Disability Benefit Claims

ERISA Claims Overview

Employee Retirement Income Security Action of 1974 (ERISA) is a Federal Law which regulates the employee benefits, nationally. When you receive your disability insurance coverage through work, or you belong to a pension plan that has a disability benefit, you are most likely covered under an ERISA Plan.

When litigating an ERISA long-term disability case, the case must be filed and litigated in Federal court. ERISA litigation is an extremely specialized area of the law that requires specific expertise.

There are very few exceptions to ERISA’s application to group disability plans. The most common exception include plans offered by employers who are governmental entities (local, county, city, state or federal) and churches (religious organizations).

ERISA plans have a mandatory application and appeal process which must be followed before filing a lawsuit in Federal Court to recover disability benefits. You generally have 180 days to appeal an ERISA denial.

If you need assistance our office of experienced disability benefits lawyers is happy to help. You can call (615) 234-6000, toll free nationwide (844) LTD-CODY, or email cody@codyallison.com.

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Long-Term Disability Claims (Non-ERISA)

A non-ERISA claim is not subject to the strict ERISA fiduciary standards regarding exclusive benefits, but is subject to state law and other standards. If your long-term disability policy is not subject to ERISA, your claim will require a different course of action to appeal your disability denial.

If you buy an individual long-term disability insurance policy, ERISA likely does not apply.

If you need assistance our office of experienced disability benefits attorneys is happy to help. You can call (615) 234-6000, toll free nationwide (844) LTD-CODY, or email cody@codyallison.com.

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Own Occupation Vs. Any Occupation

First request a copy of your long-term disability policy (whether governed under ERISA, or state law). When requesting a copy of your long-term disability policy, do so in writing and send the letter to the insurance company by certified, return receipt mail. This will be proof that you requested the policy. Remember, it’s your policy and your entitled to a copy. In fact, ERISA requires the insurance company to send you a copy.

Most ERISA insurance policies have disability definitions for the individual’s own occupation for a period of time then the definition changes to any occupation. When reviewing your long-term disability policy, look for an own occupation provision and any occupation provision. Policies with an own occupation provision usually pay for a certain period of time if the individual is found to be disabled from their own occupation (what they were doing at the time their disability began and they stopped working). Any occupation claims only pay if you are not able to make a certain percent of your pre-disability income at an occupation other than your own, for which you are reasonably required.

Unfortunately, the insurance industry does not regulate the various terms used in long-term disability policies. One carrier’s definition of an own occupation is not necessarily the same as that of another carrier. Therefore, it is very important to know your long-term disability policy definitions. If you need assistance in reviewing your policy, you can call (615) 234-6000, toll free nationwide (844) LTD-CODY, or email cody@codyallison.com.

If the insurance carrier finds you disabled and pays you benefits for your own occupation, after a certain period of time, the definition changes to any occupation. This means after your own occupation period is over you must now qualify for disability under the any occupation definition in your policy. Many people are denied any further disability benefits after their own occupation period has expired. If the insurance company feels that you can work in any occupation based on your condition (disability), education, training, and experience, they will deny any future benefits and send a denial letter telling you that you have a right to appeal and that you will not receive any more long-term disability benefits. At that point, as far as the insurance company is concerned, they have reviewed your medical records, and determined that you can work.

If you need assistance our office of experienced ERISA and NON-ERISA disability lawyers is happy to help. You can call (615) 234-6000, toll free nationwide (844) LTD-CODY, or email cody@codyallison.com.

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Common Health Conditions Connected with LTD Claims

Bipolar Disorder

Diabetes

Chronic Fatigue Syndrome

COPD

Chronic Pain

Crohn’s Disease

Failed Back Syndrome

Fibromyalgia

Lyme Disease

Lupus

Migraines

Mental Disorders

Reflex Sympathetic Dystrophy (RSD)

Vertigo

Meniere’s Disease

Multiple Sclerosis (MS)

Irritable Bowel Syndrome (IBS)

Macular Degeneration

Arthritis, Osteoarthritis, Rheumatoid Arthritis, Psoriatic Arthritis

Seizures (All Kinds)

Side effects from prescription medications

Spinal Stimulator/Mophine Pump Implant

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