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11 Things to Know about ERISA and Filing an LTD Disability Insurance Claim

If you are an employee at a private or publically traded company, chances are your long term disability insurance and other employee benefits are regulated under the Employee Retirement Income Security Act, or ERISA. Passed by Congress in 1974, ERISA’s main purpose is to regulate and protect the employee benefits plans of workers employed at private or publicly traded companies. ERISA governs two type of benefit plans: pension benefit plans (such as 401K plans) and welfare benefit plans (such as short and long term disability insurance).

ERISA and Long Term Disability Claims

As a Houston LTD claims attorney with over 20 years’ worth of experience of helping disabled workers in Texas, M. Stanley Whitehead knows that ERISA makes filing a claim for long term disability benefits a complicated process. There are quite a few factors that will impact the outcome of your claim – knowing them can mean the difference between being approved or denied benefits.

ERISA makes the rules for filing an STD or LTD claim. Here are some important things to remember if you are considering filing a claim to collect long term disabilities:

  1. Knowing the definition of “disability” as stated in your LTD policy can have a huge impact on your case. It’s important to carefully review the policy’s summary plan description – it’s the “rule book” for your insurance plan – to make sure you meet your insurer’s definition of disability and other LTD requirements.
  2. The decision to approve or deny your claim will be made by your insurance company or LTD plan administrator.
  3. Whether or not your LTD benefits are taxable is determined by what type of insurance policy you have.
  4. You will be under close scrutiny by the insurance companies while applying for LTD benefits. This can include undercover surveillance by insurance company investigators to determine if your claim is legitimate or not.
  5. The amount of time your LTD policy will provide benefits can vary. Some policies pay benefits for only a fixed number of years; others provide benefits until retirement age.
  6. There is a waiting period of 90 or 180 days between the time you become disabled and the date you become eligible to receive LTD benefits. The length of this period is determined by the length of your short-term disability policy.
  7. Often times, if you have been approved for LTD benefits you will have to file for Social Security Disability Insurance (SSDI) as well.
  8. Your LTD policy may limit payments for disabilities based on certain mental and/or nervous conditions.
  9. LTD benefits don’t cover the entire amount of your former salary – usually only about 60 percent, depending on the plan.
  • Evidence such as expert opinions and medical records will be critical in determining your LTD claim.
  • All evidence in your case must be submitted during the claim process. Submitting new evidence is almost never allowed in the during the appeals process.

Speak With an Experienced Disabilities Claim Attorney

ERISA claims can be difficult to navigate without the help of an experienced disabilities claims attorney. The last thing you can afford is to be denied STD, LTD and other disability benefits because of a technicality or easily avoided mistake.

If are experiencing problems getting approved for ERISA benefits, or have been denied a claim, please give the Law Offices of M. Stanely Whitehead a call at (713) 993-7311 to schedule a free private consultation with one of our disability claim lawyers. We are often able to handle these cases on a contingency basis, which means there is no cost to our clients until they receive their disability compensation payments.

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