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Understanding
Long Term Care Disability
Long-term disability or LTD refers to disability
insurance policies. There are basically two types of disability
policies. At Daggett Shuler we have experience with both types of
policies. If you have a question about a disability policy, you
can talk to us for free.
The most common is “long-term disability benefits”
that are offered by employers as part of an employee benefits package.
Often combined with short-term disability, these benefits are available
to employees if they become disabled through an injury or sickness
while they are covered by their respective benefit plan. Most often,
an insurance company that actually provides insurance coverage for
the employees under the benefit plan processes long-term disability
claims. The Employee Retirement Income Security Act or ERISA governs
the claims procedures that employers must follow.
In addition to long term disability benefits provided
through an employee benefits package, long term disability coverage
can also be obtained through an individual policy purchased from
an insurance company. These policies provide disability benefits
to individuals that meet the policy’s definition of a disabling
condition while they are covered under the policy. Since these policies
are purchased privately from an insurance company, the ERISA statute
does not govern them.
How do you file a claim for long-term disability
benefits?
Most employer sponsored plans have specific procedures that must
be followed in order to file a claim for long-term disability benefits.
Once a claim is filed, and then the claims administrator, which
is usually an insurance company, has a certain amount of time to
investigate and make a decision on the claim. If the claim is denied,
then an individual usually has the right to challenge the decision
through an administrative appeal. An individual’s rights and
the procedures that must be followed for the appeal are specified
in the ERISA statute and the benefit plan. If an individual’s
claim is ultimately denied through the available administrative
appeals, then the only recourse is to file a lawsuit under the ERISA
statute.
When do you need an attorney to help you
with your long-term disability claim?
Most individuals are able to file a claim for long-term disability
benefits without the help or assistance of an attorney. Frequently,
personnel from the employer’s human resources or benefits
department can help an employee get the process started by filing
a claim. However, if the claim is denied, then an individual should
seek the advice and counsel of an attorney experienced in long term
disability cases. This is because the administrative appeal process
is fraught with traps and pitfalls. The single most important pitfall
is the failure to develop the administrative record during the appeal
process. If this happens, then a case can be irreparably harmed
for future litigation. This is because the administrative record
is generally the only evidence a reviewing court will consider and
the record is closed at the end of the administrative appeal process.
Consequently, a claim has to be prepared for litigation during the
administrative appeal process.
Daggett Shuler can help you with your long-term
disability case!
At Daggett Shuler, our attorneys are experienced in handling ERISA
and private long-term disability cases. Ideally, with employer sponsored
ERISA cases, we like to get involved as soon as the claims administrator
denies the claim so that we can appeal the decision immediately.
This allows us to develop the administrative record in the event
a lawsuit has to be filed. If a claim is denied through the administrative
appeal process, then we have the experience and knowledge needed
to litigate the claim.
If your long-term care benefits have been denied,
you can talk to us for free, and we’re paid only if we collect
for you. Click here for a Free Case Evaluation
or call 1-800-815-5500.
Daggett Shuler, you can depend on us.
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