Long-Term Disability Insurance / ERISA Law
Answering Questions about LTD & ERISA Law
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 is an “offset provision”?
How much does it cost to hire Andalman & Flynn?
What is the definition of disability?
What other key provisions of my LTD policy should I know about or look for?
Can I work and still get LTD benefits?
What are my appeal rights?
Why should I hire Andalman & Flynn to handle my LTD claim?
Q: Where do I file my application and from what date do my benefits start?
A: You normally can obtain the application paperwork from your human resources department. The application commonly contains sections for you, your employer, and your physician to complete. The application is often submitted through your human resources department, which then submits it to the insurance company. The start date of your benefits depends upon your policy, but there is often an elimination period, meaning a period of time after your disability onset date during which you are not eligible to receive benefits or back benefits. Usually elimination periods range from 60 to 180 days after the date of disability.
Q: How long does the process take?
A: Applications for Long Term Disability benefits are generally decided quickly on initial application. The regulations issued by the Department of Labor for ERISA claims require the insurance company to make a decision within 45 days of receiving your completed application. If the insurance company needs more time, it must notify you in writing, and the insurance company may take up to two 30-day extensions.
If your claim is denied, however, the process takes much longer. In ERISA claims you must file an administrative appeal, which often takes six months. You have 180 days (approximately 6 months) to file the appeal. Once the appeal is filed, the insurance company again has 45 days to make a decision and can ask for an extension of 45 days.
If your administrative appeal is denied, then you must appeal the decision with the Court, which often takes one to two years. Please see question What are my appeal rights? Look below for additional information about appeals.
If you have filed an application for LTD benefits and have not received a response, or have been denied, you should contact an attorney immediately to discuss your rights.
Q: How much will I get paid?
A: The amount of your benefit is determined by your policy. It is most commonly paid monthly and is a percent of your salary. Most policies pay either 60% of salary or 66.67% of salary. Salary is also defined in the policy and may or may not include bonuses.
Q: What is an “offset provision”?
A: An offset provision allows the insurance company to deduct, or offset, certain other income from your disability benefits. For example, if you are receiving Social Security Disability benefits, or workers™ compensation payments, among other benefits, the offset provision allows your Long Term Disability carrier to reduce your monthly LTD payment by the amount of other income you receive from other disability-related benefits.
Other income commonly includes your personal benefit, as well as any benefits paid to your dependents, such as benefits payable to minor children in Social Security Disability awards. The award of Social Security Disability or other benefits, which often occurs after LTD payments start, may also result in an overpayment from your Long Term Disability carrier, and your Long Term Disability carrier may seek repayment of any overpayment from you.
Q: How much does it cost to hire Andalman & Flynn?
A: Andalman & Flynn provides clients with a choice of retainer agreements on claims for Long Term Disability benefits, which include payment on an hourly basis for work performed, contingency fees, and mixed fee agreements. A contingency fee means that the fee is not owed unless the claim is won. An hourly fee is paid for all work performed on the case, whether the case is won or lost. A mixed fee agreement usually provides a flat fee owed at the beginning of the case and then a lower contingency fee if the case is won.
Q: What is the definition of disability?
A: Each Long Term Disability insurance policy can have different definitions of disability. Therefore, it is important to pay close attention to the definition of disability in your Long Term Disability insurance policy, which is often referred to as the plan document. You should try to get a copy of the plan document; do not rely on the abbreviated summary plan document; and, do not rely on word of mouth or what is provided by another insurance policy. The three most common definitions of disability are:
- Your own occupation – you only have to prove that you are disabled from performing the material duties of the occupation you were in when you became disabled to work.
- Any job for which you are reasonably qualified – you have to prove that you are disabled from performing any job for which you are reasonably qualified for based on your education, training, and experience.
- Any occupation – you have to prove that you are disabled from performing the material duties of any occupation.
Even if you have been determined to be disabled by the Social Security Administration, Long Term Disability insurance plans must consider this finding but are not required to make the same decision. Proving disability to the satisfaction of the insurance companies is not easy and an experienced disability lawyer can be a great help in gathering the medical, vocational, and factual proof necessary to win. If you wish to meet with an attorney to discuss your case, please contact us for assistance throughout Northern Virginia, Southern Maryland, and Washington, DC.
Q: What other key provisions of my LTD policy should I know about or look for?
A: When reading your Long Term Disability policy, pay careful attention to definitions of disability, time limits, elimination periods, offset provisions, mental and nervous limitations, and partial disability. As mentioned, these definitions can vary in each policy, and the definitions determine how decisions will be made by the insurance company in your particular case. An attorney experienced in LTD can explain how each of these terms affect your particular case and how best to present the facts and circumstances of your situation to the insurance company. If you are disabled and would like to discuss your LTD policy and filing a claim in Virginia or Maryland, please contact us to schedule a consultation.
Q: Can I work and still get LTD benefits?
A: Whether you can work and also receive Long Term Disability benefits depends upon the terms and conditions in your policy. There is often a provision that allows you to earn up to a specified percent of your previous salary and still receive benefits. For instance, some policies allow you to earn up to 20% of salary with no reduction in benefits, and then a sliding scale of reduced benefits up until you reach 80% of prior salary, at which time benefits are stopped. Andalman & Flynn’s disability law attorneys are available to discuss your LTD policy and changes to your benefits if you are considering returning to work. To schedule a consultation, please contact us.
Q: What are my appeal rights?
A: The majority of Long Term Disability policies are group policies issued through an employer, and are governed by federal law, specifically ERISA (Employee Retirement Income Security Act). If your initial application is denied, ERISA regulations grant you 180 days to file an administrative appeal. If the insurance company issues a final denial decision, then your only appeal under ERISA is to federal court for review of the decision on the record, meaning based only upon the documents submitted to the insurance company. There is usually no right to a trial and no right to a jury under ERISA. Most often employees are required to prove to the Court that the insurance company decision is not supported by any substantial evidence, which is difficult to prove. Therefore, it is important to seek the advice and representation of an attorney experienced in Long Term Disability claims early in your case so that the insurance company has all the documents it needs from the start, and so the necessary information is on the record in the event of an appeal. Please contact us if you would like to schedule a consultation to discuss your LTD claim or appeal with an experienced disability attorney in the Washington, DC area.
Q: Why should I hire Andalman & Flynn to handle my LTD claim?
A: Andalman & Flynn has many years of experience representing disabled employees with their claims for Long Term Disability (LTD) benefits in Maryland, Virginia, and Washington, DC. We know how to evaluate the medical evidence, fill in the missing pieces of medical, vocational, or other factual proof, and work with you and your doctors to best present your claim for LTD benefits. Simply put, we can help maximize the chances of winning your claim. If you consult with us prior to applying for LTD benefits we can assist you in strategizing what is the best course of action for you. We also offer assistance for disabled employees seeking reasonable accommodations from their workplace to continue working; advice on how to discuss your disability and needs for reasonable accommodation with your employer; and, assistance with related claims such as for leave under the Family and Medical Leave Act, Short Term Disability benefits, or severance pay. If you are interested in meeting with an experienced disability attorney, please contact us.
Long-Term Disability Lawyers in VA, MD & DC
When a claimant is denied, there is typically a 180-day period in which to submit an administrative appeal to the insurance company that denied the claim. If this is not done, it may be impossible to later challenge the denial in court. Once you receive a denial letter, it is important to contact a long-term disability lawyer as soon as possible. Looking for a long-term disability lawyer in Maryland, the District of Columbia, or Northern Virginia? Andalman & Flynn concentrates on ERISA law, focusing on protecting the rights of our clients as they seek LTD benefits. Our attorneys provide a compassionate service, working to give each client the best chance at success.
Contact us today for help obtaining LTD insurance benefits in Virginia, Maryland, and Washington, DC.