Those who have become disabled and unable to work because of a serious injury or long-term illness may qualify to file an ERISA claim. Benefits cover both short-term and long-term or permanent disability.

Long-term disability (LTD) insurance policies are provided by private insurers through employee benefit programs, and are regulated under federal ERISA rules. How much compensation you will receive and for how long depends on the insurer’s definition of “disability” as outlined in the declarations sheet, however; it is a good idea to understand the terms of the policy before filing an ERISA claim.

What is ERISA?

ERISA stands for “Employee Retirement Income Security Act.”  Signed into law by President Richard Nixon in 1974, ERISA is actually a number of statutes that together, protect the interests of workers in the private sector by regulating employee benefit plans by establishing minimum standards. It does this in three ways:

• Mandates full disclosure of all policy information to insureds
• Establishes a code of ethics for plan administrators
• Provides legal remedies and access to federal courts in case of a dispute

Interpretation and enforcement of ERISA statutes are the responsibility of the Labor and Treasury Departments as well as the Pension Benefit Guaranty Corporation.

What Happens When I File an ERISA Claim?

If a disabling injury or illness makes you unable to carry out your work duties and you file a claim on your coverage , your employer and/or the insurer will try to determine the validity of your claim according to their definition of disability.

Under some coverage, “disability” is defined as the inability to perform job duties specific to your occupation. Other coverage defines it as the inability to work in any occupation at all. In some cases, the definition will change after a period of time of receiving benefits (generally 2 full years) from inability to do your own job to being unable to work in any occupation.

Are My Benefits Taxable?

It depends. Benefits from an employer-provided group policy that was paid for by pre-tax funds may be subject to withholding. Those from an individual policy paid for with the policyholder’s own net earnings (after withholding) should not be taxed.

What if My ERISA Claim is Denied?

Under ERISA, the administrator of the LTD must either approve or deny your claim within a certain period. If your ERISA claim is denied, you have the right to file an appeal. If your appeal is denied, and you have reason to believe the denial was unfair, you may be able to take legal action against the the administrator.

Some companies that administer LTD plans make it a point to deny as many claims as possible, and have been successfully sued for hundreds of thousands, even millions of dollars.

Note that if your long term disability is the result of a work-related injury or illness, you may not be covered by ERISA. If this is the case, you will need to file a claim with your state’s Workers Compensation program. In either case, you will also need to apply for Social Security Disability Insurance as well.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The bad faith insurance attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual lawsuit or Unum class action lawsuit is best for you. [In general, Unum bad faith lawsuits are filed individually by each plaintiff and are not class actions.] Hurry — statutes of limitations may apply.

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