ERISA Long-Term Disability Benefits

If your employer provides private disability benefits, and you’ve suffered injuries or conditions outside the workplace that keep you from working, disability benefits can be an important financial lifeline. However, insurance companies control these benefits and can make it challenging or impossible to get or keep them. Our lawyers can help you navigate the complicated disability benefits system and get the benefits you’ve earned.

Private disability benefits are regulated under the Employment Retirement Income Security Act (ERISA). These benefits may also be referred to as employer-sponsored disability insurance or more commonly short-term disability (STD) and long-term disability (LTD). When you make a claim for disability benefits, your employer and insurance company must comply with ERISA regulations and give you a fair opportunity to present evidence of your disability. If your claim for disability benefits is denied or terminated, you can demand that the insurance company reconsider their decision. If the insurance company upholds its decision to deny or terminate benefits, you have the right to have a court review the decision.

At Baillon Thome Jozwiak & Wanta LLP, we have experience with the private disability benefits system. We can help you understand your options and fight back against the insurance companies. If your private disability benefits were denied or terminated, call our office to speak with a lawyer about your options.

Frequently Asked Questions

The following FAQs offer basic information about how private disability benefits work. Depending on your disability benefit plan and your individual circumstances, your rights may be different. Under the terms of your benefit plan and the statute of limitations, you have a limited amount of time to assert your rights before losing them. Don’t rely on these FAQs alone when making important decisions about your disability benefits. For more information about your rights, contact the legal professionals at Baillon Thome Jozwiak & Wanta LLP.

Can I make a claim for private disability benefits?

Many larger private employers (and some smaller ones) offer private disability benefits to their full-time employees. These benefits can include short-term disability benefits (STD), which typically covers the six months following onset of your impairment, and long-term disability benefits (LTD), which covers impairments that continue for longer periods of time. If your employer has a human resources department, they can tell you whether your benefit package includes disability benefits and help you submit a claim.

What types of injuries or conditions can result in payment of disability benefits?

Private disability plans typically pay benefits for injuries or conditions that arise outside the workplace. Some plans may 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 am disabled?

Private disability plans typically consider whether your injuries or conditions prevent you from performing the essential duties of your occupation on a full-time basis. Under many disability 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.

How do I prove my disability?

When you make a claim for disability benefits, you’ll need to provide proof to the insurance company that you are disabled. You can get that proof from your treating physician and other medical professionals. You must reasonably cooperate with the insurance company, and you may be asked to submit medical records or participate in medical examinations.

When my claim for long-term 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 the insurance company gives you formal notice that your disability benefits are being denied or terminated, it must also provide you with information about your right to an administrative appeal. During this appeal, you can make new arguments and submit more proof of your disability. You may have other rights or limitations under the specific terms of your disability plan.

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 original decision. When the insurance company formally decides the appeal, it must also provide you with information about your right to bring a lawsuit. In most circumstances, if you bring a lawsuit without completing the administrative appeal process, your lawsuit will be dismissed.

What happens when I sue an insurance company for denying private disability benefits?

When you sue under ERISA, the court considers whether the insurance company had evidence to support its denial or termination of benefits. In most circumstances, this evidence is limited to information the insurance company received before and during the administrative appeal. If the court rules that the insurance company was wrong, it can require the insurance company to reconsider its decision or pay benefits.

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

If you’ve paid Social Security taxes (such as 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 can be different from those for private disability benefits. If you’re receiving private disability benefits, the insurance company may require you to apply for SSDI.

Contact Our Minnesota Employment 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 at 612-252-3570 or click here for a free initial consultation.