Helping Clients Throughout Kentucky and Indiana Pursue Long-Term Disability Benefits
If your short-term disability benefits are coming to an end and you are still unable to work due to an injury or illness, you expect that you will be able to continue receiving assistance through your employer’s long-term disability plan. Unfortunately, getting the long-term disability benefits, or LTD benefits, you need is not always straightforward.
Your employer or their insurance company may contest your eligibility or deny your valid claim. When this happens, it is easy to feel powerless. After all, you are already unable to work, and the loss of benefits puts you in significant financial jeopardy.
If you are facing this situation, contact the Karl Truman Law Office today for a free review of your legal options. Our law firm serves clients in Louisville and throughout Kentucky (call (502) 222-2222) as well as Jeffersonville and southeastern Indiana (call (812) 282-8500).
During your complimentary case review, we will discuss all of your legal options, including your rights under ERISA.
What Is ERISA?
The Employee Retirement Income Security Act (ERISA) specifies the protections that participating employees have in employer-provided disability benefits and other programs. Most employer-provided benefit plans are governed by ERISA, with the exception of disability benefits for public employees and employees of religious institutions.
As it applies to LTD benefits, ERISA establishes several rights and responsibilities for employers and insurance companies:
- Employees must be informed of the benefits to which they have access
- Employees must be provided with information on how they can file a claim
- Insurers are required to approve or deny claims for benefits in a timely fashion
- An employer may not terminate you or discriminate against you for filing a claim
- In the event that a claim is denied or benefits are terminated, the employer and/or insurer must provide the employee with records pertaining to the decision
ERISA gives you the right to appeal the decision to deny or terminate your benefits. However, you must submit this appeal within a deadline (by statute, that deadline is a minimum of 180 days from when you were notified about your claim status). The insurance company then has 45 days to evaluate and make a decision on your appeal.
In the event that your appeal for benefits is denied, you may have the right to file a second appeal. Alternatively, you may have to pursue a lawsuit against your employer and/or the insurer.
Do I Need an Attorney for My ERISA Claim?
It is often difficult to prove that your long-term disability benefits were wrongfully denied or terminated. Although you have rights under ERISA, the claims process can be long, complicated, and arduous.
Some of the situations commonly encountered in ERISA claims that an experienced disability benefits lawyer can help you navigate include:
Your Employer Claims That You Are Not Disabled
Some LTD benefits plans provide very narrow definitions of what constitutes disability. An injury or illness may be unable to perform the duties of their current job, but the employer might argue that the plan only covers disability benefits if you are unable to perform any job.
Disability qualification is generally not black-and-white. Insurers rely heavily on the input of medical professionals, and it is important that your plan take into account the full impact of your illness or injury on your ability to do your job or any job – and thus your eligibility for benefits.
Your Employer Claims That You Are Not Covered by the Policy
Employee classification is critical to many cases where eligibility for benefits is disputed. Sadly, it is not uncommon for employers to present an employee as a part-time or contract worker in order to limit the benefits available to them.
If your employer argues that you are not eligible for LTD benefits due to your employment status, the attorneys at the Karl Truman Law Office will investigate your employment records, tax returns, and other documents to present evidence to the contrary.
Your LTD Benefits Are Offset by Other Disability Benefits
Long-term disability benefits are a percentage of your monthly income (generally 50% to 70%, depending on your employer’s policy), less any other benefits you receive. If you receive benefits through Social Security Disability Insurance (SSDI), the LTD provider is allowed to reduce the amount you receive accordingly.
However, in some cases the private insurer may cite the decision of the Social Security Administration in its decision to approve or deny your benefits. If you are denied SSDI benefits (as the majority of first-time applications are), that decision should have no bearing on your eligibility for long-term disability benefits. Our experienced lawyers can help you appeal denials of one or both benefits.
The Insurance Company Deals with You in Bad Faith
Insurance companies are required to deal with claims in good faith. That is, a legitimate claim must be processed and a decision rendered in a timely fashion. If the claim is approved, the amount of benefits must be provided in accordance with the policy. And, in the event of a denial, clear and sufficient reasoning must be given.
Unfortunately, the priority for any insurance company is its profits. As a result, unethical LTD insurers may draw out the application process, delay making a decision, or deny your claim without proper grounds.
The ERISA law generally precludes a claim of bad faith against the insurance company. However, when the benefits replacing your income are on the line, it is in your best interest to consult an experienced lawyer who can investigate the circumstances surrounding your claim and take action on your behalf.
How Karl Truman Law Office Can Help with Your ERISA Claim
The Employee Retirement Income Security Act is an extremely complicated piece of legislation. Furthermore, it is often very difficult for claimants to identify employer misconduct, insurance bad faith, and other issues affecting their benefits.
As a result, you need a law firm with the experience and resources to handle complex legal matters. Furthermore, the firm you choose should understand what’s at stake in your case.
The Karl Truman Law Office has extensive experience in SSDI and veterans’ disability benefits claims. As such, we understand the importance of getting the benefits to which you are entitled, as well as the frustration of having a legitimate claim denied or the benefits you rely on terminated.
Timing Is Everything in Long-Term Disability Cases
Our firm can help you with any aspect of your LTD benefits claim. You can contact us if you are getting started on your initial claim application or if you have been notified that your claim is denied or your benefits are terminated.
Bear in mind that claims for long-term disability are subject to strict deadlines. It takes time to build a strong claim or make an effective appeal. Therefore, we encourage you to contact our lawyers as soon as possible to explore your rights under ERISA and how to proceed with your claim.
Beginning with your free consultation, we will provide you with guidance on your legal options as the case unfolds. Lawyers and staff at the Karl Truman Law Office will always return your calls and emails in a timely fashion.
Contact the Karl Truman Law Office for Your ERISA Claim Review
Nobody plans to suffer from an injury or illness that prevents them from working. If you are unable to work, however, it is only reasonable that you have access to your employer-sponsored long-term disability benefits.
Unfortunately, your employer, their insurance company, or both parties may deny the benefits you are rightfully owed, delay your claim, or engage in other misconduct. You can count on the Karl Truman Law Office to provide qualified assistance with filing your claim, launching an appeal, and all aspects of the process.
For a free evaluation of your LTD disability benefits claim, please contact the Karl Truman Law Office today. Our office in Louisville, Kentucky, can be reached at (502) 222-2222, or you can dial (812) 282-8500 for service in and around Jeffersonville, Indiana.
Appealing your ERISA Long Term Disability Claim
Don't Try This Alone explains the difficulty in appealing your ERISA Long Term Disability (LTD) claim without an experienced attorney. It is written in plain English the without the complicated legal language. It is a tool to help claimants know what to look for in an attorney and when to hire one if your long-term disability (LTD) claim is denied. This book will help you avoid mistakes that can cost you benefits if you are unable to work.