People purchase disability insurance to provide supplemental income in the event that they become too ill or injured to work. There are two types of long-term disability insurance policies: group and private. Group disability insurance policies are purchased by employees as part of a “group” insurance plan provided by their employers. Private disability policies are purchased directly from insurance company agents by individuals for their own personal needs.
While both provide benefits to their policyholders after they’ve become too disabled to work, the claims process for group and private disability benefits policies are very different.
The Group Disability Benefits Claim Process
Insurance companies don’t like to pay out claims. Therefore, they often make it difficult for policyholders to qualify for benefits. This includes being made to apply for Social Security benefits or being examined by an insurance company doctor as part of the claims process. They’ll delay as long as possible, only to deny a policyholder’s claim.
The Employee Retirement Income Security Act (ERISA) is the federal law that regulates group insurance policies. It gives individuals the right to appeal a decision an insurance company’s to deny a claim for disability benefits. However, ERISA imposes its own special rules pertaining to deadlines for filing and appeal and the submission of evidence.
Under ERISA, an applicant is forced to go through the entire appeals process before being able to file a lawsuit. And even then your case will be decided and reviewed by a federal judge, not a jury.
The Private Disability Benefits Claims Process
Unlike group policies, private disability insurance policies are tailored to the specific needs of a particular individual. While they offer better coverage than group policies, the premiums are more expensive.
Since private disability insurance policies don’t fall under ERISA rules, individuals with private insurance policies don’t face the same restrictions as group insurance policyholders. Individuals who have had a private insurance disability claim denied don’t have to go through an appeals process.
There are many legal options available to private disability insurance holders, including filing suit for breach of contract and bad faith insurance fraud. They can file a lawsuit in state and federal courts; the trial can be decided by a judge or jury and seek compensatory and punitive damages.
Houston Group and Private Disability Claim Attorney
M. Stanley Whitehead is a long term disability denial attorney who has been helping clients all over the nation navigate the disability claims process for over 20 years. He’s exceptionally skilled in the appeals process — not just private and group insurance policies, but also Social Security and Veterans’ Administration disability claims.
If you’ve become too disabled to work, it’s important that you take swift action to secure the benefits you’re entitled to. As stated above, strict rules and deadlines apply to disability benefits claims, and the sooner you get experienced representation, the better.
Reach out to the law offices of M. Stanley Whitehead without delay. M. Stanley Whitehead’s extensive experience could mean the difference between getting the full benefits you deserve and having your claim denied completely.