Denied Long-Term Disability Benefits?

February 28, 2018 – If your employer provides private disability benefits, and you’ve suffered injuries or conditions outside the workplace that keep you from working, short and long-term 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.

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 benefits (STD) and long-term disability benefits (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.

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 for long-term disability benefits 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.

Click here for more information about private disability benefits.

Contact Our Minnesota Employment Lawyers
Wanta Thome PLC 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, contact firm attorney Scott Moriarity or any of our attorneys at 612-252-3570 or click here for a free initial consultation.