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Federal Disability Retirement (FERS and CSRS)
- TURN A REMOVAL ACTION TO YOUR ADVANTAGE: HOW TO USE GETTING TERMINATED TO HELP WIN A DISABILITY RETIREMENT
- Federal Disability Retirement - Know Your Time Limit to Appeal! - Appealing an OPM Decision to the MSPB
- DISABILITY RETIREMENT BENEFITS FOR FEDERAL EMPLOYEES AND POSTAL WORKERS: AN OVERVIEW
- Coordination of FERS Disability Benefits and Social Security Disability Benefits
Divorce, Custody, and Family Law
- Personal Expense Budget Excel Spreadsheet
- Court-Appointed Lawyers Representing Children
- Client Financial Worksheet
- Joint Statement for Marital & Non-Marital Property
- Debts and Assets Fact Sheet
Protection from Abuse and Violence
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- Considerations When Filing a Petition for Relief from Domestic Violence in Maryland
- Petition for a Maryland Peace Order and How if Differs from a Domestic Violence Case
Criminal Law
- Discovery Requirements in Maryland Criminal Trials
- Drinking and Driving - Automatic Suspension of your Driver's License
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Alternative Dispute Resolution
Collections
- Collection Under the Federal Miller Act
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- The Bad Check Law is Back (Did you know it was missing?)
Personal Injury
Social Security Disability Insurance
- Social Security Disability Claims
- Vocational Experts Are Your Friends
- Drugs and Alcohol Burden of Proof on the Claimant
- Update on Judicial Review and Additional Evidence at the Appeals Council
- October 25, 2005 letter to Commissioner of Social Security
Long Term Disability Insurance / ERISA
- Standards of Review in ERISA Claims
- Maximize Chances of Winning Long Term Disability Claims
- LTD Victory: Independent Physican Review Without Examination Ground to Reverse Denied Claim
- Employee Retirement Income Security Act (ERISA) Claims Procedures
- ERISA Policies and Pre-Existing Conditions
Maryland Teacher and State Disability Retirement
Employment Law
- Maryland Employees - You Get Your Vacation Time!
- What Agency Actions Are Illegal Because Of Discrimination Laws?
- Federal Employees: You Must Act To Protect Your Rights Against Discrimination
- Have You Been Discriminated Against Because You Are A Female "Caregiver"?
- Maryland Workers' Compensation 2004
Disability
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- Visual Impairment & Blindness
- Overview of Employee Disability Programs
Wills, Trusts, Probate & Estate
General
Long Term Disability Insurance / ERISA
The ERISA Maze: Navigating every twist and turn in your long-term disability claim
Are you suffering from a debilitating injury or illness that has sidelined your career and left you indefinitely unable to perform your job? If so, you may be eligible for long-term disability (LTD) insurance benefits. While you may buy a private LTD insurance policy, most workers obtain LTD insurance through group policies provided by their employers. These group policies are regulated by federal legislation known as the Employee Retirement Income Security Act of 1974, or ERISA. ERISA governs, among other things, the obligations of LTD insurance companies in the event that a serious disability or illness prevents an employee from doing his or her job for an extended period of time.
ERISA is very different from workers' compensation. Workers' compensation covers what happens if you are involved in an accident while you are on the job. In cases of workers' compensation, most states will prescribe fixed amounts a worker should receive for a specific injury, usually based on what part of the body is injured. Partial disability in your leg, for instance, may earn you $400 a week for five years. Partial disability in your arm may earn you $400 a week for four years. Related medical bills and therapy for an on-the-job injury are usually covered by workers' compensation as well. The compensatory figures for workers' compensation are reviewed and updated annually, usually by a state-appointed commission. Click here for more information on District of Columbia and Maryland Workers' Compensation Laws.
While LTD benefits include coverage for injuries or disabilities that are incurred on the job, LTD insurance was designed to protect employees in the event of a serious injury or illness that prevents them from returning to work. With LTD, the extent of disability, rather than the cause of the disability, is what is important. Disabilities sustained through auto collisions, slips and falls or other personal injuries may qualify an employee for ERISA long-term disability benefits. Crippling diseases such as multiple sclerosis, Parkinson’s disease, and other acquired or hereditary diseases affecting mobility, coordination, speech, hearing or the immune system also qualify workers for coverage under ERISA LTD benefits.
ERISA: Forms, forms, and more forms
While ERISA benefits are “available” under most employee benefits programs, that doesn’t mean they are easy to get. On the contrary, since its enactment in 1974 the complex processes of ERISA have become a tangled web of technicalities exploited by tight-fisted insurance companies to ensure that making a claim for a long-term disability or illness remains a daunting, discouraging and dubious ordeal.
Under ERISA law, an injured worker is responsible for filing a long-term disability claim. This claim may include of all of your medical records, including your complete medical history prior to your disability or illness; detailed accounts of your work duties and in what ways your disability limits or prohibits your work performance; and, dozens of other forms and documents with which the average person is unfamiliar.
Once completed, the initial claim is submitted to an ERISA Plan Administrator, who reviews every aspect and circumstance of your claim, along with any evidence or reports submitted by your employer. Typically, Plan Administrators (who are almost always employees of your employer’s insurance company) aren’t looking for reasons why you should receive long-term disability – they’re looking for reasons why you shouldn’t. Never mistake Plan Administrators for advocates in your disability claim. Their prime directive is to render your claim invalid, and by ferreting out the most trivial omission or irregularity in your claim, they often succeed.
In every ERISA case, it is very important to thoroughly present your claim. The evidence you supply in your initial claim and in your administrative appeal becomes the basis for all Court decisions regarding your case. Additional evidence, no matter how pertinent to your claim, may be impossible to add to your claim under ERISA in Court once a final decision has been made by the insurance company.
For the typical disabled worker, trying to maneuver through the ERISA claims process on his or her own without competent and experienced legal advice is a recipe for failure. While there are exceptions to that rule, based on more than 15 years of ERISA representation, Andalman & Flynn attorneys strongly recommend that in order to maximize your chances of obtaining LTD or other insurance benefits under ERISA, you obtain the assistance of an experienced ERISA attorney from the very beginning. We have seen numerous cases that came to us too far along in the process for us to be of any real assistance. An ERISA claim should be handled and directed from the beginning by a seasoned ERISA attorney.
If you’ve become disabled and are unable to perform your job through illness or injury, the first step you need to take is to hire an experienced ERISA attorney. By hiring Andalman & Flynn ERISA attorneys, you’ll be working with accomplished and respected ERISA attorneys who have successfully helped many disabled workers through the ERISA claims and appeals process. We are experienced in ERISA litigation and in protecting the rights of sick and disabled workers to collect what they deserve. We can quickly evaluate your claim and your medical records, write a compelling, well-documented claim and fully prepare your case for review by the Plan Administrator. If for some reason your initial claim is denied, we’ll find out why and develop an aggressive appeal that will spell out the merits of your case. If it becomes necessary, we won’t hesitate to take your ERISA case to Court to help you exercise every option in the effort to obtain your ERISA benefits.
Other Laws related to ERISA
Since its inception in 1974, several other types of legislation governing long-term worker leave and disability have come under the purview of ERISA law. These include:
- COBRA – Consolidated Omnibus Budget Reconciliation Act
- HIPAA – Health Insurance Portability and Accountability Act
- Newborns’ and Mothers’ Health Protection Act
- Mental Health Parity Act
- Cancer Rights Act
- Women’s Health Act
If you need strong legal guidance and representation on these laws or any other laws related to ERISA, contact an Andalman & Flynn ERISA attorney today for help with your ERISA claim or appeal.
Library for Long Term Disability Insurance / ERISA:
- Discretionary Clauses in Disability and Health Insurance Policies [PDF]
Description: Letter to State of Maryland Insurance Commissioner requesting that the Commissioner immediately take steps to protect the insurance consumers in Maryland from the insurance industry’s unfair grant of discretionary authority to itself with respect to disability income and health insurance benefit claims. - COMMON LIMITATIONS ON BENEFITS IN LONG TERM DISABILITY INSURANCE POLICIES [PDF]
Description: Many group insurance policies for Long Term Disability (LTD) benefits contain provisions for limitations on benefit payments for disabilities based on certain conditions. - ERISA Policies and Pre-Existing Conditions [PDF]
Description: What is a pre-existing condition and why do you need to think about it when applying for Long Term Disability (LTD) benefits?
Each policy for LTD benefits is written a bit differently. However, LTD policies typically include a pre-existing condition clause with a definition of a pre-existing condition. - LTD Victory: Independent Physican Review Without Examination Ground to Reverse Denied Claim [PDF]
Description: A victory for long term disability (LTD) benefits applicants: "Independent" physician review without physical examination found arbitrary and capricious and reversed. - Maximize Chances of Winning Long Term Disability Claims [PDF]
Description: A claim for Long Term Disability (LTD) benefits can be a confusing process. Often, when you are too sick to work, you are also too sick to effectively fight the insurance company for your benefits. It's important to be aware of several key points to maximize your chance of winning your LTD benefits claim. - Employee Retirement Income Security Act (ERISA) Claims Procedures [PDF]
Description: The Employee Retirement Income Security Act of 1974 ("ERISA") regulates a vast number of employee benefit claims which are commonly thought of as insurance claims. Long Term Disability, Health Insurance, and Life Insurance claims, if the benefit stems from a group policy or "plan" issued through an employer, will normally be controlled by ERISA. - Standards of Review in ERISA Claims [PDF]
Description: A vast array of employee benefits are now controlled by the Employee Retirement Income Security Act (hereinafter ERISA). See 29 USC 1001 et. seq. Appeals from the denial of these benefits to employees, most commonly long term disability benefits, medical insurance benefits or pension benefits, go to federal court. The standard of review to be applied often is determinative of the outcome in these appeals. Oddly, the Act itself fails to set forth a standard of review for courts to apply.
Frequent Questions for Long Term Disability Insurance / ERISA:
- Why should I hire Andalman & Flynn to handle my LTD claim?
- How much does it cost to hire Andalman & Flynn?
- What is the definition of “disability”?
- Where do I file my application and from what date do my benefits start?
- How long does the process take?
- How much will I get paid?
- What are my appeal rights?
- What is an “offset provision”?
- What other key provisions of my LTD policy should I know about or look for?
- Can I work and still get LTD benefits?
Case Results for Long Term Disability Insurance / ERISA:
- Disability Appeal Won for Client Suffering from Lupus -
- Success on Long Term Disability Claim Improperly Filed by Employer -
- Continued Success for Claimant Subject to Long Term Disability Insurance Review -
- Attorney Elliott Andalman Wins Disability Appeal for Client with Multiple Sclerosis -
- Blue Cross Concedes Health Insurance Coverage for Hospitalized Client -
- Successful Disability Claim for Client with Chronic Fatigue -
Web Resources for Long Term Disability Insurance / ERISA:
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