Employers use many different types of long-term disability plans. Most plans are provided by insurance companies, to whom your employer pays a premium each month. You may even contribute money from your paycheck for part of that premium.Navigating The Application/Appeal Process:When you have a long-term disability insurance claim, you must apply to your disability insurance provider. Your application and appeal, if necessary, should be based on strong medical support of a condition, which disables you from continuing in your occupation. If you are denied benefits, you can appeal to the insurance carrier for reconsideration. If the insurer continues to deny your benefits, you have the right to take your claim to a federal court.The federal laws relating to group benefit claims are part of ERISA - the Employee Retirement Income Security Act of 1974. ERISA also sets forth administrative rules for the procedures of handling a long-term disability claim. The rules and regulations set forth in ERISA must be followed. They often are not what you may logically expect, and they are complicated. At the point of the appeal of a denial you may want to consult with an attorney who specializes in long-term disability insurance claims. Typically, you have 180 days to appeal to the insurance company its denial of your benefits. If the appeal is also denied, you may then proceed to federal court for a lawsuit against the insurance carrier, based primarily on the medical records, witnesses, statements, documents contained in the insurance claim file, including internal emails, noting that in ERISA governed cases (employer provided insurance programs) there are very strict limits on what, if anything, can be used in court outside of documents in the claim file.Employer provided or group long-term disability policies have many limitations and are often not what they may appear. You may want to carefully review your policy with a knowledgeable attorney if you believe you may need to file an application for disability benefits.Randy Noah, a lawyer specializing in the representation of individuals denied long term disability insurance benefits.
Nature has a wonderful beneficial effect both on the practice of law concentrating on assistance to long term disability insurance claimants, and for people who are living with total work disabilities. A persistent drought kept Lake Tahoe dry this Christmas, but travelling to Yellowstone National Park on Christmas found winter in all it's white glory.
The fight goes on in 2014 with states such as California pursuing the elimination of long term disability insurers' ability in ERISA governed policies to enforce a "discretionary clause." In essesence the discretionary clause in the policy makes the insurance company the judge and jury of their own determiniations of who qualifies as totally disabled under the policy. The results are predicatable. Countless denials of LTD benefits when the court system would have enforced LTD benefits under the terms of the insurance contract, if they were not obligated to give deference to the insurance company's finding of "not disabled." Attorneys and advocates for disabled individuals seeking LTD insurance benefits keep hammering away at the iron curtain of the discretionary clause. Perhaps 2014 will be the break through year.
Full steam into the Holiday time. Made it through a wonderful Thanksgiving (grilled turkey - my favorite - happy to share grilling methods), and now straight into the jaws of Christmas and the New Year.
Happy Halloween from the Law Office of P. Randall Noah
Long Term Disability Insurance AttorneyEmployers use many different types of long term disability plans. Most of them are provided by insurance companies to which your employer pays a premium each month. You may even contribute money from your paycheck for part of that premium.At the Law Office of P. Randall Noah, we understand long term disability insurance. When you have been denied long term insurance benefits, we will assist you in pursuing your claim.Navigating the Appeal ProcessWhen you have a long term disability insurance claim, you must apply to your disability insurance provider. If you are denied benefits, you can appeal to the insurance carrier for reconsideration. If the insurer continues to deny your benefits, you have the right to take your claim to a federal court, if your long term disability insurance is provided by your employer.The federal laws relating to group benefit claims are part of ERISA - the Employee Retirement Income Security Act of 1974. ERISA also sets forth administrative rules for the procedures of handling a long term disability claim.Typically, you have 180 days to appeal to the insurance company its denial of your benefits. If the appeal is also denied, you may then proceed to federal court for a lawsuit against the insurance carrier, based on the evidence, witnesses, statements, documents, and other materials.This complex process can be simplified with the help of a lawyer who knows and understands the rules associated with it. At the Law Office of P. Randall Noah, we have helped many clients file their claims promptly and efficiently.Contact our office to arrange for an initial consultation. We will listen to your concerns, evaluate your case, and advise you of your legal options.Law Office of P. Randall Noah
21 Orinda Way, Suite C, #316
Orinda, CA 94563
P.O. Box 9421
South Lake Tahoe, CA 96158
Reply to Orinda, CAPhone: 925-253-5540
There's been a great deal of activity in my law practice the past few months with long term disability insurance denial appeals and lawsuits. Hard to discern trends, but it is clear the insurance companies such as MetLife, Hartford, Liberty Mutual, Sun Life and Lincoln are aggressively looking for ways to stop benefits under LTD insurance policies. The same issues as always continue to be recycled: Ability to work in "any occupation" after two years of benefits; two year limit on mental health disabilities; no coverage due to a pre-existing condition; lack of medical evidence to objectively verify a work disability; and the insurance company retained medical consultant has determined medical treatment and medical records do not support disability. And then the rare rabbit that does run the gauntlet of predators and is approved for benefits is consumed by "offsets," such as state disability benefits, social security disability benefits, worker's compensation benefits, and retirement or pension benefits. If there is any trend I have observed this past year, it is an ever expanding definition of offsets. These have to be carefully examined to see if in fact the policy language does support deductions for claimed offsets, which often reduce LTD benefits to near zero.Any storms on the horizon, or is it clear sailing for long term disability insurance beneficiaries? Long range radar indicates a potential for heavy seas with LTD policies forcing a venue at carefully selected locations where the ERISA LTD lawsuit must be filed (to the advantage of the corporate plan), and the ability to amend ERISA governed LTD policies and enforce the amendments on existing beneficiaries under much older (and more liberal) LTD policies. These trends will be commented on in later posts. Do not hesitate to contact me with questions, or post comments. Please also visit my new business facebook page. Randy Noah
Law Office of P. Randall Noah
This months entry deals with a fairly recent phenomenon in ERISA governed long term disability policies. To the surprise of many, and over the strong opposition of the U.S. Dept. of Labor, federal courts are allowing corporations (I have not seen this yet in an insurer's LTD policy) to write into their ERISA governed employee welfare plans a specific location where all cases must be filed. That is, in legal terms, the federal courts are holding that a corporation's choice of venue clause in a disability plan is not contrary to any provision in ERISA. In practice what this means for example is that Xerox can now force all disability benefit plan lawsuits to be brought at their home site of Rochester, New York, regardless of where the disabled person lives or worked. Clearly, large corporations believe that they will receive favorable treatment from a home court. The U.S. Dept. of Labor is so strongly opposed to this trend because the obvious result is to deny access to federal court for many disabled workers who would have to travel hundreds or thousands of miles to the company selected court to try to enforce benefit rights. Denial of access to enforce employee benefits in court is directly contrary to the intent and language of ERISA, yet the interests of large corporations are prevailing over individual rights. For an in depth legal analysis go to the U.S. Dept. of Labor website and look for the section of "amicus" briefs. To date, no U.S. Circuit Court of Appeals has ruled on this issue. It should only be a matter of time before we get an appellate court ruling.
There is a critical component to many denials of long term disability insurance benefits. For far too many individuals, when long term disability insurance benefits are denied, correspondingly health insurance benefits are also terminated in ERISA governed claims. The results can be tragic.
It's already that time. Certainly on the wish list for the New Year will be accesible medical care for all forms of mental illness. In the realm of ERISA long term disability insurance denials and appeals, increased availability of mental health care would have numerous positive benefits. Mental illness is a significant portion of all long term disability insurance claims, and far too often benefits and treatment are denied with devastating effect on people in need. Recent events have linked mental health care to mass shootings, as they should be, and this will hopefully lead to an examination of mental health as an integral part of overall healthcare in the U.S. Simply put, mental health treatment must be available to everyone, if we are going to change as a society. Anyone working int the field of ERISA long term disability insurance benefits sees the effects of denying mental health medical care and benefits to people who need it. Through denial of benefits, whole families are put through extraordinary hardship and suffering to increase insurance profits. Mental illness can be difficult and expensive to treat. Denying benefits is the simple solution to increase short term profits for disability and health care insurers. The New Year provides a new opportunity to examine the value of those profits in relation to the costs of failing to address the need of so many for mental health treatment. There is no question ERISA governed long term disability insureds will have a brighter New Year when the right to mental health medical treatment is recognized.