When you’re a worker suffering from long-term illnesses, you may rely on long-term disability insurance (LTD) to provide financial compensation. Many workers would struggle to manage their finances without long-term disability insurance.
When you receive a denial of your disability claim from the insurance company, it can feel devastating. If the insurance company has wrongfully denied your long-term disability benefits, the Houston long-term disability lawyers at ERISA Insurance Claim Attorneys can help.
We have over 30 years of legal experience. Call us today to learn how our Houston insurance claims lawyer can help you.
How Workers Can Benefit from Having Long-Term Disability Insurance
Long-term disability insurance is part of an employee’s benefits package. This type of insurance can provide workers with financial benefits when they are unable to work due to an injury or illness. Depending on the policy’s terms and conditions, long-term disability insurance can provide benefits to workers until retirement age.
While workers take time off to recuperate from long-term illnesses or injuries, they can receive between 50% and 70% of their wages through long-term disability insurance. This is especially beneficial for workers in physically demanding or dangerous occupations.
For a free legal consultation with a long-term disability lawyer serving Houston, call (225) 201-8311
Medical Conditions That Long-Term Disability Insurance Covers
Every long-term disability insurance policy defines a disability differently. However, policies will generally accept most medical conditions that seriously affect a person’s ability to work, as long-term disability insurance typically covers these conditions.
Some examples of medical conditions that can qualify for long-term disability benefits include:
- Asthma
- Disorders of the spine
- Multiple sclerosis
- Traumatic brain injury
- Alzheimer’s or other Dementia
- Heart disease
- Depression / Anxiety
- Cardiovascular disease
- Cancer and related treatment
- Bipolar disorder
- Hearing loss
- Chronic Fatigue Syndrome
- Carpal tunnel syndrome
- Knee injuries
- Post-traumatic stress disorder
- Sleep disorders
- Loss of speech
- Eye disorders
At ERISA Insurance Claim Attorneys, our Houston long-term disability attorneys can fight for the employee benefits you worked for and guide you through the claim process.
Houston Long-Term Disability Lawyer Near Me (225) 201-8311
Long-Term Disability Insurance Features
While each insurance policy varies, each long-term disability insurance policy contains:
- Monthly benefits: The average long-term disability policy allows workers to receive at least 60% of their gross income in benefits.
- Elimination period: The elimination period refers to the time the worker must wait before they can receive their benefits. It begins on the day the worker first becomes sick or injured and continues for as long as the worker chooses. Most long-term disability insurance plans have an elimination period from 90 days to two years.
- Disability definition: The long-term disability policy also outlines what the insurance company considers a “disability.”
- Coverage options: The policyholder has the flexibility to determine the duration of coverage. Some plans offer coverage for periods ranging from one year to five years, and even lifelong coverage.
- Reporting: All LTD policies contain special instructions on how policyholders can file claims.
Our long-term disability lawyers in Houston know how to calculate disability benefits and can help you through the claims process.
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Our Houston Attorneys Can Explain the Various Definitions of Disability in LTD Policies
Regarding the policy’s definition of disability, some long-term disability policies contain either own-occupation or any-occupation provisions. Own-occupation policies provide coverage to workers who are unable to perform the job duties associated with their specific occupation.
Any-occupation policies, on the other hand, are a type of policy that only benefits workers when the insurance company has determined that they are unable to work in any occupation. The key difference between the two policies is how the term “total disability” is defined.
For example, own-occupation policies consider a “total disability” as a disability that prevents the worker from performing all duties related to the policyholder’s occupation.
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Filing a Long-Term Disability Claim
While each long-term disability policy varies, long-term disability claims typically begin when a claimant completes an application online, over the phone, or in person.
When filling out an application, claimants must provide credible medical documents explaining the claimant’s injury and the limitations associated with the injury.
After the insurance company receives the claim, it may request the claimant to undergo an independent medical examination.
What Is an Independent Medical Examination?
An independent medical examination is a medical assessment that insurance companies may require a claimant to undergo regarding a long-term disability policy.
During a medical examination, the physician does not perform any medical treatment on the claimant. Instead, the physician asks the claimant questions about their disability and medical history.
Many claimants do not want an independent medical examination performed for justifiable reasons; however, the insurance company has the right to deny your long-term disability claim if you refuse an independent medical examination.
Therefore, it is better to attend the independent medical examination and dispute any questionable results later than to refuse to participate altogether.
How to Act During the Independent Medical Examination
While attending an independent medical examination, the doctor and their staff will monitor you from the second you step into the office. Answer the physician’s question as honestly as possible without volunteering additional information they didn’t ask for.
This includes information outside of your medical history, such as the dynamics of your workplace. If possible, take as many notes as you can during the medical examination. Take particular note of the questions that the physician asks you.
What Happens When Your Long-Term Disability Claim Is Denied?
Receiving a denial of your long-term disability claim can be traumatic. You risk your family’s financial security. When you receive a denial letter from the insurance company, you still have several legal rights that you can exercise to obtain your long-term disability benefits.
Why Should You Consider Filing for an Appeal?
Despite what the situation may appear to be, you have nothing to lose when you pursue your long-term disability rights. Suppose you have followed the correct procedures and truly qualify to receive benefits.
In that case, there is no justifiable reason why you should receive a denial of benefits, nor should you accept it. The appeal process you will have to follow depends on the type of long-term disability insurance you purchased.
If your long-term disability insurance is through a private insurance group, you can follow the state laws in pursuing your disability benefits. If you purchased your long-term disability insurance through your employer, you must follow the federal ERISA laws.
What Is ERISA?
The Employee Retirement Income Security Act (ERISA) is a federal law that allows certain federal protections to employees and their benefit plans. Through ERISA, employees have the right to hold plan administrators accountable for any abuse or wrongdoing related to their benefits packages.
Suppose that any inappropriate actions with a benefit plan result in a significant loss for the employee. In that case, the employee can hold the plan administrator liable for restoring that loss.
How Does ERISA Affect Your Long-Term Disability Policy?
When you purchase your long-term disability policy through your employer, ERISA automatically covers your insurance policy. That means you must follow the ERISA appeal process when filing an appeal for your claim.
Just like retirement and life insurance policies, disability insurance policies are part of the benefit packages covered under ERISA.
ERISA Guidelines When Filing an Appeal
During an ERISA appeal, claimants must respond to the insurance company’s decision with an administrative appeal. The claimant has 180 days to submit an administrative appeal, along with an administrative record that includes all new additional evidence.
The claimant must submit the following documents to the insurance company within the designated timeframe; failure to do so will result in the permanent loss of the opportunity to appeal.
If the claimant still receives a denial after filing their administrative appeal, they can file a lawsuit against the insurance company in federal court. Our Houston LTD attorneys understand the regulations governing benefit claims and advocate for disability claimants.
Filing a Federal Lawsuit
Before filing a federal lawsuit against the insurance company, the claimant must undergo the administrative appeal process. After exhausting that option, can the claimant hold the insurance company liable in federal court?
The federal lawsuit will not proceed in the same manner as a traditional lawsuit. Instead of presenting your case to a jury trial and introducing new evidence to the court, a federal judge will evaluate your case.
The judge will look at all of the evidence presented in your administrative record, such as your medical records, and decide based on that evidence.
How Our Houston Long-Term Disability Lawyer Can Help
Going up against a conglomerate like an insurance company can seem intimidating. Even when you know that the insurance company committed a violation against you, figuring out how to prove that in a court of law can overwhelm you.
At ERISA Insurance Claim Attorneys, our long-term disability lawyers in Houston have experience with designing successful strategies against insurance companies. We are knowledgeable in the areas of ERISA laws and the appeals process. Our long-term disability lawyers can assist your case in several ways.
Prepare Your Appeal
Missing deadlines is one common reason why claimants fail to overturn their denials. Our long-term disability lawyers know the tight deadlines you must meet and can organize your case for the claims process.
Hold the Insurance Company Accountable for Abiding by the Terms of Your Policy
While constructing your administrative record, your long-term disability lawyer can review the terms and conditions of your insurance policy and determine how the insurance company failed to abide by the regulations in the policy.
An experienced long-term disability lawyer is familiar with the technical language of insurance policies and can accurately interpret the meaning of those terms.
Our experienced attorneys can also use examples of how insurance companies have abused their discretion by failing to comply with the policy terms.
Address Unfair Evidence Collection
From the moment you file your long-term disability claim, the insurance company will search for ways to deny your claim. They often resort to tactics you may not suspect, such as searching your social media accounts, taking video surveillance of you outside, and engaging in physical activities.
Our experienced long-term disability lawyer can help you through the insurance company’s process by advising you on how to proceed after seeking legal counsel.
Gather Evidence for Your Administrative Record
Your long-term disability lawyer can gather the appropriate evidence to present in your administrative record. The insurance company will review that during your appeal. You may use the same evidence in a federal lawsuit.
Our experienced long-term disability lawyer in Houston can gather medical evidence that demonstrates why a court should overturn the denial of your initial disability benefits application.
Let Our Houston Long-Term Disability Lawyer Help
Being denied disability benefits can seem overwhelming. Let the long-term disability lawyers at ERISA Insurance Claim Attorneys alleviate that stress by providing personalized legal representation.
You deserve compensation when suffering from a long-term disability, especially when you have coverage through your employer. Our lead attorney, Price McNamara, leverages his extensive experience in insurance to advocate for injured and disabled individuals in claims against insurance companies.
Call our law firm for your free denial review with a Houston long-term disability lawyer today.
Call or text (225) 201-8311 or complete a Free Case Evaluation form
