Experienced ERISA Attorneys Serving The State of Illinois
The Employee Retirement Income Security Act of 1974 (ERISA) is the body of federal legislation that likely governs your employer-sponsored group disability insurance policy. It might sound like it’s protecting your financial interests, but the reality is often the exact opposite.
If you file a claim for benefits on your Illinois ERISA disability policy, your insurer may try various strategies to delay paying you or deny your claim outright. Unfortunately, as you’ll see, ERISA can help insurance companies with tricky, time-sensitive claim ending rules.
Luckily, there is an effective way to fight back if this happens to you; hiring an experienced Illinois ERISA lawyer with a track record of delivering excellent results for their disability clients.
Are You Entitled to ERISA Disability Benefits?
If your employer provides a group short- or long-term disability insurance policy for you as a perk of your employment and you suffer a sickness or accident that renders you disabled, you should become entitled to income replacement benefits once the elimination or waiting period on your policy has elapsed. These periods vary from one policy to the next, though they are typically significantly longer on employer-sponsored group plans than on individually purchased policies. (Some policyholders choose to supplement their employer-sponsored group policies with individual plans that have shorter elimination periods, meaning they won’t have to wait as long for monthly benefits to kick in in the event of the onset of a disability.)
In order to verify the nature and extent of your disability, you’ll have to visit your physician. They should document and confirm that your condition is preventing you from doing the essential duties of your occupation and any occupation by which you are trained, educated, or suited. They will also have to confirm that they gave you the most appropriate treatment for your sickness or injury.
Why You Might End Up Needing an Illinois ERISA Lawyer
From the claimant’s viewpoint, one of the major difficulties with ERISA is the mandatory administrative appeals process it sets out. If you have a dispute with an insurer over the benefits payments on an individually purchased policy, you have the right to take the company straight to court. Under ERISA rules, it’s not that simple.
When you submit an ERISA group disability claim and your insurance carrier rejects it, you must file an administrative appeal with the company, generally within a period of 180 days. This mandatory appeals process involves the compilation of an administrative record, which is a collection of all the documents up to the denial and new medical records and reports that relate to your claim during the appeal. Your insurer also contributes to the administrative record, but will only add the items of evidence that support their case. It’s up to you, along with your attorney, to make sure all the documents that benefit you are in the administrative record as well.
Your administrative record is crucially important. If your insurance carrier denies your administrative appeal, you generally cannot introduce any evidence outside of what’s in your administrative record in any subsequent ERISA disability lawsuit. So, if you fail to include a key record or report when submitting your administrative appeal, you could lose out later in federal court despite having a genuine claim.
Insurance companies are familiar with this dynamic and know how to take advantage of it. They often try to downplay the importance of the administrative record when interacting with claimants during the appeals process. Without the help of a highly experienced Illinois ERISA lawyer, many claimants in the state fail to realize the significance of doing a thorough, comprehensive administrative appeal and leave out crucial details on their medical, financial, occupational, and vocational/evidence.
How Do Benefit Offsets Work?
Illinois insurers will do whatever they can to reduce the amount they need to pay you in monthly group disability benefits. Benefit offsets are one means they use to achieve this.
Most group ERISA disability policies contain clauses stating that an alternative source of income can offset monthly benefits. So, if you begin receiving money from somewhere other than your insurance company following a successful initial claim, the company may be entitled to deduct that amount from your benefits each month.
In order to capitalize on these clauses, insurers require you to timely file for Social Security Disability benefits. The Social Security Administration generally does not view applicants as disabled unless they have a total disability. However, even if your condition does not satisfy this standard, insurers may reserve the right to withhold your benefits unless you submit an application for social security or workers’ compensation.
If you collect on a lawsuit against some third party causing your sickness or accident, this may also give rise to a dollar-for-dollar benefit offset.
Statistics on Disability in Illinois
According to the latest statistics from the Centers for Disease Control and Prevention (CDC), over 2.2 million Illinois adults are living with a disability of some kind. This number represents 23% of the state’s adult population.
The most common disabling conditions in Illinois are those related to mobility, affecting 11% of the state’s residents. Other prevalent categories of disabling conditions include cognition (10%), independent living (6%), hearing (4%), vision (4%), and self-care (3%).
Getting the Help You Need With Our Illinois ERISA Lawyer
Learning about the various difficulties associated with ERISA disability claims can be frightening, especially when you’re also coming to terms with an accident or sickness that’s left you unable to work and earn an income. Unfortunately, the federal legislation’s rules do leave many claimants without the income replacement benefits to which they’re entitled. An Illinois disability lawyer can help you.
If you want to minimize the risk of a wrongful denial, you need a seasoned Illinois ERISA disability attorney in your corner. Contact DarrasLaw today to start working with one of our top ERISA disability insurance lawyers. We offer initial claim, appeal, and policy analyses free of charge. Remember, filing a timely administrative appeal after an initial ERISA disability denial is crucial, so don’t delay in starting the process.