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How an Attorney Can Help With Disability Insurance Benefits

Disability law covers a wide range of regulations designed to secure the rights and fair treatment of people with disabilities. Whether you are navigating the initial application of your disability claim or challenging a denial, the complex nature of this law makes it helpful to have a legal representation.

This article provides a comprehensive overview of disability law, highlighting disability insurance. You can also get clear insight into how a disability attorney can help you understand these federal laws, secure your rights, and advocate on your behalf.

What Is Disability Law?

Disability law focuses on the legal rules and protections that secure the rights of people with disabilities.

Understanding Types of Disability Insurance

Disability insurance has two main types: Short-term coverage and long-term coverage. Both types of insurance coverage replace a part of your monthly salary up to a certain amount when you suffer from a disability.

Short-term disability insurance often covers 60% to 70% of your base salary. Depending on your policy type, it often pays you benefits for up to six months. Long-term disability insurance usually covers 40% to 60% of your base salary. The benefits end once your disability ends. But if your disability continues, your benefits end after a determined number of years or up until retirement age.

Private Disability Insurance (PDI) and Social Security Disability Insurance (SSDI)

Private Disability Insurance (PDI) often requires you or your employer to pay a monthly premium to an insurance company. Employers often offer the option to buy this coverage. But, people can also buy PDI separately from employer disability insurance. With PDI, your monthly premium usually depends on various factors. These factors may include your insurance coverage level, your age, and any existing health conditions. The type of job you have and its associated risks can also influence the premium cost.

Social Security Disability Insurance (SSDI) is government-provided coverage. You don't have to pay a monthly premium. Instead, the government deducts the amount from your FICA Social Security taxes. You can be eligible for SSDI coverage if you earn enough work credits. You gain work credits by working and paying Social Security taxes.

Self-employed people must earn credits by filing self-employment tax returns. This ensures that they earn the credits needed to qualify for SSDI.

Employer Disability Insurance

Many workers across the U.S. get disability insurance provided by their employers. The Employee Retirement Income Security Act (ERISA) regulates these policies. ERISA is a federal law that provides the minimum criteria for most health plans and private-sector retirement plans.

Understanding ERISA

ERISA requires private industry plans to give participants crucial information about the plan features and funding. It also sets base standards for vesting, participation, benefits, accrual, and funding. The law assigns responsibilities to those managing these plans, ensuring that they act in the best interests of the plan holders. ERISA also guides appeals processes and grievance procedures that participants use when claiming benefits. This empowers the participants to file lawsuits for benefit claims and in cases where there is a breach of duty on the part of the private industry plan.

A proficient disability lawyer can offer legal representation when tackling claims under ERISA. Depending on your medical condition, they can help you understand the claim process and the back pay you deserve.

Strict Deadlines and Procedures

If a covered employee becomes disabled and files a claim, it triggers some particular timelines. ERISA's complex regulations control every aspect of an employer's plan, including how employees get plan benefits. Employers must provide employees with detailed information about their disability benefits. An employee often receives this as part of the new hire paperwork at the start of employment.

After an employee files a claim, ERISA sets time limits for the insurance provider to decide its merits. An insurance provider must determine whether to accept or deny a disability claim within 45 days of filing. But, this time limit can extend by 30 days upon notifying the employee.

Odds of Overturning an ERISA Denial

The ERISA process can be arduous, and applicants don't always get the desired results. If you apply for long-term disability benefits and the insurance company denies your claim, ERISA gives you the right to pursue a lawsuit in federal court.

But know that it's not easy to overturn an ERISA disability benefit denial in court. The insurance company must typically show just a modicum of evidence to support its denial. If you made errors during the application process or didn't provide enough support for your claim, your chances of winning will be slim. This means that your initial claim should be as strong as possible to reduce the odds of denial.

Contacting an ERISA attorney is helpful, particularly if you have questions about an employer-sponsored disability benefit. They can help with your Social Security disability initial application and appeal a denial. You can also speak with a disability lawyer for legal questions about individual disability insurance.

What Are the Steps in Filing a Social Security Disability Claim?

The steps in filing a Social Security disability claim come in four basic steps:

1. Submitting Your Initial Application

To qualify for a Social Security disability benefit, you should first file your initial application to the Social Security Administration (SSA). You can file your application in one of the following ways:

  • Apply through the Social Security Administration website at www.ssa.gov.
  • Contact SSA at 1-800-772-1213, Monday to Friday, 8 a.m. - 7 p.m. local time.
  • Visit your local Social Security office. SSA has a Social Security Office Locator to help you find an office near you.

After you file your Social Security disability application, SSA will turn it over to the Disability Determination Services (DDS) in your state's division. This organization determines and evaluates disability claims and whether you're eligible for government benefits. During this process, DDS will ask you to complete questionnaires about your medical condition and how it affects your daily life. DDS may also ask you to see a physician or psychologist to assess your medical condition. They could also look at your medical records and ask your family or friends about the limitations you experience.

After DDS collects and assesses all this information, it will decide whether you qualify for SSDI benefits. If they approve your claim, you can expect to get your benefits. But if they deny your claim, you will get a notification and can file an appeal.

disability attorney can help you with the appeal process. They can check to ensure that you have all the necessary documentation. They can also represent you in any disability hearings or legal proceedings.

2. Requesting Reconsideration

After the SSA denies your initial application, you can file an appeal called a Request for Reconsideration. This step is crucial before you go to a hearing.

Once you file your appeal with the SSA, your disability claim proceeds through a similar evaluation process as when you filed your initial application. But this time, different evaluators will arrive at a decision. If they deny your appeal again, you can file another appeal, this time with an administrative law judge.

3. Scheduling a Hearing

After the denial of your request for reconsideration, you can ask to go before an administrative law judge (ALJ). The judge will consider all the medical evidence attached to your file. They will ultimately make a new decision on your Social Security disability case.

During the hearing, the administrative law judge will allow you to discuss your condition and how these limitations affect your daily life. The judge may ask for an expert medical witness to give testimony about your disability claim. If necessary, you can also have a witness testify on your behalf. After hearing, the judge often issues their decision in writing.

4. Appealing to Social Security Administration Appeals Council

If an administrative law judge denies your claim, you can bring your case to the Social Security Administration Appeals Council. Although the council will not hear your case, you can send them a letter seeking approval of your Social Security disability case or grant you a new hearing. If you want a new hearing, you should base it on the fact that the administrative judge made blatant or legal errors.

Social Security disability lawyer's help is crucial in the appeal process. They can help you craft a compelling argument to submit to the Appeals Council. For instance, a disability lawyer can help you pinpoint and highlight the legal errors in earlier hearings. They can also help you collect more evidence, compose legal briefs, and give strategic advice that could strengthen your appeal.

Considerations When Hiring a Disability Attorney

Hiring a disability attorney can significantly improve your chances of success. But you should do your due diligence. Most attorneys will offer a free consultation to explain the disability process and ask about your medical records and work history. This is a two-way interview, so when looking for a disability attorney to work with, consider asking questions like:

Will you work on a contingency basis (i.e., no up-front money)?

Disability attorneys generally charge about 25% of their clients' disability back benefits, with a cap of $6,000. The attorney's fee may change if your case gets denied at the hearing level and proceeds to the Appeals Council. When a lawyer works on contingency, their fee is a contingency fee. Under their government-mandated agreement with you, they will only seek payment if they successfully secure your Social Security disability claims.

Do you have specialized disability law training?

Disability law is a highly specialized area of the law. A general practitioner who practices criminal or family law is probably not qualified to handle such a case. Ask if the attorney is a member of NOSSCR, the National Organization of Social Security Claimants' Representatives. NOSSCR provides continuing education and training in disability law.

Could my case benefit from an on-the-record (OTR) request?

A lawyer can help you draft an on-the-record request, asking the judge to approve your claim without a disability hearing. This happens in particular when evidence of disability is clear. Although it does not apply in all cases, your attorney should consider submitting an OTR request if it is suitable. A lawyer can help you assess whether this step is possible during a case evaluation.

Related Resources

Review the following resources to learn more:

  • The Americans with Disabilities Act. Review FindLaw's overview of this legislation, which affects essential aspects of Social Security insurance benefits and claims.
  • How To Prove Disability. This resource explains what you must do in an application and under other legal circumstances to prove a disability. Supporting documents almost always include medical evidence provided of your disability, from a medical professional. That evidence must point to how your impairments make it impossible for you to work.
  • Disability. Review FindLaw's overview of disability law.

More on Social Security Disability Attorneys

Claiming Social Security disability benefits can be a complicated process. But you don't have to face your disability case alone. You can consult with a disability attorney for legal services. They can provide clear guidance about your eligibility and be your disability advocate. You can also contact your state bar association and ask for a disability attorney.

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