Experienced ERISA Attorneys Serving Clients in Chicago, Illinois
According to data the US Census Bureau collected between 2016 and 2020, 7.2% of Chicago residents under the age of 65 have a disability of some kind.
When an accident or illness prevents you from doing your full- or part-time occupation, you may be able to rely on an employer-sponsored group disability insurance policy to sustain your income. However, the claims and appeals process for disability insurance benefits is far from straightforward, particularly for group policies (also known as ERISA disability policies).
Our award-winning Chicago ERISA lawyer has helped a large number of claimants in The Windy City to secure income replacement benefits despite wrongful delays and denials by their insurance carriers. In fact, our founding partner Frank N. Darras was born and raised in the Chicago area.
Do You Have a Chicago ERISA Policy?
Before considering the differences between various types of short- and long-term disability insurance policies, it’s important to figure out which category your own policy falls into. If your plan is employer-sponsored, as is the case with the majority of short- and long-term disability insurance policies, it will most likely be governed by ERISA. However, if you bought a policy yourself rather than receiving it as a perk of employment, the legislation’s rules may not apply to that plan.
ERISA (or the Employee Retirement Income Security Act of 1974) sets out federal rules and minimum standards in relation to most employer-sponsored group disability insurance policies. There are some limited exceptions to this, including some group policies granted by religious organizations and government agencies. Chances are, however, that your employer-sponsored short- or long-term disability insurance policy falls under the scope of ERISA.
It’s also worth noting the difference between individual or group long-term disability insurance and Social Security Disability Insurance (SSDI). Any American worker who has earned a sufficient number of Social Security contributions through their tax payments is eligible to apply for SSDI; no insurance policy, employer-sponsored or otherwise, is necessary. However, in order to qualify for SSDI benefits, you must have a total disability that prevents you from doing any occupation. Also, your disability must last for more than twelve months.
The ERISA Appeals Process
Any good disability insurance attorney will tell you that the ERISA legislation makes life more difficult for group policy claimants than people applying for monthly benefits under an individually purchased plan. The main reason for this is the ERISA mandatory appeals process.
When a group insurance carrier rejects your initial ERISA disability claim, they direct you to submit an administrative appeal. The administrative record is the entire collection of everything done through denial and new or updated medical records and reports that you and your insurance company collectively submit during this appeal. Crucially, ERISA provides that you cannot take your insurer to court before partaking in this mandatory appeals process, and also that you cannot use any record or report in any subsequent federal lawsuit unless it’s in your administrative record or part of the initial claim.
This means many valid claims fail because claimants make fatal mistakes when compiling their administrative records. To give yourself the best possible chance of success, you need to file a thorough, comprehensive appeal in a timely fashion, including all items of medical, vocational, occupational and financial evidence that back up your case. The appeal must clearly set out how your sickness or injury is preventing you from carrying out the essential duties of your full- or part-time occupation. It must also refute any medical opinion from the insurance company along with all your vocational proof supporting your claim.
ERISA law also means that you do not have the right to a jury trial. You cannot call witnesses to support your case, nor can you cross-examine opposition witnesses as no one is coming to court. The federal judge will look at what happened during the denial and the appeal and rule.
These complicating factors make the assistance of an expert Chicago ERISA lawyer hugely beneficial. Without an attorney’s assistance, you’ll incur a much higher risk of claim failure.
Does Your Condition Qualify for Chicago ERISA Disability Benefits?
Disabling conditions lie on a broad spectrum. The most common categories of disabilities that affect Chicago residents are mobility or ambulatory conditions, loss of hearing, loss of vision, depression, long COVID and cognitive conditions.
In order to succeed in a group short- or long-term disability ERISA insurance claim, you must;
- Visit your physician and have them confirm how your illness or injury is preventing you from performing in the workplace. If your policy uses an “any occupation” definition of disability, which most ERISA plans do, your condition must be serious enough to prevent you from doing any work for which you are trained, educated, or suited with reasonable continuity.
- Receive the “most appropriate treatment” for your illness or injury from your physician.
- Wait for the elimination period on your policy to elapse. These periods vary from one policy to the next, though they are typically significantly longer on group policies than individually purchased plans. You’ll have to research your plan document to figure out what elimination period applies in your case.
The Role of Your Employer in Your Chicago ERISA Claim
You might think your company’s HR department would be fighting in your corner in any dispute over your claim with their disability insurance provider. While every employer is different, it’s important to understand that employers typically are not reliable allies in ERISA disability disputes, for a couple of reasons.
Firstly, group disability insurance premiums can be expensive, and successful claims can make them even costlier. Therefore, your employer has a financial interest in seeing your claim fail. While that doesn’t mean they’re going to work against you, it does mean they have no incentive to do their best to help.
Additionally, HR executives are not legal or insurance experts. Even if they do their best to assist you, they won’t be able to effectively respond to the less than honorable tricks of an ERISA insurance provider.
So, while your employer may be of some limited assistance, they won’t be a substitute for an expert Chicago ERISA lawyer, like those that work at DarrasLaw. Our founding partner Frank N. Darras is a native of Chicago, and he’s ready to fight against the faceless insurance conglomerate that’s standing between you and financial security.
When It’s Time to Hire a Chicago ERISA Disability Lawyer
Are you confused about how you should approach your initial ERISA claim filing? Has your insurance carrier delayed or denied your income replacement benefits without being clear about the reasons why? Are you worried about making a fatal mistake on your appeal that could irreparably damage your claim?
If so, it’s time to contact DarrasLaw. Our Chicago Disability lawyer has a track record of succeeding in difficult battles against insurance companies, on claims both big and small. If you’ve already encountered an initial claim rejection, don’t delay in starting the process. Filing a thorough and comprehensive appeal in a timely manner is crucial if you want the best chance of emerging with the monthly benefits to which you’re entitled.