SHORT & LONG TERM DISABILITY INSURANCE (ERISA) CLAIMS

Much of this Firm's practice concentrates on representing individual claimants in the pursuit of short-term disability (STD) or long-term disability (LTD) claims.

As a general matter, many employers offer STD and LTD coverage as part of an employee's benefit package. In most instances, an employer contracts with an insurance company, which then issues a "group" policy. STD and LTD coverage is intended to provide an employee with replacement income (usually from 50 - 66 2/3% of prior earnings) in the event that the employee becomes disabled, regardless of whether the disability is caused by illness or injury, and regardless of whether it has anything to do with the workplace. (Note that this is different than Workers' Compensation coverage which applies only when one is injured at work.) Typical LTD coverage includes the promise of continuing benefits until the employee either recovers from the disability or reaches retirement age.

The federal statue, the Employee Retirement Income Security Act of 1974, commonly known as "ERISA," applies to most STD and LTD plans. ERISA requires that the plan be administered to meet certain standards. For example, it provides that a claimant must be given an opportunity to appeal a denial of benefits, and it sets up specific time-frames and other requirements to which the claimant and the insurer or "administrator" must adhere. ERISA also provides a claimant the opportunity to challenge a denial of benefits in the federal courts.

But, for all of ERISA's mandated procedural requirements, over the past several years the federal courts have effectively reduced a claimant's protections under the Act.

And, of course, the insurers of STD and LTD benefits will seize on any opportunity to deny benefit claims.

In light of the limit of legal protections for claimants and the propensity of insurers to close claims, it is important that each claim be carefully developed with an eye to possible future litigation.

Contact us if you believe you could benefit from our experience in STD and LTD claims.

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