BRYANT LEGAL GROUP
Chicago Private Long-Term Disability Insurance Attorneys
Some Americans receive some form of long-term disability insurance through their employer. But for others, a group policy offered by an employer isn’t available or doesn’t provide enough financial security.
Private long-term disability policies that are purchased independently follow a different set of rules than employer-sponsored group long-term disability policies. The appeals process, your right to sue the insurance company, and even the damages you can claim can be very different from group policies.
If you purchased individual disability insurance and need to make a claim, or have recently had a claim denied, contact Bryant Legal Group as soon as possible. Our team has extensive experience handling private disability claims in Illinois, against insurers like Unum, Cigna, New York Life, and many more.
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Jennifer made my experience in getting my social security benefits effortless and painless. Thank you for a successful verdict. She was knowledgeable and asked all the right questions.
Individual Disability Insurance Policies Follow State Law—Not Federal ERISA Regulation
The Employee Retirement Income Security Act (ERISA) governs most employer-sponsored benefits plans, including disability benefits plans. Disability insurance policies purchased directly by individuals, however, are not governed by ERISA regulation.
This is not a bad thing. While ERISA was created with the goal of protecting the rights and interests of plan beneficiaries, it has evolved into a bulky and complicated regulatory scheme that, in many cases, works against the interests of disability policyholders.
With individual disability coverage, your claims are governed by state law, not federal ERISA regulation. That means, in Illinois, you may have a longer filing deadline and can request a jury trial. Similarly, in some states, you might even be able to bring a bad faith action against your insurer, which could lead to significant compensation.
Do You Have a Non-ERISA Disability Insurance Policy?
If you purchased a long-term disability insurance policy on your own, directly from a disability insurance company (rather than through your employer), you have a non-ERISA plan. This coverage is also often called individual disability or income protection coverage. Individuals who are likely to have private disability insurance include:
- Self-employed individuals
- Business owners
- High-income professionals like doctors, lawyers, and executives who need extra income protection beyond what their employer-sponsored group disability insurance provides
- People with specialized skills or occupations who need a stronger definition of disability
- People who are ineligible for their company’s group coverage due to pre-existing conditions
- Anyone who is dissatisfied with the long-term disability benefits offered by their employer and wants additional income protection
Additionally, government organizations and religious institutions that offer disability insurance benefits to their employees are exempted from ERISA. If you currently have long-term disability insurance through a government or religious employer, the insurance company’s obligations to you (and your rights as a policyholder) will follow the same set of state law as private long-term disability insurance, unless a specific set of state pension law applies.
Key Differences Between Group (ERISA) and Individual Disability Insurance (Non-ERISA)
Some of the major differences between private and group disability insurance include:
- Cost. Individual disability insurance policies tend to have higher premiums than group coverage, even at a similar level of coverage (due to the “bulk purchasing power” of group policies). However, you can generally purchase much stronger protections—for example, policies with a specialty-specific definition of disability, or non-cancelable coverage that prevents the insurance company from altering or canceling your policy in any way as long as you continue to pay your premiums.
- Customizability. Generally, individual disability insurance plans tend to be more customizable. Various optional riders may be available, such as cost of living adjustment, partial or residual disability benefits, or lifetime benefits. These can give you a chance to personalize your coverage to suit your needs.
- Portability. Individual insurance coverage is portable, meaning that it stays with you even if you switch jobs. Group insurance coverage, by contrast, will terminate when you end your employment.
- Underwriting. Individual disability insurance is typically underwritten specific to you—your medical history, the type of work you perform, etc. To obtain this type of coverage, a blood test or medical examination may be required.
- Your rights. Because private disability insurance policies are governed by state contract laws, you enjoy different rights and protections. For example, people with private individual disability insurance can choose to sue an insurance company directly without going through an administrative appeals process. In Illinois, you can also seek bad faith damages if you believe the insurance company was deliberately dishonest or malicious in denying your claim.
Why Work With an Experienced Private Disability Insurance Lawyer?
Private disability insurance plans have very different legal standards and procedures compared to ERISA plans. So, you want to be sure your attorney has a strong understanding of your state’s insurance and contract laws.
There may also be a wider array of legal remedies. For example, in an ERISA claim, you must go through the insurance company’s administrative appeals process before you can file a lawsuit. Even then, once you file, you usually can’t add additional evidence, and you don’t have a right to a jury trial. A judge will simply review the administrative record and make a decision.
By contrast, disability claimants who are not constrained by ERISA have more options. Depending on your circumstances, it might be to your benefit to go through an administrative appeal first—or you could be better off filing a lawsuit immediately to put pressure on the insurer. You also may have the option of a jury trial or pursuing a bad faith claim.
An attorney with direct experience (and a track record of success) in handling non-ERISA long-term disability claims can help you make the most of these options and put you in the best possible position to obtain the benefits you deserve.
Focused on the Individual Needs of Our Clients
At Bryant Legal Group, we do not believe in using a one-size-fits-all approach in individual disability insurance cases. We communicate all available options to our clients, and when a client makes a decision as to what is most important to them, we tailor our strategies to meet their particular objectives.
Our attorneys work collaboratively on each case to present the strongest possible claim for benefits. We carefully review the matter at hand and conduct in depth research, using all the ammunition available against the insurance company.
Achieving success in an individual disability income case requires extensive experience, time and dedication and our firm does not take a case to litigation without serious thought and consideration.
The attorneys at our firm pride themselves on resolving individual disability income policy cases as quickly as possible for our clients. Whether we are assisting with the filing of your initial claim, appealing a denial of benefits or litigating your case in state or federal court, our objective is to help you get the benefits deserve when you need them the most.
Looking for Personalized Advice From an Insurance Lawyer?
Contact a Chicago Private Disability Attorney at Bryant Legal Group PC
If you need help navigating the maze of insurance claim paperwork, or if your private disability insurance claim has been denied, let us help you create a game plan to get you the coverage and benefits you need.
Our team frequently represents professionals with complex ERISA and non-ERISA claims. Contact a Chicago private disability attorney at Bryant Legal Group PC at (312) 634-6415 or complete our online form for the most up-to-date advice and guidance.
We know that dealing with an insurance dispute or disability coverage matter can be difficult, but you do not have to face the insurance company and its lawyers alone. We are here to help.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.
Frequently Asked Questions
- Evaluating their coverage and identifying possible issues with the policy’s language before they need to file a claim
- Guiding clients through the disability insurance application process
- Negotiating with the insurance companies
- Filing appeals with the insurer, state, or federal court
As soon as you have a question or concern about a claim, reach out. Often, you only have one chance (and a limited amount of time) to appeal a denied claim. The earlier you seek legal advice, the better.
It’s critical that you do not forgo such notification, or you could not only lose your benefits, but you could also be held liable for damages.
In any case, if your plan does include some provision for residual benefits, then you may be entitled to receive a portion of your total disability benefits in circumstances where you have not been rendered “fully disabled” but have still had your ability to work and earn impacted by your condition.
How does it work?
- Residual benefits qualification can vary greatly, but generally, it is measured by a percentage reduction in income or hours.
- For example, if your total income has been reduced by 40 percent in the wake of your disabling injury, then you may be entitled to receive 40 percent of your total disability benefit (monthly) as a partial income replacement.
- Thus, if you would have been entitled to $5,000 monthly disability benefits (for a fully disabling condition), you would be entitled to receive $2,000 per month in partial benefits.
It should be noted, however, that most insurers require that the impact of your partial disability meet a baseline percentage amount before you are entitled to receive residual benefits. If the impact of your partial disability on income is just five percent, for example, you might be ineligible to receive any benefits.
Common justifications for a claim denial include:
- Lapse of coverage
- Material misrepresentations in the original insurance application
- Insufficient evidence of disability
- Application of a coverage exclusion
- Disability is tied to a pre-existing condition
- Failure to seek ongoing medical treatment
Specialty Specific Own-Occupation
If your insurance policy includes a specialty specific own-occupation definition of disability, then you will be entitled to benefits if you can prove that your condition renders you incapable of substantially performing the primary duties of your own occupation in the specialty in which you perform it.
For example, suppose you work as a trial attorney, but you experienced a cognitive disability. If you are unable to meet your profession’s cognitive demands, you should be entitled to benefits under the policy.
Own-Occupation
If your insurance policy includes an own-occupation definition of disability, then you must prove that your condition renders you incapable of substantially performing the primary duties of your current occupation.
For example, suppose you work as a financial analyst. Because of a disability, you cannot remain on task for more than 10 minutes at a time and are incapable of performing the complex, hours-long analyses necessary for you to perform your job as a financial analyst. In this case, you might qualify for own-occupation disability even if you can still do other, simpler work.
Sometimes, insurers deny benefits in the own-occupation context by arguing that the duties of your current occupation can be different, and that the duties of your current occupation are not indicative of the “norm” in the industry. If you experience this kind of pushback, consult with a lawyer immediately.
Any-Occupation
If your insurance policy includes an any-occupation definition of disability, then you must prove that your condition renders you incapable of substantially performing the primary duties of any other job for which you are reasonably qualified. This is an extremely strict definition of disability and often requires a nuanced approach to overcome.
In Illinois, you may still be entitled to receive disability benefits, even if you misrepresented certain facts on your original application, so long as those facts were not: 1) intended to deceive the insurer, and 2) material to the disability coverage.
For example, if you simply forgot to write about some minor health condition, the insurer cannot use that as justification for a denial (or rescinded coverage). Further, if the health condition is unrelated to the disability coverage — in other words, if they would have still extended coverage to you had you no misrepresented the facts — then the insurer is required to pay out benefits for a legitimate disability claim.
It’s worth noting, however, that the insurer may be entitled to payments to cover any difference that there would have been to the insurance premium.
If an insurer violates their duty of good faith, you should seek legal help from one of our Chicago disability claim attorneys. If you purchased your policy in a state where there is bad faith law, the insurer may be liable for significant compensatory damages. In particularly egregious cases, you may be able to bring a separate fraud claim, and the court may award punitive damages.
Bad faith conduct includes, but is not necessarily limited to:
- Fraud and other knowing misrepresentations
- Unreasonable delays in claim processing
- Intentional interference with claim processing
- Wrongfully denying a legitimate claim in order to force the policyholder to expend additional effort through litigation
- Refusing or failing to payout benefits (for an accepted claim)
- Failing to adequately investigate the submitted claim
- Failing to maintain consistent communication with the policyholder
- And more
Generally speaking, courts will find bad faith when the insurer has conducted themselves in a vexatious, unreasonable, or outrageous manner. For example, if the insurer failed to payout your benefits, but an investigation reveals that they simply had the wrong address and contact information in their system, it is unlikely that the court will find the insurer liable for bad faith (though they will almost certainly order the insurer to make the necessary payments).
- When it comes to supplemental income sources, such as passive income, inheritance, personal gifts, etc., your private disability benefits are generally entirely unaffected.
- Private disability benefits are a form of wage replacement, they are not income-variable.
- Whether you are rich or poor, you are entitled to the full disability benefit that was bargained for through the insurance contract.
Now, when it comes to Social Security Disability Insurance benefits, most ERISA long-term disability plans have an offset that requires you to apply for SSDI benefits. However, private disability policies usually do not have the same application and offset requirement. This is policy specific, and our experienced disability insurance attorneys are available for consultation in order to help you understand your policy.
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