Long-term disability insurance protects you if you become disabled and can no longer work. At least, in theory.<\/p>\n
In practice, many people find that when they go to use their disability insurance, their claim gets denied<\/a>. That\u2019s when it\u2019s time to discuss your legal options. The next steps, however, depend on the type of insurance you have.<\/p>\n Both types offer similar kinds of coverage. However, there can be significant differences in how they work\u2014especially if you need to dispute a claim you believe is wrongfully denied. Here\u2019s what you need to know.<\/p>\n \u201cERISA\u201d stands for the Employee Retirement Income Security Act<\/a> of 1974, the federal law that governs employee benefits.<\/p>\n Among many other things, ERISA spells out the specific requirements that employers and insurance companies have to follow to protect employees in the plan. That includes a detailed legal framework for resolving disputes when an insurance company denies a claim. Since ERISA is a federal law, those rules apply to ERISA-covered disability insurance in every state.<\/p>\n If you filed a claim you believe was wrongfully denied, ERISA lays out an appeal process that you and your insurer have to follow. Through each step of the process, the insurer is required to provide precise information and ensure you receive a full and fair review. If you can’t reach an agreement, you and your attorney can attempt to overturn the denial in federal court in order to receive your benefits.<\/p>\n Getting coverage through your employer is not the only way to get long-term disability insurance. You can also buy an individual policy directly from an insurance company like you would purchase life or auto insurance.<\/p>\n If you purchased long-term disability insurance yourself, your policy is not<\/em> governed by ERISA. That doesn\u2019t mean you have no recourse if your claim is wrongfully denied.<\/p><\/blockquote>\n If you purchased long-term disability insurance yourself, your policy is not<\/em> governed by ERISA.<\/strong> That doesn\u2019t mean you have no recourse if your claim is wrongfully denied. You still have the right to appeal that decision. However, because ERISA does not govern individual policies, the appeal process is covered by state laws, which can differ from state to state.<\/p>\n In some cases, individual policies give you more options to resolve a dispute. With ERISA plans, every dispute must follow the same rigid rules. You do have the right to sue in federal court, but it can take a long time to get a denial overturned and receive your benefits.<\/p>\n If you have an individually purchased policy and the insurer denies your claim, you may be able to sue in state court immediately. Under many states\u2019 laws, if the insurer wrongfully denied your claim, you may also be eligible for punitive damages.<\/p>\n Whether you have ERISA or Individual Disability Insurance, you likely have one of three basic types of coverage:<\/p>\n This type of insurance provides benefits if you become unable to perform your current job<\/em>. You might be able to work another job, but you are still entitled to benefits if you have a disabling condition that prevents you from performing the functions of your \u201cown occupation.\u201d<\/p>\n This type of insurance provides benefits only if you cannot perform any\u00a0job<\/em>. Sometimes, this type of insurance contains an income qualifier that protects your level of income if you become disabled. You may still be able to work. However, if the job you have now doesn\u2019t pay as much as your pre-disability income (usually at least 60-80 percent), you\u2019re entitled to benefits.<\/p>\n Most disability insurance is a combination of both own and any occupation coverage. This means it may cover your ability to work your own occupation for the first 24 months of disability. After that, it will only pay if you are unable to work in any<\/i> occupation.<\/p>\n Read more: <\/em>Own Occupation vs. Any Occupation<\/em><\/a><\/p>\n If your disability claim has been wrongfully denied, you have a right to appeal that decision and receive the benefits that are rightfully yours. This is true no matter what type of insurance policy you have. However, the laws and regulations governing appeals are incredibly complicated. If you make an error or miss an important deadline, you might not have a chance to fix that mistake.<\/p>\n Whether you have ERISA or Individual Disability Insurance, you should speak with a legal advisor specializing in disability insurance law. Working with an experienced disability attorney<\/a> who knows this complex area of law inside and out is one of the best decisions you can make.<\/p>\n Has your disability claim been wrongfully denied? Feel free to\u00a0contact us directly with your questions!<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":" Long-term disability insurance protects you if you become disabled and can no longer work. At least, in theory. In practice, many people find that when they go to use their disability insurance, their claim gets denied. That\u2019s when it\u2019s time to discuss your legal options. The next steps, however, depend on the type of insurance read more<\/a><\/p>\n","protected":false},"author":4,"featured_media":6049,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[248],"tags":[252,6,224,251,93],"acf":[],"yoast_head":"\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\n\t\n\n\n\nThere are two basic types of long-term disability insurance:<\/h3>\n
\n
What is ERISA?<\/h2>\n
What is Individual Disability Insurance?<\/h2>\n
The three types of disability coverage<\/h2>\n
Own Occupation<\/h3>\n
Any Occupation<\/h3>\n
Own and Any Occupation<\/h3>\n
What should you do if your claim has been wrongfully denied?<\/h2>\n