San Antonio, Texas Long-Term Disability Attorney

A long-term disability claim under an ERISA policy in San Antonio, is a request for benefits by an employee who is unable to work for an extended period of time due to a serious injury or illness. ERISA (Employee Retirement Income Security Act) governs these claims, requiring the employer’s disability insurance plan to provide financial support if the employee meets the policy’s definition of disability and other requirements.

At J. Price McNamara ERISA Insurance Claim Attorney, our team can aggressively fight for the benefits and compensation you deserve by negotiating with the insurance company on your behalf or pursuing litigation, if necessary.

For a free case evaluation and legal consultation with a skilled San Antonio, long-term disability attorney, please contact us online right away.

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Why Should We Represent You?

Insurance companies routinely do everything possible to deny or significantly undervalue a long-term disability claim under an ERISA policy. At J. Price McNamara ERISA Insurance Claim Attorney, we are not afraid to take on the insurance company directly and challenge an adverse claim decision. Moreover, we are fully prepared to litigate your case in the court system on your behalf if necessary. You can see our most recent client testimonials if you visit us online.

How Much is a Long-Term Disability Claim Worth in San Antonio?

The value of a long-term disability (LTD) claim under an ERISA plan in San Antonio, depends on several factors, including your salary before becoming disabled, the terms of your policy, and how long you’re expected to be unable to work. ERISA (Employee Retirement Income Security Act of 1974) governs most employer-sponsored disability plans, and it sets specific rules for how claims are handled.

When you file a long-term disability claim, the amount you can receive is usually a percentage of your pre-disability income. This percentage is typically between 50 and 70 percent, depending on your specific plan. For instance, if you were earning $5,000 a month before becoming disabled, and your policy pays 60 percent of your salary, your monthly LTD benefit will be $3,000.

However, there are often caps on how much you can receive. For example, your policy may limit your monthly benefit to $5,000 or $10,000, no matter how much you were earning before your disability occurred. It’s important to check your specific policy details to know exactly what to expect.

In addition to the basic benefit, some ERISA plans may offer additional compensation. For example, your plan may include cost-of-living adjustments (COLAs), which increase your benefit amount over time to keep up with inflation. Another compensation may include coverage for rehabilitation programs to help you return to work. Some plans may also offer partial disability benefits if you can work part-time but not full-time.

When dealing with an ERISA plan, it’s important to understand that insurance companies often try to minimize the amount they pay out. They may challenge your claim, require extensive proof of disability, or periodically re-evaluate your condition to see if you still qualify for benefits.

If your claim is denied or you believe the amount you’re receiving is unfair, you have the right to appeal the decision. In these cases, having J. Price McNamara ERISA Insurance Claim Attorney on your side can be extremely helpful. Our team can handle the legal rules for you and ensure that you receive the full benefits you’re entitled to recover.

Types of Occurrences that Can Lead to a Long-Term Disability Claim in San Antonio

Many types of occurrences can lead to a long-term disability (LTD) claim under an ERISA policy in San Antonio, Texas. ERISA, or the Employee Retirement Income Security Act, governs most employer-sponsored disability plans, and it provides a safety net for employees who become unable to work due to a long-term injury or illness.

One of the most common reasons for filing a long-term disability claim is due to serious injuries. These can result from car crashes, slips and falls, or workplace injuries. Suppose the injuries cause a significant impairment, such as a spinal cord injury, traumatic brain injury, or loss of mobility. In that case, an individual may be unable to perform their job and may file a long-term disability claim.

Chronic illnesses are another major cause of long-term disability claims. Conditions like cancer, heart disease, or multiple sclerosis often prevent people from continuing to work, especially as these illnesses progress. If treatments, surgeries, or symptoms of the illness interfere with an individual’s ability to carry out the duties of their job, they may be eligible to receive long-term disability benefits.

Mental health conditions can also lead to LTD claims under an ERISA policy. Severe cases of depression, anxiety, or post-traumatic stress disorder (PTSD) can be debilitating, making it impossible for a person to function in the workplace. While mental health claims can be more challenging to prove, they are valid reasons for filing an LTD claim, particularly if the condition is well-documented and treated by medical professionals.

Degenerative conditions, like arthritis or degenerative disc disease, are also common causes of long-term disability. Over time, these conditions can worsen, making it painful or even physically impossible for someone to continue working in the same capacity. Even if the condition is not the result of a sudden accident, it can still be grounds for a long-term disability claim if it prevents someone from maintaining employment.

Finally, complications from surgeries, strokes, or other medical conditions that lead to extended recovery times may also lead to LTD claims.

How to Successfully Prove a San Antonio, Long-Term Disability Claim

Proving the legal elements of a long-term disability (LTD) claim under an ERISA plan in San Antonio, requires careful documentation and a clear understanding of the policy’s terms. To successfully win your claim, you need to show that you meet the specific criteria for receiving benefits. Here are the key elements you’ll need to establish:

• You have a qualifying disability – The most important part of your LTD claim is proving that you have a disability that prevents you from working. You must demonstrate that your medical condition meets the definition of “disability” in your ERISA plan. This typically means you cannot perform your job duties, either due to a physical injury, illness, or mental health condition. Medical evidence, such as doctor’s reports, test results, and treatment records, is essential to establish your disability. Your doctor should provide detailed notes on how your condition affects your ability to work.
• Your disability is expected to last long-term – A key difference between short-term and long-term disability claims is the expected duration of your condition. To qualify for LTD benefits, you must prove that your disability will last for an extended period – usually longer than six months. You must provide evidence that your condition is not expected to improve quickly. Medical records, prognosis statements, and ongoing treatment plans from your healthcare providers will help to support this.
• You are under regular medical care – Your ERISA plan may require that you are under continuous medical care to receive LTD benefits. This means you need to show that you are regularly seeing a doctor and following a prescribed treatment plan. Missing doctor appointments or not adhering to medical advice can hurt your case. Your treatment plan and ongoing progress reports will be used to prove you are actively managing your condition.
• You meet the policy’s other terms – Each ERISA plan has its own specific rules for what qualifies someone for LTD benefits. You must carefully review your plan to ensure that you meet all of the requirements. This can include being employed when the disability occurred, waiting through an “elimination period” before benefits begin, or filing your claim within a certain timeframe.

Fighting the Insurance Company in a San Antonio, Texas Long-Term Disability Claim

Fighting the insurance company in a long-term disability (LTD) claim under an ERISA policy in San Antonio, can be a complex process. Insurance companies often try to deny or reduce claims. Still, with the right approach, our experienced lawyers at J. Price McNamara ERISA Insurance Claim Attorney can stand up to them and fight for the benefits you deserve.

• Gathering strong medical evidence – One of the most important steps in fighting an insurance company is providing strong medical evidence that clearly shows your disability. We will work with your doctors to gather detailed reports, medical tests, treatment records, and statements demonstrating how your condition prevents you from working. Insurance companies often look for any reason to claim you’re not disabled, so we make sure your medical evidence is thorough and up-to-date.
• Understanding policy terms – ERISA policies have specific terms and conditions that must be met in order to qualify for benefits. We carefully review your policy to fully understand what is required. This includes understanding the definition of “disability” in your policy and ensuring you meet all the requirements. By having a deep understanding of the terms, we can challenge the insurance company’s interpretation and make sure they don’t unfairly deny your claim.
• Dealing with insurance company tactics – Insurance companies often use tactics to avoid paying out LTD claims. They may ask for repeated medical reviews or send you to their own doctors to find reasons to deny your claim. We know how to counter these tactics. If the insurance company tries to use biased doctors or improper methods, we’ll challenge their findings and ensure that your case is evaluated fairly.
• Filing appeals – If your LTD claim is denied, you can appeal the decision. We handle the entire appeals process for you, ensuring all paperwork is submitted correctly and on time. We’ll also present a strong case with additional evidence and legal arguments to challenge the denial.
• Taking legal action – If the insurance company still refuses to approve your disability claim, we can file a lawsuit under ERISA in federal court. Our team will represent you and fight to get you the benefits you’re entitled to recover under the law.

Successfully Litigating a Long-Term Disability Claim in San Antonio

Litigating a long-term disability (LTD) claim under an ERISA policy in San Antonio, involves a series of legal steps designed to resolve disputes over denied or underpaid disability benefits. Here’s an overview of what happens during this process:

• Initial Review and Filing – When you decide to litigate an LTD claim, the first step is to review the denial letter from the insurance company. This letter will detail why your claim was denied or why benefits were reduced. At J. Price McNamara ERISA Insurance Claim Attorney, we will carefully analyze these reasons to understand the basis for the dispute, gather and organize all relevant medical and employment records, and file a formal complaint in federal court on your behalf. This complaint outlines your claim and the legal reasons you believe the insurance company is in the wrong.
• Discovery Phase – Once the complaint is filed, the discovery phase begins. This is where both sides exchange information relevant to the case. The insurance company may request additional documentation, such as medical records or employment history, which we can provide. This phase can also involve depositions, where witnesses or experts provide sworn testimony about the case. Discovery is vital for building a strong case, as it helps both parties gather evidence and understand the facts.
• Summary Judgment – If the case does not settle, the case may proceed to summary judgment. During this stage, the lawyers typically submit briefs to the presiding judge, in which they make legal arguments and summarize the evidence. Upon reviewing the briefs and the administrative record (which includes all medical records and other pertinent documentation), the judge will determine if the insurance company denied or undervalued your claim in error.
• Decision – If the judge decides the case in your favor, then you may receive the long-term disability benefits to which you are entitled. 

Call an Experienced San Antonio, Texas Long-Term Disability Attorney Today

At J. Price McNamara ERISA Insurance Claim Attorney, our team of lawyers will aggressively fight for the benefits you deserve as part of your long-term disability claim. For a free case evaluation and legal consultation with a skilled Texas ERISA lawyer, please call us at (713) 300-0462.