Q: How does disability insurance work?
A: Individual Disability Insurance (DI) is designed to protect employed individuals from financial disaster in the event of a disability that prevents a person from working. As medicine advances, doctors can often prevent death; however, frequently the patient suffers from a permanent or long-term disability. Unlike workers compensation, DI supplements an individual's income even in cases where his or her sickness or injury did not result from a job related incident. For this reason, the availability of DI, and the ability to collect on a DI policy in the case of a long-term disability are extremely important for the average worker.
Q: I can no longer work and my insurance company is refusing to pay me. What can I do?
A: Unfortunately, you may need legal help. A lawyer can help you protect your policyholder rights and put an end to delaying tactics. If the insurer denies coverage, you can attempt to get the court to order short-term payment. Usually however, it will take over a year to fight for your benefits while the case is in litigation. The amount you may receive may include damages for the insurance company’s bad faith in denying your claim.
Q: I am out of work, how can I pay my lawyer?
A: If you have a private disability policy, have been disabled and the insurer is refusing to pay, our attorneys may represent you on a contingency basis. This means the attorney’s fees would be paid out of the proceeds of any eventual settlement. The lawyer would receive a percentage of the recovery from the insurance company.
Q: What types of cases do you handle?
A: We handle claims by individuals for non-payment and termination of payment of long-term disability (LTD) benefits. We also represent people who have been denied benefits under long-term disability plans, non-ERISA (private and public employee group plans). We do not handle ERISA claims.
Q: Why do insurance companies refuse to pay?
A: Economics. In the past twenty years, many high-income professionals were believed to be good risks for disability income insurance. The industry believed most or many would never make claims, but unfortunately, the number of people injured defied the odds. The number of claims mounted and insurance companies such as Unum Provident Group, Paul Revere and Guardian faced losses on these policies. The industry aggressively looked for ways out of paying these policies, and in some cases crossed the line, unlawfully denying many professionals owed money under insurance contracts.
Q: What is ERISA?
A: ERISA is an acronym for the Employee Retirement Income Security Act of 1974, passed by Congress to combat corruption in many pension plans. Ironically, ERISA was not originally designed to control medical or disability insurance plans, but the phrase in the act "employee welfare benefit plan," has been subsequently interpreted by federal courts to allow ERISA control over nearly all private employee benefits, including health, disability, life and pension plans. We do not handle ERISA claims.
Q: Am I covered by a private plan or ERISA?
A: ERISA controls nearly every employer-sponsored benefit plan, but does not apply to individual policies purchased privately. If you are a public employee you are also outside of ERISA.