Disability Insurance Claims Attorney in San Jose, California

If you are facing a disability and need help with filing an LTD claim with your insurer, it’s natural to feel frustrated. While about 40 percent of United States employers offer long-term disability insurance coverage, various federal laws aren’t always in favor of employees. In reality, insurance companies (and employers) often have the upper hand. 

Need help with your LTD claim? Contact Attorney Joel P. Waelty as soon as possible. At the Law Offices of Joel P. Waelty, a skilled professional is ready to offer detail-oriented guidance, no matter whether you are dealing with an employment-based plan or one you bought on your own. These issues are complex and time-consuming, so it’s important to reach out as soon as you know you need help. The firm proudly serves clients in San Jose and throughout the Silicon Valley, as far south as Monterey and as far north as Oakland. 

Making a Claim on a Private Disability Policy 

Private LTD policies can be purchased through work if the employer offers them or through your own initiative by contacting an LTD broker. The difference is largely that employer-sponsored programs fall under the provisions of ERISA, the Employee Retirement Income Security Act. Privately purchased policies do not.  

This may sound like an employer-offered LTD policy is the better option, and it may well be in terms of affordability, but ERISA sets up appeal standards for denials of benefits that largely favor the insurer, not the employee. The words comprising the abbreviation ‘ERISA’ may make it sound as if the law favors employees, but in reality, the statute provides a lot of ground cover for insurers who issue long-term disability policies, especially when it comes to disputes. 

So, how would you go about appealing a denial?

Appealing a Decision and Filing a Lawsuit 

First off, under ERISA, you have 180 days to appeal an adverse decision. During the appeal, you can submit additional supporting evidence. Until the appeals process plays out, however, ERISA forbids you to file a lawsuit, and when you eventually are able to do so, only the evidence you submitted during your appeal will be considered. You cannot come back with more evidence to bolster your case. 

State laws govern appeals and lawsuits against privately issued LTD policies, which generally provide for more latitude in what you as the claimant can do, but this doesn’t mean that the insurer will be any less aggressive in protecting their right to challenge your claim. Also, if your claim is approved, the insurer, whether under ERISA or not, will likely monitor you and require periodic health updates, or even assign a surveillance team to follow you not only online but also in daily life when you’re out in public. 

Lump-Sum Buyouts 

LTD insurers, faced with a disability that is expected to last perhaps until retirement, will often resort to offering a lump-sum buyout. Alternatively, you as a claimant may determine a lump-sum is in your best interests. In either case, you must approach this turning point with great caution and preparation. Consult with an experienced LTD insurance attorney to make sure all your rights are being honored and that the lump-sum settlement is really in your best interest. 

Federal, State, and Private LTD Benefits: The Intersection 

The state of California offers only short-term disability benefits. The federal government with its SSDI and SSI programs does offer long-term benefits, though. How these interact with any LTD policy underwritten by a private insurer is important to note. Many, if not all, private LTD policies will require you, at least in the Golden State, to resort to the state’s SDI program first before applying for benefits from your LTD policy.  

In addition, these privately-backed LTD policies, whether or not they are administered through your employer, will most likely require you to file for SSDI benefits. Once you qualify for SSDI, your LTD benefits will likely be reduced by the amount that you receive from the federal government. In other words, disability benefits are often intertwined. That’s why it’s even more important to contact a skilled attorney for guidance.