• Long Term Disability Denials
    Long Term Disability Denials
  • Accidental Death & Dismemberment Denials
    Accidental Death & Dismemberment Denials
  • Life Insurance Denials
    Life Insurance Denials
  • Personal Injury Claims
    Personal Injury Claims

Texas ERISA Disability and Offset Provisions

Employees who file for disability benefits are often in a rough patch of their life. Between a lack of income and mounting medical expenses, you may be struggling to pay your bills and make ends meet. You need all the support you can get—which is why it can be rather surprising to find out that your group ERISA disability insurance benefit can be reduced by the amount of SSDI you are entitled to.

At a time when you thought you could count on these benefits to come through for you, they may actually be working against each other. If you have questions about Texas ERISA disability and offset provisions and your claims, an experienced ERISA attorney may be able to help answer them.

What is ERISA Disability Insurance?

The Employee Retirement Income Security Act of 1974 (ERISA) governs the abilities and actions of the most group and private insurance companies. Under ERISA, insured parties have certain rights, and health, life, disability, and health insurance companies have certain responsibilities. Plan participant rights under federal law include the right to:

  • Obtain benefits without being fired or discriminated against to prevent the receiving of benefits
  • Be given a written explanation for a denial if one occurs, as well as to make at least one appeal
  • Receive a copy of any material change to a plan within 210 days of the plan year in which the change is adopted

Defining Offset Provisions

There are certain aspects to keep in mind when defining Texas ERISA disability and offset provisions. For example, if an insured party is granted disability benefits, their disability insurance policy likely includes language that says they also must apply for Social Security Disability Income (SSDI). Employees who have worked and paid taxes for long enough are usually eligible to receive these benefits, though the amounts can vary from one person to the next.

At first glance, this may seem to be beneficial to the insured, as they get both their group or private disability benefits and SSDI benefits. However, nearly all disability insurance policies have a provision that allows offsets. This means that the amount of SSDI benefits a person receives each month would be deducted from their monthly amount of group disability insurance benefits, therefore reducing the total income between both types of benefits.

Are Offset Provisions Legal?

Code of Federal Regulations §404.408 governs ERISA disability and offset provisions and reductions in Texas, and in general, this statute establishes offset provisions as being legal. Even though many people with disability benefits may be unaware of this provision, it is still a legal practice if it is contained within the policy.

In some rare cases, though, courts may be able to exercise equitable power to deny offsets. For example, if someone’s employer denied their ERISA disability benefits and threatened to fire them if they did not come back to work, an ERISA lawyer might be able to help that employee avoid disability and offset provisions in Texas as a condition of a successful settlement.

Get Questions About ERISA Disability and Offset Provisions in Texas Answered

Texas ERISA disability and offset provisions can significantly impact your income. Our qualified attorneys understand this and could work to help you understand what is legal and what is not when it comes to these offsets. If your insurance company is not acting in accordance with the policy that was provided to you, you may have legal recourse. Call today to consult with an ERISA insurance lawyer about your options.

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