Experienced ERISA Lawyers Serving San Francisco, California
According to official statistics, around 10% of San Francisco’s population (roughly 94,000 individuals) report having a disability of some kind. A handful of these would need to acquire a San Francisco ERISA lawyer to assist them.
Disabilities can have an impact on your life in many ways, including participation in leisure activities, interaction with family and friends, and self-care. When sickness or an accident affects your ability to work, though, you may be able to access income replacement benefits if your employer has purchased short- or long-term disability insurance on your behalf. This kind of insurance is sometimes called ERISA coverage.
Unfortunately, due to methods insurers have of delaying or refusing apparently genuine claims, the process isn’t always as simple as it should be.
When Do You Qualify For ERISA Benefits?
Firstly, in order for you to be able to access ERISA benefits in San Francisco, your employer must have provided you with short- or long-term disability insurance as a benefit of your employment. If you purchased your own coverage without help from your employer, ERISA rules do not apply to you.
To file a successful claim on an employer-sponsored disability policy, you’ll need to meet the following requirements:
- Your physician has confirmed that your condition meets the definition of disability set out in your policy. Most ERISA policies use an “any occupation” definition, which means you must be incapable of doing any job for which you are trained, educated, or suited with reasonable continuity, as confirmed by your physician.
- Your physician has given you appropriate treatment for your condition.
- The elimination or waiting period on your policy has elapsed. These periods vary considerably from one policy to the next, so you should research your policy document carefully to see what period applies in your case.
Why You Might Need an ERISA Attorney in San Francisco
Reading the requirements for a successful ERISA claim above, you might think the process would be straightforward, and hence that lawyers are rarely necessary in these matters. Regrettably, you would be mistaken. The legislation provides a lot of methods for insurance firms to delay paying benefits or deny claims, and the most effective way to fight an insurer when they try this is to hire a seasoned lawyer who specializes in ERISA cases.
One major issue with claims arising from employer-sponsored group disability insurance policies is the mandatory appeals process under ERISA. Following an initial claim denial, you must file an administrative appeal with your insurer. If your carrier denies that as well, you can then file a federal lawsuit against them; however, ERISA rules provide that you may only use as evidence medical records and reports you submitted during your administrative appeal. The court will not consider any additional evidence you may have, regardless of how relevant it is to proceedings.
Therefore, it’s crucial to be as comprehensive as possible when you’re filing your administrative appeal. Your insurance carrier’s legal team will be sure to include every piece of evidence that might be damaging to your case. It’s up to you to make sure the evidence that supports your case ends up before the court as well.
A competent and experienced San Francisco ERISA lawyer will take care of this process for you so that you don’t have to worry about neglecting to include a crucial doctor’s report or medical record.
Are ERISA Benefits Taxable?
The monthly benefits from an individually purchased long-term disability insurance policy generally flow to the claimant tax-free, as policyholders incur tax liability when paying their premiums. However, where you receive a disability insurance policy from your employer as a benefit, any money you receive after claiming on that policy may be taxable as income, as the employer was the party paying the premiums.
The Difference Between ERISA & California SDI
The California State Disability Insurance (SDI) scheme deducts contributions from the earnings of all employees working in the state. Any employee who develops a disability (as confirmed by a physician) after paying sufficient SDI deductions and working for a certain length of time will be entitled to weekly income replacement benefits from the state government. These benefits can continue for a maximum of 52 weeks, assuming the claimant remains incapable of working for that long.
You do not automatically qualify for ERISA benefits if you become disabled as a San Francisco employee. In order for you to file a claim for benefits, you must first ensure you’re covered under your employer’s group policy, if it has one. Also, long-term disability insurance policies continue paying monthly benefits for much longer than 52 weeks.
You do not have to be completely disabled in order to claim SDI benefits, as is the case for Social Security benefits. As long as your physician confirms you have an illness or injury that’s preventing you from effectively discharging the duties associated with your specific full- or part-time job, you may be eligible.
Getting the Legal Help You Need With Your San Francisco ERISA Claim
ERISA is a complex piece of legislation, and it often does insurance companies more favors than insurance claimants. However, that doesn’t mean you should give up on your claim after an initial rejection. A competent San Francisco ERISA lawyer will know how to level the playing field in your favor if your insurance provider refuses to act in good faith.
At DarrasLaw, we’ve dealt with ERISA claims of all sizes for clients across San Francisco and the Bay Area. Contact our disability lawyers to schedule a free policy, claim, or appeal analysis. Filing a thorough and timely appeal is crucial if you’ve encountered an initial rejection, so don’t waste any time in starting the process.