Ten Things You Should Know About ERISA Disability Insurance Benefits

Make Sure You Know Everything You Can Before You File

If you have become disabled and unable to continue to work, you may qualify for long term disability benefits under an LTD plan with your employer. Long term disability policies are designed to help you replace some of your income when you become disabled while employed. Most group LTD policies are subject to E.R.I.S.A (the Employment Retirement Income Security Act), which is a federal law.

There are many important things to know about ERISA and long term disability benefits but here are the top 10:

  1. The exact definition of what “disability” means in your policy. Even if your doctors agree that you are unable to work, you must primarily concern yourself with the definition of disability as it is written in your policy. Your disability must satisfy the contractual definition of the term “disability” or you will be denied benefits.


  1. Does your policy have a waiting period? Most long term disability policies have a waiting period of 90 to 180 days. This means that you will have to wait between 90 and 180 days to receive your benefits even if you are approved right away. Make sure you have made payment arrangements with your creditors and talk with your family about your situation so you can be more prepared during this waiting period.


  1. You could be under surveillance. When filing for LTD benefits, you may be under surveillance. It’s not uncommon for insurance companies to have claimants put under scrutiny by a private investigator when applying for benefits. Always follow your doctor’s orders, you never know who is watching. This also goes for social media. More insurance companies are monitoring the social media activities of claimants. If you are not supposed to be lifting significant weight or bending, but the insurance company adjuster sees a picture of you rock climbing in the mountains or lifting your grandchild for a picture, the adjuster may assume you are not truthful about your pain level.


  1. Your monthly payment is likely to be taxed. Whether benefits are taxable depends entirely upon who paid the premiums for the LTD benefits while you were working. If the employer paid for the LTD insurance premiums, then any benefits paid under a claim are taxable. If the claimant paid the premiums while working, then the benefits are not taxable. Unfortunately, most group policies are paid in full without withholding taxes. This means that the tax bill gets passed on to you if the benefit is taxable. For example: a $400 payment will be subject to federal, state and/or local tax. This is usually a shock to first-time beneficiaries so plan your budget with the adjusted amount in mind, not the gross amount.


  1. You will be encouraged to apply for Social Security Disability benefits (SSDI and/or SSI). If you are granted long term disability benefits, you will probably be encouraged to apply for social security disability. That is because most insurance companies can lower payments to you if you receive SSDI/SSI benefits, paying only the difference between your LTD and SSDI/SSI benefits.


  1. Your medical record is critical to your claim. Before applying for benefits, talk to your doctor about your intent to apply for LTD benefits. Discuss with your doctor your medical file and make sure your doctor has noted all of your symptoms, including complaints about pain which are usually left out by doctors. Make sure all the dates are correct for office visits, and test results are all together in your file.


  1. You will likely only receive a portion of your salary. If you are approved, you will not receive your entire salary. You will receive a portion which is usually 60-80%, depending on your policy. Make sure you review the exact terms of your policy to know what you should receive. Plan your new budget with that number minus taxes.


  1. Benefits will likely end. Some policies will pay until retirement age, but most policies do have a limit, such as a 24 month maximum or to age 64. Check your policy for the exact number of years you can plan to receive benefits.


  1. Most mental health benefits are limited. Most policies have a minimal amount of time that you can receive benefits for mental health conditions like depression and anxiety.


  1. The insurance company decides if you qualify. The insurance company and/or adjuster will determine if you are eligible for benefits. Your case will only go before a judge if you appeal the decision. It’s not uncommon for insurance companies to deny claims the first time.


If you are denied long term disability benefits, you should file an appeal. Under most policies you can appeal the decision multiple times. It is common for benefits to be denied by insurance companies and move on to a judicial court.

Hiring an experienced LTD attorney to represent you in court is a great way to increase your chances for approval of benefits; The attorney will help you gather facts to support your case and will not get paid a fee until you receive your past due benefits or a settlement.

Although based in Florida, the Ortiz Law Firm is a national LTD law firm and represents claimants across the United States. If you’d like to speak to one of our Long-Term Disability Insurance Attorneys contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine whether you qualify for Long-Term Disability Insurance Benefits and how to navigate the appeals process if your benefits have been denied or terminated.


How to Appeal a Long Term Disability Claim Denial

Long Term Disability Process with Our Firm