Skilled ERISA Attorneys Serving Clients in The State Of Oregon
Does your Oregon employer provide you with short- or long-term group disability insurance as a perk? If so, that policy is more than likely governed by a body of federal legislation called the Employee Retirement Income Security Act of 1974 (ERISA).
Although the legislation purports to protect the insured employees, the reality is often quite different. ERISA sets out mandatory claims and appeals processes that benefit insurance companies more than the people they insure.
For that reason, it’s usually a good idea to hire an award-winning Oregon ERISA Lawyer if you’re embroiled in a dispute with your group disability insurance provider.
The Difference Between Individually Purchased & Employer-Sponsored Group Disability Insurance
There are many similarities between employer-sponsored group disability insurance (or ERISA disability insurance) and individually purchased disability insurance. Both should provide you with total or partial income replacement benefits, in the event you develop a disabling illness or injury. However, there are a number of important differences too.
ERISA sets out a mandatory appeals process claimants must complete prior to filing a federal lawsuit in the event of a claim denial. After you receive notice of an initial rejection, you generally have 180 days to submit a timely, comprehensive administrative appeal. Part of this mandatory appeals process is the compilation of an administrative record, which is a record of all the medical, financial, vocational, and occupational reports and other data, as well as the location-specific legal precedent, that relate to your disability claim. You and your legal team are responsible for ensuring that the administrative record contains all the important information that supports your side of the story in the dispute with your insurer.
Failure to include all relevant pieces of evidence in your administrative record can have dire consequences. If your insurer rejects your appeal, you can sue the company in federal court, but you generally cannot introduce any evidence in that lawsuit unless it appeared in your initial claim filing or your administrative appeal. So, even if you have a valid claim, an overlooked item of evidence during the appeal stage could force a judge to reject and deny your case.
No such mandatory appeals process applies to individually purchased policies. If your insurer tries to delay or wrongfully deny benefits arising from your policy, you can simply take the company straight to state or federal court.
There are also differences between ERISA group disability policies and individually purchased policies once you make it to court. Firstly, you cannot file an ERISA disability lawsuit in state court, but this is possible with individually purchased policies. Also, you do not have the right to a jury trial in an ERISA disability case, and you cannot call witnesses, cross-examine opposition witnesses or have expert testimony.
As you can see, individually purchased policies are much more favorable for insured parties than ERISA group disability plans. This is part of the reason why the assistance of an experienced Oregon ERISA Lawyer is so valuable in a dispute over an employer-sponsored group disability insurance policy.
Does Your Condition Qualify for ERISA Disability Benefits?
Generally speaking, you will be entitled to monthly disability insurance benefits if your physician confirms that your condition meets the definition of disability your policy sets out. The majority of ERISA policies define disability using “any occupation” terms, meaning you will be regarded as having a qualifying disability once you can no longer execute the necessary duties associated with any occupation for which you are trained, educated, or suited. Additionally, your physician needs to administer the most appropriate treatment for your sickness or injury.
You must also wait for the elimination period on your policy to elapse before you begin to accrue benefits. The length of these periods varies substantially from one policy to the next.
You should note that some policies exclude disabilities arising from certain causes. If, for example, you suffered disabling injuries while committing a crime (including a DUI offense) your insurance company may refuse to pay you monthly benefits.
Every disability insurance policy is different. To develop a real understanding of the features and advantages of your coverage, you’ll need to carefully research your own policy, ideally with the help of a lawyer. Also, if you’re in the process of filing a claim and you think you might be denied on the basis of one of the points raised in this post, you should consult with an Oregon disability lawyer before sharing any of the specifics of your case with your insurance company.
Oregon Disability Statistics
According to statistics from the Oregon Office on Disability and Health, there are significant disparities between Oregon’s counties with regard to disability rates. Malheur County reportedly has the highest rate of disability in the state, with 40.2% of adult residents suffering from some disabling condition. Benton County’s disability rate (17.5%) is the state’s lowest.
Overall, just over one in four adult residents of the state of Oregon has a disability of some kind.
Hiring an Experienced, Dedicated Oregon ERISA Lawyer to Help You Win Your Claim
Many Oregonians enter the ERISA disability claims process believing it will be a simple matter of submitting a few documents and collecting a monthly check. Unfortunately, the reality is often very different. Insurance companies will do whatever they can to try to delay or deny claims, and, sadly, they often succeed.
However, if you have a top-class Oregon ERISA Lawyer on your side, you stand a much better chance of avoiding this fate. Contact us today to schedule a free initial consultation, including a free policy analysis or claim assistance. If you’ve already received an initial claim denial, don’t wait to start this process; filing a comprehensive administrative appeal in a timely fashion is vital if you want to secure your monthly disability insurance benefits.