If you are ill or have been injured and can no longer work, disability insurance benefits can protect you and your family from financial hardship by insuring a portion of your income when you are unable to work.  The disability benefits process can be complicated, though, so you may want to consult with an attorney as soon as you consider ceasing working.

What Are Disability Insurance Benefits?

Disability insurance benefits protect your income in the event you become disabled and can no longer work.  While many employers offer disability benefits to their employees, some do not.  Many employer-sponsored disability benefits plans will cover short-term disability benefits (STD) for the first three to six months you are out of work, and then long-term disability (LTD) benefits for those conditions and injuries lasting for more extended periods of time.  LTD benefits are typically payable until you reach retirement age.  If you are self-employed, work for an employer that does not offer disability insurance, or have disability insurance through your employer, but it covers only a small portion of your income, you can purchase individual disability insurance on your own.

What Laws Apply to Disability Insurance Benefits?

If you work for a private-sector employer that offers disability insurance, your benefits are likely governed by the federal benefits law called the Employee Retirement Income Security Act of 1974 (ERISA).  If you work for a government or church-related entity, then your benefits are exempted from ERISA coverage.  If you purchased your own individual disability insurance policy, then your benefits are governed by state insurance bad faith law.

Do You Need an Attorney to Seek Disability Insurance Benefits?

You do not need an attorney to file for disability insurance benefits.  You should be able to request and obtain the claim forms from your employer or insurance company on your own.  Although legal counsel is not necessary to begin the application process, it may still be prudent to hire counsel as soon as you begin to consider filing a claim.  For one thing, the terms and conditions that apply to your claim will depend on the particular provisions of your plan, which can be pretty complicated.  Most group disability benefits plans contain exclusions for “pre-existing conditions,” which are disabilities related to a medical condition that existed before you were covered under the plan if you cease working within the first year of your coverage becoming effective.  Most disability benefits plans also only pay benefits for limited periods for specific types of disabilities, such as those caused by a mental illness, substance use disorder, or “self-reported” condition.  As a result, it can be crucial that you consult with an experienced benefits attorney who can review your plan and advise you of its specific terms and conditions before you even start the application process.

Should I Hire an Attorney If I Am Denied Disability Insurance Benefits?

If you decide to apply for disability insurance benefits on your own, but your claim is denied, or your benefits are later terminated, then you should consult with a lawyer as soon as possible.  If your disability benefits are denied or terminated, then you will likely need to submit an appeal to the insurance company and/or plan administrator.  The appeal must be submitted before you can file a lawsuit in court, and there are strict timing deadlines that apply.

In addition, in most cases, you will not be allowed to introduce new evidence in court if your appeal is unsuccessful and you have to initiate litigation against the insurer and/or administrator.  That means the judge would only review the evidence collected by the insurance company or supplied by you during the claim and appeal process.  It is imperative that you use the appeal process to ensure there is a complete record for the court to review, if necessary.  Otherwise, the insurance company and/or administrator can fill the file with evidence that is biased against you and not reflective of your disability.  Some examples include covert surveillance footage or medical reviews performed by doctors who never even evaluated you.  An attorney specialized in disability benefits issues and ERISA can assist you in ensuring that you have provided sufficient documentation and other evidence to support your disability benefits claim.

Will I Be Awarded Disability Insurance Benefits If an Attorney Represents Me?

Hiring counsel to represent you while you are seeking disability insurance benefits can maximize your chances of getting your claim approved because experienced benefits counsel can advise you through every step of the process, educate you on the specific terms of your plan, and familiarize you with the business practices of the large insurance companies.  If you are no longer able to work, it is critical that you receive your disability benefits without interruption, so you can continue to meet your financial obligations.  The benefits attorneys at DeBofsky Sherman Casciari Reynolds P.C. can help you navigate the complicated process of applying for disability benefits and represent you if you need to submit an appeal.  That way, you can protect your finances and focus on improving your health.

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