Disability Insurance in a Nutshell
If you search “disability insurance” or “long-term disability” online, you’ll find a mishmash of information that talks about employer-sponsored insurance plans, private policies, and Social Security benefits. Some of this information may apply to your situation, but much of it will seem confusing and even contradictory. Sorting everything out can seem almost impossible.
At Bryant Legal Group, we want to help. Our team of respected lawyers takes a practical approach to disability insurance claims and deeply values client education. In this article, we’ll explain the essentials of disability insurance.
What Is Disability Insurance?
Disability insurance provides a monthly benefit if you cannot work due to an illness, injury, or health condition. Unlike Social Security benefits, which are administered by the government, disability insurance is sold by private companies to individuals and employers. In exchange for a premium, you get coverage.
There are two primary types of disability insurance:
- Short-term disability: Typically covers disabilities that last from 30 days to a year
- Long-term disability: Typically covers disabilities that last more than one year
Depending on your insurance policy, you may have both short-term and long-term benefits. However, it is not uncommon for people to only have long-term disability (LTD) coverage.
What Is ERISA?
If you’ve spent time researching disability insurance, you’ve probably run into the term “ERISA.” ERISA (Employee Retirement Income Security Act of 1974) is a federal law that controls most employer-sponsored insurance benefits, including group disability insurance plans.
If ERISA covers your short-term or long-term disability policy, you must follow the law’s strict timelines, procedures, and appeal processes. However, if you have private disability insurance, then Illinois’ insurance laws control your claim, not ERISA.
How Do I Qualify for Disability Insurance Benefits?
When you or your employer purchased disability insurance, you agreed to specific terms and conditions, which are set out in the Plan Document created by the insurance company. The terms and conditions in the Plan Document can vary dramatically from plan to plan. Before you file for short-term or long-term disability benefits, you should request a copy of your Plan Document or your Summary Plan Description (SPD) and carefully review its contents.
Insurance plans typically define disability in one of two ways:
- You are disabled if you cannot perform your own occupation.
- You are disabled if you cannot perform any occupation.
Sometimes, your plan will also include an elimination period or waiting period. If so, you cannot receive benefits until this period ends.
If you meet your plan’s definition for disability and the elimination period has passed, you can apply for benefits. However, getting disability insurance benefits involves much more than filling out a quick form or two.
To get disability benefits, you will need to provide the insurance company with detailed information about your medical history, medical providers, functional limitations, symptoms, and treatment plan. Then, the insurance adjuster will investigate your claim, review all your information, and either approve or deny your benefits.
This entire process of interpreting your Plan Document, compiling evidence, and negotiating with the adjuster requires attention to detail and extensive legal and medical knowledge. If you’re feeling overwhelmed, it’s best to consult an experienced disability lawyer early on.
How Much Will I Get in Disability Insurance Benefits?
Your Plan Document will determine how much you’ll receive in monthly benefits. Most plans pay about 50–60% of gross income. For a short-term disability policy, you may receive benefits for up to a year or until your condition improves. With long-term disability benefits, the insurance company should pay your benefits until you no longer qualify, which usually happens at retirement age or when you become capable of working again.
Many LTD policies have additional limitations. For example, if your disability is solely due to mental health issues, the majority of long-term disability plans will only pay benefits for 24 months. The same is often true for claims involving addiction and substance use.
I Was Denied Disability Insurance Benefits — Now What?
First, don’t assume that the insurance company made the right decision. Every day, we meet with people who had legitimate LTD claims denied, and we’ve recovered millions of dollars in insurance benefits for our clients. Before you walk away from your claim, you should talk with a lawyer. And don’t wait to call a lawyer — you may only have 180 days to file an appeal with the insurance company, and you’ll have a lot of work to do during that time.
If your disability insurance benefits are employer-sponsored, the ERISA law says you must appeal with the insurance company before you file a federal lawsuit. During this “administrative appeal,” you will need to add any missing evidence to your file. Once the insurance company makes its final decision, you cannot present additional evidence.
As part of the appeal process, you’ll need to request a copy of your insurance company file, review it, identify any gaps in the records, and supplement the record, all within ERISA’s strict deadlines. Because this takes so much work, most people get help from a disability insurance lawyer.
If your appeal involves a private disability policy, you have 10 years to file your lawsuit in state court. However, you should never wait until the last minute to file a claim. Your lawyer will still need to investigate and develop your case, and you probably don’t want to wait a decade for your long-term disability benefits.
Get Help From the Experienced Disability Attorneys at Bryant Legal Group Today
As you try to navigate a disability insurance claim, you’re going to have questions. While we’ve tried to outline the basics in this article, nothing compares to personalized advice from an experienced attorney.
At Bryant Legal Group, we’ve built a reputation for our practical and client-focused approach. We’ll listen to your story, review your claim, and explain your legal options. To schedule your initial consultation with our team, call us at 312-561-3010 or complete our online contact form.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.