You can get help from a San Antonio long-term disability lawyer if you need help applying for benefits or appealing a denial of your claim. Our team at ERISA Insurance Claim Attorneys can step in to help today; we have been assisting people in your situation for over 30 years.
Our San Antonio insurance claims lawyer can aggressively fight for the benefits you deserve by negotiating with the insurance company on your behalf or pursuing litigation, if necessary. For a free case evaluation and legal consultation, please contact us online right away.
Why Hire a Long-Term Disability Lawyer in San Antonio?
Insurance companies routinely do everything possible to deny or significantly undervalue a long-term disability claim under an ERISA policy.
Having a lawyer on your side means you’ll have someone putting you first and leveling the playing field, improving the odds that you’ll get the benefits you need.
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.
We Understand ERISA Long-Term Disability Claims
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.
The Employee Retirement Income Security Act (ERISA) 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.
We can answer any questions you have about these claims and the benefits they offer. We can also help you determine if you qualify for ERISA long-term disability insurance.
We Understand Claim Denials
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 the insurance company denies your claim or you believe the amount you’re receiving is unfair, you have the right to appeal the decision. In these cases, having us 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.
You can take charge now with help from a long-term disability lawyer in San Antonio.
For a free legal consultation with a long-term disability lawyer serving San Antonio, call (225) 201-8311
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’ll be unable to work. ERISA governs most employer-sponsored disability plans, and it sets specific rules for how companies handle these claims.
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%, depending on your specific plan.
For instance, if you were earning $5,000 a month before becoming disabled, and your policy pays 60% of your salary, your monthly LTD benefit will be $3,000. You can use our long-term disability payout calculator to learn more about your possible benefits.
ERISA Plans Can Cap Your Benefits
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, regardless of your pre-disability earnings. It’s important to check your specific policy details to know exactly what to expect.
You May Receive Additional Compensation
Your policy 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.
Additionally, in some cases, you may qualify for benefits from additional sources. For example, some of our clients receive further funds through the Social Security Administration’s (SSA) Supplemental Security Income (SSI) program.
Your Benefits Can Adjust for Inflation
Some ERISA plans may include cost-of-living adjustments (COLAs), which increase your benefit amount over time to keep up with inflation.
San Antonio Long-Term Disability Lawyer Near Me (225) 201-8311
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, we must demonstrate that you meet the specific criteria for receiving benefits.
Here are the key elements a San Antonio long-term disability attorney needs 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. We must demonstrate that your medical condition meets the definition of “disability” in your ERISA plan.
Typically, you qualify as disabled if you cannot perform your job duties, generally due to a:
- Physical injury
- Illness
- Mental health condition
Medical evidence, such as doctors’ reports, test results, and treatment records, is essential to establishing your disability. Your doctor should provide detailed notes on how your condition affects your ability to work.
You Face a Long-Term Disability
A key difference between short-term and long-term disability claims is the expected duration of your condition. To qualify for LTD benefits, we must prove that your disability will last for an extended period, usually longer than six months.
We must provide evidence that doctors do not expect your condition to improve quickly. We can support your claim with:
- Medical records
- Prognosis statements
- Ongoing treatment plans from your healthcare providers
We can immediately begin gathering evidence to back up your claim.
You Are Under Regular Medical Care
Your ERISA plan may require that you be under continuous medical care to receive LTD benefits. You need to show that you are regularly seeing a doctor and following a prescribed treatment plan in this situation.
Missing doctor appointments or failing to adhere to medical advice can harm your case. We can use your treatment plan and ongoing progress reports to prove you are actively managing your condition.
You Meet the Policy’s Other Terms
Each ERISA plan has its own specific rules for determining who qualifies for LTD benefits. We must carefully review your plan to ensure that you meet all the requirements, which may include being employed at the time the disability occurred, waiting through an “elimination period” before benefits begin, or filing your claim within a specific timeframe.
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Fighting the Insurance Company in Your Long-Term Disability Claim
Fighting the insurance company in a long-term disability (LTD) claim can be a complicated process. Insurance companies often try to deny or reduce claims.
Still, with the right approach, an experienced long-term disability attorney in San Antonio can stand up to them and fight for the benefits you deserve.
We focus on:
Gathering Strong Medical Evidence
One of the most critical 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 test results, treatment records, and statements that demonstrate 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 you must meet to qualify for benefits. We carefully review your policy to ensure a thorough understanding of the requirements. We will explain the definition of “disability” in your policy and why 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 they evaluate your case fairly.
Filing Appeals
If the insurance company denies your LTD claim, we can appeal the decision. We know the steps to take after a denial of benefits.
We handle the entire appeal process for you, submitting all paperwork correctly and on time. We’ll also present a strong case with additional evidence and legal arguments to challenge the denial of your disability insurance benefits.
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.
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Successfully Litigating a Long-Term Disability Claim
Litigating a long-term disability (LTD) claim under an ERISA policy 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 the company denied your claim or why the company reduced your benefits.
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 why you believe the insurance company is in the wrong.
Discovery Phase
Once we file the complaint, the discovery phase begins. During this phase, 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, it may proceed to summary judgment. During this stage, your San Antonio long-term disability lawyer typically submits 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 ERISA disability benefits to which you are entitled.
Types of Occurrences that Can Lead to a Long-Term Disability Claim in San Antonio
Many situations can lead to a long-term disability (LTD) claim. ERISA, or the Employee Retirement Income Security Act, governs most employer-sponsored disability plans, providing a safety net for employees who become unable to work due to a long-term injury or illness. We can help with your claim if you become disabled due to:
Serious Injuries
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
- 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
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
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. We can help with filing a claim for long-term disability due to depression, anxiety, or another mental health condition.
Degenerative Conditions
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.
Talk to Us About Your Long-Term Disability Claim
At ERISA Insurance Claim Attorneys, our team 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 our skilled San Antonio long-term disability attorney, reach out to us now.
We understand disability law, and we’re here to provide the guidance you need to get the long-term disability insurance benefits you deserve.
Call or text (225) 201-8311 or complete a Free Case Evaluation form