Buying disability insurance is a good idea if you don’t have enough savings or other means of income to support you if you are unable to work for a period of time due to illness or injury. There are two types of short term and long term disability insurance plans: group and individual.
Group plans are provided by employers to their employees. Because they cover a group of people, the premiums are usually less than individual disability insurance plan rates. Individual disability insurance plans are purchased by individuals to supplement a group plan or to provide coverage if a group policy is not available through their employer or if they’re self-employed.
Individual plans are more expensive than group plans, but there are benefits available through individual plans that are not available to those with group plans. Participating in a group plan through work depends on employment. If you lose or quit your job, the policy isn’t portable. The costs and benefits of a group policy may change from year to year; however, the benefits and costs of an individual disability policy are contractually guaranteed, no matter what your employment status may be.
Individual and group policies are governed under different sets of laws. Group disability plans are governed by the Employee Retirement Income Security Act of 1974, or ERISA, a federal law that was enacted to set minimum standards for employee group benefits, including health, life, retirement and disability benefits. Individual plans are regulated by both state and federal laws. Your rights and legal options when it comes to filing a claim or appealing a denial of disability benefits depend on what type of plan you have.
Appealing a Denial of Group Plan Disability Benefits
If you participate in a group plan, ERISA requires you to appeal a denial of disability benefits with the company your policy is with. Once you go through the appeals process and it’s still denied, you can have your case reviewed by a judge if you still believe the insurance company erred in their decision.
However, the appeals process can be long and complicated. There are strict deadlines that apply to filing an appeal. And you won’t be able to submit additional evidence after your first administrative appeal. An ERISA benefits attorney can provide crucial assistance during the group disability benefits appeals process, gathering the evidence you need to establish your claim and making sure it’s submitted before your deadline.
Appealing a Denial of Individual Plan Disability Benefits
Since they are governed by state laws as well as federal laws, individual plans offer their holders a wider range of options when it comes to appealing an insurance company’s decision to deny benefits. These options include breach of contract law, bad faith insurance laws, and others. If you are unable to resolve your dispute with the insurance company you can file a lawsuit and are entitled to a trial by jury.
The rights you have under an individual plan differ from state to state; so the assistance of an experienced long term disability denial attorney could prove helpful to ensure you obtain the full amount of benefits to which you are entitled.
Contact a Disability Denial Attorney Today
Appealing a disability claim denial can be a difficult process, especially if you are not familiar with the laws that apply in your situation. One mistake is all it takes to lose your appeal and your benefits. No matter if you have a group or individual disability benefits plan, board certified disability benefits attorney M. Stanley Whitehead may be able to help you obtain the long term disability benefits that you deserve after your initial claim has been denied. Contact the Law Offices of M. Stanley Whitehead today to schedule a free consultation to discuss your options.
