Disability law generally focuses on disability insurance policies offered by employers and bought by individuals. If you are disabled and can't work you may qualify for disability benefits if your employer has a disability plan. Getting the benefits isn't always easy, though. An experienced disability attorney can help you file a successful claim and navigate the appeals process.
Note that disability law is a practice area that's distinct from Social Security disability. Private disability insurance is not the same as federal Social Security disability insurance. See FindLaw's Social Security Disability section for information on pursuing a claim with the Social Security Administration. For purposes of this article, we're focusing only on employer and private disability insurance claims.
Employer Disability Insurance
Millions of employees nationwide are offered disability insurance by their employers. But how many of them read the fine print or know what 'ERISA' stands for unless they pursue a claim?
Employer-provided disability insurance plans are governed by the Employee Retirement Income Security Act, a federal law commonly known as ERISA. This law regulates nearly every aspect of any employee welfare benefit.
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.
However, ERISA only affects disability insurance benefits that are offered by an employer as part of an employee benefits package. In other words, ERISA would not apply to private disability insurance plans that workers buy on their own.
Strict Deadlines and Procedures
If a covered employee becomes disabled and files a claim, some very specific timelines are triggered. ERISA's often complex regulations control just about every aspect of an employer's plan, including how employees obtain plan benefits. Employers must provide employees with detailed (and we mean very detailed) information about their disability benefits. This is often part of the new-hire paperwork an employee is given at the start of employment.
After an employee files a claim, ERISA sets time limits for the insurance provider to decide the merits of the claim. An insurance provider must determine whether to accept or deny a disability claim within 45 days of filing, though this time limit can be extended 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 results they want. 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 be forewarned that it's not easy to overturn a denial of ERISA disability benefits in court. The insurance company typically needs to 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 in the first place. As you can see, qualifying for long-term disability benefits is not a simple process. It's often wise to enlist the help of an experienced disability attorney.
Considerations When Hiring a Disability Attorney
Hiring a disability attorney can greatly improve your odds of success, but you should do your due diligence. Most attorneys will offer a free consultation to explain the disability process and inquire about your medical problems and work history. This is a two-way interview so consider asking the questions like:
- Will you work on 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 fee may change if your case is denied at the hearing level and proceeds to the Appeals Council.
- Do you have specialized disability law training? Disability law is a highly specialized area of the law -- a general practitioner who does 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? In cases whether there is overwhelming evidence of disability, an attorney may draft an OTR request to ask the judge to approve you without a hearing. While not appropriate in all cases, your attorney should be willing to consider submitting an OTR request if applicable.
Simply put, having a lawyer significantly increases your chances of winning disability benefits. You're at a disadvantage if you apply for benefits or appeal a denial without a lawyer's help. It's a complex process and an experienced lawyer will have valuable strategies and insights. As a result, you should contact an ERISA attorney if you have questions about an employer-sponsored disability benefit, and speak with a disability lawyer for legal questions regarding individually procured disability insurance.