With affluent suburbs like Greenwich and Westport and busy cities like Stamford and Bridgeport, Connecticut has a high concentration of insurance companies. Hartford, located in central Connecticut, has been nicknamed “The Insurance Capital of the World.” Connecticut is the corporate home of Travelers Insurance, The Hartford, New York Life, and many others.
Licensed to practice law in Connecticut, Justin Frankel and Jason Newfield are dedicated disability insurance attorneys. We represent clients in disability benefits claims where employers provide the policies (ERISA or group policies) and high-income-earning individuals who own private disability insurance policies. If you need help with your long-term disability insurance benefits claim or appeal of a denied or terminated claim, don’t hesitate. Contact us at 877-583-2524 or use our online contact form to request your free consultation.
The exact amount of benefits your long-term disability insurance will pay varies based on your situation and the terms of your contract, but insurance companies tend to use the same factors to determine the total based on your income. The kind of policy you opt for also affects the amount of benefits you’ll be paid, but it tends to be between 50 percent and 66 percent of the income you earned before the onset of your disability.
Keep in mind that there is a maximum amount of benefits you can receive regardless of your previous earnings. Your plan may include a cost of living adjustment (COLA). This allows your benefits to increase each year, depending on inflation or other policy terms.
Are you an employee at a company that owns a disability insurance policy paid for through wage deductions? If so, your disability policy is governed by the Employee Retirement Income Security Act (ERISA). This federal law was created initially to protect pension funds from unscrupulous employers. Today, ERISA governs all retirement, disability, and healthcare needs of employees. While the intent behind the creation of ERISA was to protect employees, insurance companies now use it to constrain the process of appealing denied or terminated long-term disability benefits.
ERISA tends to cover group insurance plans, while private long-term disability (LTD) plans are more individualized. Because of this, ERISA plans tend to be less expensive overall, but an individual LTD benefits plan can be more comprehensive when covering one’s specific needs. While coverage specifics can change depending on the policy, ERISA plans tend to define a disability as something that prevents you from doing your occupation. However, it will use the “own occupation” definition for a set period of time (typically 12-24 months), after which they will reevaluate if your disability prevents you from “any occupation.”
Individual long-term disability plans can be more comprehensive and cover disabilities like depression, chronic fatigue, and fibromyalgia, which are all disabilities that ERISA policies may limit the benefit period in their coverage of that disability. These individual long-term disability plans may also have a higher monthly maximum of benefits under the law, while ERISA plans may cap their benefits at $10,000 or even $5,000 per month.
The appeals process for denied or terminated claims also differs based on whether you have an ERISA plan. ERISA has its own internal appeals process that must be exhausted before you can move forward with any kind of lawsuit. This appeals process is known as administrative appeals. If you hold private long-term disability insurance, you can go straight to filing a lawsuit for your denied or terminated claim. The process provides more protection for private disability insurance policies.
Your deadline to file a long-term disability insurance claim in Connecticut will vary based on your specific policy. That is why you must contact a long-term disability insurance attorney as soon as possible to review the requirements of your specific policy.
You may find that some policies are packed full of special conditions that can alter the allotted timeline. Remember, insurance companies do whatever they can to avoid paying out benefits, so filing your claim as soon as possible is in your best interest. When you file quickly and accurately with the help of an experienced long-term disability insurance claims lawyer, you can avoid any stipulations that could shorten the time frame.
Don’t wait to get started on your long-term disability insurance claim. Contact us at 877-583-2524 to schedule your free consultation.
Filing a long-term disability insurance claim in Connecticut involves several steps, and you must complete each step to have a chance at benefits. Today most companies require claimants to use an online portal, but this is not always in the claimant’s best interest. However you file your claim, you must keep copies of all records provided to the insurance company and you must document delivery of the documents. Anything sent to the insurance company should require a signature on delivery.
To submit a long-term disability claim, you must complete a number of forms to document the severity of your condition. These forms provide evidence to the insurer that you are eligible for benefits under the conditions of your policy. Note that these documents are specifically to demonstrate long-term disability. Here are some of the documents you will need.
Your personal statement briefly summarizes your claim and who you are. It includes your name, address, workplace, disability details, income sources, other benefits, and more. You may even have to include your insurance information and doctor’s name. The exact requirements will be detailed in your policy.
Given that these documents are primarily designed to demonstrate your condition to your insurer, a statement from your attending physician is extremely important evidence. Your doctor needs to make a statement that shows the extent of your disability and functional impairments. The attending physician’s statement (APS) highlights your diagnosis, history with the condition, and treatment history. The doctor will also detail your level of impairment regarding both mental and physical condition. The reports must show not just that you are disabled but what tasks and duties you cannot perform as a direct result of your disability. Having a long-term disability insurance attorney help the doctor draft the APS can help make it a persuasive piece of testimonial evidence when fighting for your benefits.
Your employer’s statement describes your work responsibilities and role within the organization. This statement should include the specific duties of your position and how your disability prevents you from accomplishing them. Specifically, your employer should provide a checklist of tasks you were previously responsible for that your disability has prevented you from completing.
Should you start receiving long-term disability benefits, your insurer will need a place to put the money. Include direct deposit information in your claim to indicate where the funds should go. This process is similar to signing up for direct deposit with an employer, so all you need is bank information and potentially a voided check to submit alongside the other benefits claim forms.
Disability insurance claim denials occur for various reasons. The following are the most common reasons a claim may be denied.
With disability insurance claims, it is on you to demonstrate the severity and nature of your disability. If you fail to present the proper medical evidence, the claim may be denied because the insurer may refute that your disability exists or that it prevents you from performing the tasks and material duties of your occupation.
Every insurance contract can potentially use a different definition of disability. For example, one contract may define disability as something that prevents you from doing your job, known as “own occupation,” while another may define disability as something that prevents you from doing any job, which is defined as “any occupation.” In many policies, the first 24 months of benefits are for your “own occupation,” and then the contract switches to “any occupation.” This is often when claims are terminated. If your condition is not included in your policy’s definition of disability, your claim may be denied.
Many insurers will be eager to deny your short-term or long-term disability claim if you can work. The level of severity that your disability must reach to qualify for long-term benefits can be tricky to define, so insurers will often argue that you do not meet the requirements.
There are also disability insurance policies that address the issue of being able to work but in a dramatically reduced manner. This is known as a residual claim, and an experienced long-term disability insurance attorney will be needed to navigate this complex type of claim.
Your policy may have a waiting period before you can file for long-term disability benefits. If this waiting period has not yet expired, your claim will not be accepted.
Deadlines are critical and often strict regarding disability insurance claims. Going through the details of your contract and working with a disability insurance lawyer can help you meet all the necessary deadlines. In the case of an ERISA policy, a missed deadline may mean you permanently lose the right to file or to fight a claim.
Quite a few technicalities can get between you and long-term disability insurance benefits. These come in many forms, most often including filing errors, missing documents, and coding errors.
When you file a long-term disability claim, the insurer will investigate it thoroughly. They may even capture video surveillance of you when you think you are not being recorded. If you do not appear disabled in the footage, they will use it against you.
If your long-term disability insurance claim has been denied, call us at 877-583-2524 for a free consultation. We know the insurance companies’ tactics and will fight for you.
The process of an ERISA appeal is rigorous and has strict deadlines. This is not an area of the law that can be navigated easily by someone with no legal experience in ERISA law.
One of the more significant problems with an ERISA appeal is that the very same entity that is denying a benefits claim is also the one that is in complete control of the appeals process. It feels as if the claimant can’t possibly win an appeal. However, powerful legal representation and experience in this area can make a difference.
The ERISA appeal has two purposes. One is to fight the denial of benefits. Frankel & Newfield has successfully appealed denied benefits for many of our clients, although each situation differs.
The other part of the ERISA appeal is creating a thorough and complete record for any necessary future litigation. The evidence allowed in an ERISA appeal is limited and specific. The only medical records that can be referenced are those in the insurance company’s file. This is why we advise clients to retain us before they file a long-term disability benefits claim. The correct medical records must be in the file, including full documentation of all relevant tests and procedures. The treating physician must understand the importance of the doctor’s notes within the file.
In most cases, denied ERISA claims will come with details explaining how you can file an appeal. Double-check that the insurer has all your contact information so you do not miss out on any deadlines from not receiving the information on time. Filing earlier can be beneficial because the timeline to make an administrative ERISA appeal and the timeline to file a lawsuit are not counted separately. If you file an administrative appeal that gets rejected and then pursue a lawsuit, the federal judge will use the record created during the administrative appeal as part of the case.
With non-ERISA appeals, you only have to deal with your individual disability insurance company. While you can deal with them directly, nothing prevents you from going straight to a lawsuit if your benefits claim is denied. However, that may not always be the simplest or most effective option, so it is important to consult with a Connecticut disability insurance lawyer first to determine your options based on the stipulations of your specific policy.
Disability insurance attorneys understand disability cases and can guide you through the often-complicated process of filing benefits claims and appeals. Here are just a few ways a disability lawyer can help with your Connecticut long-term disability insurance benefits claim.
Documentation and proper filing is essential in any long-term disability claim or appeal. A Connecticut disability insurance lawyer will know what kind of paperwork is required for your specific benefits claim and can help put everything in order every step of the way. A long-term disability attorney can even go so far as to collect important documents for you, like a doctor’s statement.
Insurers are not there to help you get disability insurance benefits, and medical providers are trained in medicine, not disability law. Because of this, having a disability insurance lawyer work with you can help you communicate effectively with these parties. While a doctor may write up a statement that they think accurately describes your condition, a lawyer can help them with the wording to include all the details that insurers and the courts are looking for in your filing. Plus, a lawyer can communicate with insurance companies on your behalf, and an experienced Connecticut long-term disability insurance claims lawyer will know the common tricks insurers try to use to deny you benefits.
Deadlines in disability insurance benefits cases are absolute, and a Connecticut disability insurance lawyer can help you meet all the necessary deadlines. It is already enough work to make your benefits claim as strong as possible without getting denied due to a missed deadline.
Having a long-term disability insurance lawyer by your side means you get professional representation throughout the entire process. That includes filing the initial claim for benefits and filing the appeal if those benefits are denied. A Connecticut disability insurance lawyer can help represent your interests in pursuit of a settlement and even represent you in federal court if required.
Ready to get started? Call today at 877-583-2524 to schedule your free consultation.
Living with a disability is hard enough as it is, so connect with a lawyer to take care of the legal claim process for you. At Frankel & Newfield, PC, we put our extensive experience to work for your case. Our law firm’s clients in Connecticut, from Hartford to New Haven, work directly with our partners, so you get the full effect of our legal team’s history of success right by your side.
If you are about to file a long-term disability insurance benefits claim in Connecticut or are in the middle of an administrative ERISA appeal for a denied claim and feeling overwhelmed, call our office for a free consultation to learn how we can help. We provide custom legal advice for every case and condition.
Secrets the Disability Insurance Companies Don't Want You to Know!