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ERISA Attorney Answers Disability Policy FAQs: Part 2
7March 18

ERISA Attorney Answers Disability Policy FAQs: Part 2

What Benefits Can I Receive Through a Disability Insurance Claim?

ERISA attorneyIf your disability claim is approved, you will receive a percentage of your salary and wages. You may also be eligible for cost-of-living increases. Because every disability insurance plan is different, you should rely on your plan’s summary plan description (SPD) for more detailed information.

If you need help interpreting the SPD, speak with an experienced ERISA attorney.

Can I Work and Still Receive Disability Insurance Benefits?

Depending on the language in your disability insurance plan, you may be eligible for benefits while working. Carefully read your plan’s summary plan description (SPD) for more information.

First, determine whether you have an “own occupation” or “all occupation plan.” You have a disability under an “own occupation” plan if you are unable to perform the material duties of your last job. You are eligible for benefits under an “all occupation” plan if you cannot perform any work within the national economy.

“Own occupation” plans may allow you to work and receive benefits. However, some “own occupation” plans will not pay benefits if you are working. (Again, read your plan’s SPD for guidance.) Others may pay partial benefits.

Additionally, some “all occupation” plans allow for full or partial disability if you are limited to part time work or your earning capacity is dramatically reduced. It can be difficult to interpret the disability requirements of your SPD. If you need help, contact an ERISA attorney.

Can the Insurance Company Reduce My Disability Benefits?

Many disability insurance plans allow the company to reduce or offset your benefits by the amount of Social Security Disability you receive. If your monthly Social Security check is larger than your disability insurance benefit, your insurance checks may stop (unless there is a minimum benefit set out in the plan).

Some disability insurance plans also allow for offsets for workers’ compensation and personal injury benefits.

Can I Appeal a Disability Insurance Denial?

Yes. ERISA sets out a specific appeals process for disability insurance claims.. First, you must file an appeal with the insurance company. This first level of appeal is very important — you cannot submit additional evidence after the insurance company denies your appeal.  (It is probably in your best interest to hire a skilled ERISA attorney before filing the first-level appeal.)

If the insurance company denies your appeal, you can file a complaint with the federal courts. At the federal court level, a judge or magistrate will review your claim and issue a decision. Typically, there will not be a hearing and you will not testify.

Do I Need an ERISA Attorney in a Disability Insurance Claim?

Disability insurance claims require a lot of technical analysis. In order to win a disability insurance claim, you must interpret ERISA law, medical and vocational evidence and the insurance policy’s language. Most disabled workers do not have the ability to perform this analysis on their own. Instead, they rely on an experienced ERISA attorney.

Additionally, there are strict evidentiary rules in ERISA claims. It is almost impossible to submit evidence after the insurance company has denied an appeal. If your disability insurance claim has been denied, you should contact a skilled ERISA attorney right away. A lawyer can help you build a complete evidentiary record and give you the best possible chance of winning your claim.  

How Are Disability Insurance Lawyers Paid?

Most disability insurance lawyers receive payment on a contingency basis. This means that they do not have entitlemtn to an attorney fee unless you make a recovery. Your ERISA attorney should explain the fee schedule at your first appointment. Do not sign a contract with an attorney unless you understand and agree to his or her fee schedule.

Additionally, a federal judge may order the insurance company to pay your attorney fees in ERISA appeals.

Click here to read Part 1.

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