Skilled ERISA Attorneys Serving Those in The State of Ohio
Statistics from 2019 show that the rate of disability in Ohio (14%) is markedly higher than the national average. Many Ohioans, therefore, have to rely on their employer-sponsored group short- and long-term disability insurance benefits for their income. Unfortunately, as many people who have filed claims of this nature will tell you, the process can be extremely challenging. Our Ohio ERISA attorney has helped clients across the state deal with unfair denials and wrongful delays from their insurance companies. From Cincinnati to Cleveland, we’re ready to come to your assistance when you need it most.
Why ERISA Can Hurt Disabled Claimants
The Employee Retirement Income Security Act of 1974 (ERISA) sets out rules and standards for the majority of employer-sponsored group short- and long-term disability insurance policies. In particular, it lays down specific mandatory procedures when it comes to claims and appeals.
If you file a claim for monthly disability insurance benefits on an employer-sponsored policy and your insurer rejects it, there is a mandatory appeals process, per ERISA rules, that you must complete before you can take the company to federal court. Part of this process is the compilation of an administrative record, which is an exhaustive collection of all the medical, vocational, occupational, financial, and other reports and data that relate to your claim, as well as the legal precedent that applies in your area. Your insurance company will also contribute to this record, but it will generally only contribute the information that supports its side of the story. You (along with your Ohio ERISA attorney) need to take responsibility for adding all the records and reports that support your case.
Though group insurance providers frequently try to downplay the significance of a comprehensive administrative record, it is critically important. If your insurer rejects your appeal, you can sue the company in federal court. However, you may not generally introduce any record or report in that lawsuit unless it appeared in your initial claim filing or your administrative record. So, if you fail to include a vital piece of evidence at this stage, it could doom your claim.
There are some exceptions to ERISA’s jurisdiction in terms of employers. If you work for a church, the government, or a school, ERISA rules may not apply to your claim.
When You Become Entitled to Benefits Under an Ohio ERISA Disability Policy
The first step to take after developing a sickness or injury that has left you unable to work as normal is to pay a visit to your physician. Before you can file a claim on your ERISA disability policy, they must confirm that your condition would prevent you from carrying out the necessary duties associated with your occupation, or any occupation for which you are trained, educated, or suited. They must also administer the most appropriate treatment for your condition.
Additionally, you must allow the elimination or waiting period on your policy to elapse before you start to collect monthly benefits. On employer-sponsored policies, these periods average 180 days.
The Difference Between Individually Purchased and Employer-Sponsored Group Disability Insurance
There are a host of differences between individually purchased disability insurance policies and their ERISA equivalents.
First, no mandatory appeals process exists in relation to individually purchased long-term disability insurance policies. If you purchase an individual policy and your insurance carrier attempts to delay or deny your claim, you can file suit against the company in state or federal court straight away. The appeals process tends to be quicker for individually purchased policies than ERISA plans. Also, you may seek emotional distress and punitive damages in a lawsuit related to an individually purchased policy, whereas this is not possible in an ERISA lawsuit.
Another important distinction to be aware of is the tax implications of your monthly benefits payments. If your employer funded the premiums on your disability insurance policy fully, without any contribution from you, your benefits will generally be treated as taxable income. On individually purchased policies, however, the authorities may hold that you discharged your tax liability when paying your premiums individually, allowing monthly benefits to flow to you tax-free.
In general, the terms on individually purchased long-term disability insurance tend to be much more favorable than those on their employer-sponsored group disability counterparts. Individual policies usually have shorter elimination periods, more generous disability definitions, and broader coverage, and they often pay a higher percentage of your working income in benefits following a successful claim.
It’s important to note that no two insurance policies are the same. In order to figure out exactly what kind of disability coverage you have, you should research your own policy document and seek free policy analysis help from a stellar Ohio long-term disability lawyer.
Disability Statistics in Ohio
Statistics show that Ohio is the seventh-biggest state in America by population. Of the state’s adult residents, the CDC estimates that around 28% suffer from a disability of some kind. Disabling conditions related to mobility are the most prevalent type, affecting 14% of the state’s adults. The other most common categories of disability in the state are cognition (12%), independent living (8%), hearing (6%), vision (5%), and self-care (4%).
How an Ohio ERISA Attorney Can Help You
So, as you can see, ERISA disability claims pose a unique set of challenges. Not only are you dealing with a massive insurance conglomerate that likely has no intention of playing fair, you’re also contending with federal legislation that plays right into the insurer’s hands.
For these reasons, it’s crucial that you enlist the services of a top-rated Ohio ERISA attorney if you become entangled in a dispute with your disability insurance provider. Contact DarrasLaw today to schedule a free initial policy or claim analysis. Remember, time is of the essence if you’ve already met with a claim denial; once you get in touch with our firm, we can start putting your appeal documents together right away.