disability plans offered by a private employer are governed by ERISA. A claimant challenging a disability denial under an ERISA governed plan or policy must bring the claim pursuant to ERISA regulations and procedures. All state law remedies are preempted, meaning they do not apply to an ERISA claim.