ERISA Disability Benefits

If your employer offers disability insurance, and you’re unable to work (for reasons other than a workplace injury), then you may be entitled to disability insurance benefits. But insurance companies control these benefits, and they can make it confusing or challenging to get or keep them. Our lawyers help you navigate the complicated disability benefits system and get the benefits you’ve earned.

Our firm has the experience you need to navigate the disability insurance system. We can help you understand your options and fight back against the insurance companies. If your disability benefits were denied or terminated, call our office to speak with a lawyer about your options.

Private disability benefits are governed by the Employment Retirement Income Security Act (ERISA). Your employer may refer to these benefits as “employer-sponsored disability insurance,” or more simply, “short-term disability” (STD) and “long-term disability” (LTD). If the disability insurer has denied or terminated your disability benefits, you have a limited amount of time to assert your rights or you could permanently lose them. Don’t rely on this webpage alone when making important decisions about your disability benefits. Contact us for more information about your rights.

Can I make a claim for disability benefits?

Many large employers (and some smaller ones) offer disability benefits to their full-time employees. These benefits typically include short-term disability (STD), which covers the first six months from the onset of disability, and long-term disability (LTD) after that. If your employer has a human resources department, they can tell you whether your employer offers disability benefits and help you submit a claim.

What types of conditions result in payment of disability benefits?

Disability benefits are typically limited to injuries and medical conditions that arise outside the workplace. Some plans also limit benefits for certain types of injuries, medical conditions, or mental disorders. If you suffer harm at your workplace or due to workplace conditions, those issues are handled through the workers’ compensation system.

What is the standard for determining whether I’m disabled?

Disability benefit plans typically consider whether your injuries or medical conditions prevent you from performing the essential duties of your occupation on a full-time basis. Under most disability benefit plans, after you have received two years of LTD benefits, the standard changes to whether you can perform the essential duties of any qualifying occupation on a full-time basis.

If my claim for disability benefits is denied or terminated, what can I do?

Under ERISA regulations, you have a limited amount of time to submit an “administrative appeal” to the insurance company. When you submit your administrative appeal, you can make new arguments and submit more proof of your disability. Ask your caregivers and other medical professionals to supply you with medical records and other evidence that objectively shows your disability, and make sure to submit those records with your appeal.

When can I sue the insurance company?

After your claim is denied or terminated, you must complete the administrative appeal process before you sue. The appeal is not complete until the insurance company upholds or reverses its decision to deny or terminate benefits. When the insurance company decides the appeal, it must notify you about your right to bring a lawsuit. If you bring a lawsuit without completing the administrative appeal process, your lawsuit may be dismissed.

What happens when I sue the insurance company?

When you sue, the court considers whether the insurance company had enough evidence to support its decision to deny or terminate benefits. In most circumstances, this evidence is limited to documents the insurance company received prior to the lawsuit. If the court rules that the insurance company was wrong, it can require the insurance company to reconsider its decision, or it can order the insurance company to pay past benefits.

What’s the difference between ERISA disability benefits and Social Security Disability Insurance (SSDI)?

If you’ve paid Social Security taxes (through FICA withholding), you may qualify for Social Security Disability Insurance (SSDI), a government program administered by the Social Security Administration (SSA). When you apply for SSDI benefits with the SSA, it considers whether you’re disabled, but the legal standards are different than those for private ERISA disability benefits.

Contact Our ERISA Disability Benefits Lawyers

Baillon Thome Jozwiak & Wanta LLP is dedicated to protecting the rights of employees throughout Minnesota. If you have been denied long-term disability through your employer-sponsored disability benefits plan, our employment lawyers want to hear from you. Contact us for a free initial consultation.