About 10 percent of all working-age Portland residents report suffering from a disabling illness or injury, but this misleading statistic can leave out a lot of truly disabled people. Disability has a different meaning depending on how it’s used.
A blind person, for example, may suffer from a legal disability. However, this does not mean the terms and limitations of individual or long-term disability insurance policy will consider such a person disabled from work.
On the other hand, if you work for one of Portland’s major technology companies and begin suffering from unrelenting migraines, your individual or long-term disability insurance policy may consider you disabled because you can’t perform the important duties of your occupation. Just because you don’t have a commonly recognized or total disability, such as blindness or paralysis, does not mean you can’t take advantage of your individual or employer-sponsored long-term disability insurance benefits.
The award-winning long-term individual and group disability lawyers at DarrasLaw have more than 100 years of combined litigation and claim experience helping America’s disabled take advantage of their individual and group disability benefits. Led by Frank N. Darras, the nation’s top disability lawyer, his firms have recovered nearly $1 billion in wrongfully delayed and denied insurance benefits. To schedule a free, no-obligation disability insurance policy analysis and free claim consultation, call us at (800) 458-4577 or contact us online today.
Do I Have Individual or Long-Term Disability Insurance?
To be clear, individual and group-sponsored disability insurance is not the same as Social Security Disability Insurance (SSDI). Most working Americans pay into SSDI, which they may take advantage of if they become totally disabled from all work. Private individual or group long-term disability insurance, however, acts to replace income if you suffer from a disabling illness or injury.
If the covered injury or illness prevents you from engaging in the essential duties of your normal occupation or in some policies any occupation based on your education, training and experience you’re typically entitled to a percentage of your monthly salary during your disability period.
A group or individual long-term disability insurance policy may also entitle you and your employer to other benefits, including a “return-to-work” benefit, where despite working full-time you are still suffering a loss of income.
Partial disability benefits are also sometimes available if you’re able to return to work part-time. In this case, you’ll continue to receive a portion of your monthly disability benefit as well as your part-time salary or wages.
Beware, however, of common disability offsets. Your group disability insurance policy is held by a for-profit corporation looking to save money, and it will find ways to do it. Your group disability policy will typically contain provisions that prohibit you from receiving a benefits “windfall.” This means you can’t get multiple payments from different sources like SSDI, your car insurance accident, a wrongful termination related lawsuit, and your group disability insurance company. Your individual or group disability insurer may ask you whether you’re receiving or anticipate receiving income benefits from these or other sources on your disability insurance claim form. If you’re not honest, your individual or group long-term disability insurance company may terminate your benefits entirely so be careful.
Typically, three types of disability insurance plans may cover you:
- Employer-sponsored disability insurance – This is the most common type of disability insurance, and it’s normally part of an employment benefits package. Similar to your employer-sponsored health insurance, your employer provides you with long-term group disability benefits through a private insurance carrier. In most circumstances, your employer will pay all or part of your premium, and you will qualify to claim long-term group disability benefits if you’re unable to perform the important duties of your regular occupation or any occupation in some policies. These plans do not generally travel with you between jobs.
- Group-sponsored disability insurance – These disability plans are similar to employer-sponsored plans except that they’re provided through a group or professional association, such as a union. You may pay these premiums as part of your union or membership dues, or you may pay for the plan directly at a special “group” discounted rate.
- Individual disability insurance – These plans are similar to individually purchased auto insurance. You select your disability plan through a broker or agent, then pay your own disability premium, so the benefits flow tax-free. These plans follow you, not your job, and are consumer friendly with terrific legal safeguards.
Understanding the type of disability insurance plan you have is important because different laws apply to them. If you have an employer-sponsored or group disability insurance plan, a complicated set of federal laws called the Employee Retirement Income Security Act (ERISA) generally governs your policy. ERISA policyholders do not have the same litigation rights as individual policyholders, and the ERISA litigation process is more limited and extremely complex. Accordingly, if you’ve experienced a bad-faith delay or wrongful denial of your group disability insurance benefits under your ERISA plan, call our experienced ERISA attorneys today at (800) 458-4577 or contact us online.
Conditions Covered by Most Portland Long-Term Disability Plans
You don’t have to suffer from a commonly recognized or total disability to claim long-term individual or group disability benefits. A total disability, with which you cannot engage in any type of meaningful work, even if you have to change careers, will likely qualify you for individual or group disability benefits. Terminal cancer, paralysis, or severe traumatic brain injuries are common examples of common total disabilities.
Under most individual or group disability plans, a partial disability will qualify you for benefits, too. Partial disabilities prevent you from completing the important tasks of your normal occupation on a part-time basis. For example, if your occupation requires typing and you undergo surgery for carpel tunnel syndrome, you likely can’t perform your normal work functions for some time, but you might be able to work part-time doing other pre-disability duties.
The following disabilities may entitle you to long-term individual or group disability benefits:
- Broken bones, fractures, and dislocations
- Soft tissue sprains, strains, and tears
- Back pain, sciatica, and ruptured discs
- Car accident injuries
- Migraines, chronic fatigue
- Depression or PTSD
- Pregnancy complications
- Surgical recovery
- Lyme disease, Rocky Mountain spotted fever, alpha-gal allergies, and other tick-borne illnesses
- Pneumonia, asthma, and lung conditions
Some of the most common disabling illness or injuries seen in the United States include:
- Cancer: Whether it’s a Stage I or Stage IV diagnosis, cancer and its treatment takes a heavy physical and emotional toll. While you may feel like you can work after a cancer diagnosis, you’re often immediately eligible to claim long-term individual or group disability benefits. The most common types of cancer leading to long-term disability claims include skin cancer, lung cancer, breast cancer, prostate cancer, and ovarian cancer.
- Bunion surgery: A bunion actually occurs when the joint of your big toe is pushed out of alignment as your toes fold into one another. While this is often considered elective surgery, failing to undergo bunion surgery can lead to lifelong podiatric complications. If both feet require bunion surgery at the same time, it could prevent you from walking for months. If you work in a physically demanding occupation but your treating doctor says you need surgery to prevent a worsening of your condition, consider filing a valid claim for individual or group long-term disability benefits.
- Whiplash and car accident injuries: This is one of the most common reasons employees claim individual or group disability benefits. While whiplash—that is, a strain of your neck tendons—may heal after a few weeks, any lasting pain can drastically limit your ability to work. Whiplash, of course, can make manual labor excruciating, but it can also damage the careers of those who work in office or computer-based occupations. If your occupation requires you to look at a computer most of the day, working can further strain the tendons in your neck and back that you injured in the car accident. If you receive compensation for your lost wages from a personal injury lawsuit, however, your group long-term disability insurer may try to offset your payments accordingly. This means that if you receive group disability benefits of $3,000 a month and your car lawsuit pays you $2,000 in lost wages for the month, your group disability carrier will probably try to reduce your benefits to $1,000 that month.
- Broken femurs: As the largest bone in your body, breaking your femur is not like breaking your wrist. It’s one of the most painful injuries you can experience, and you must typically undergo multiple corrective surgeries. A fractured femur can result in a permanent implantation of hardware, which can cause you pain far in the future. Depending on your age and overall health, a fractured femur can take four to six months to heal, and this is not including the need for additional corrective surgeries.
- Cardiac conditions: Heart diseases are the number one killer in America. Work stress adds to the strain on your heart, whether an unexpected heart attack struck you down, or you suffer from coronary artery disease or a genetic heart condition. Shortness of breath, fatigue, chest pain, arm pain, jaw pain, or neck pain may signal a heart attack. See a physician immediately, as you may stave off the worst effects. You may also claim long-term individual or group disability benefits in anticipation of heart surgery and treatments.
Consult an Experienced ERISA Attorney or Individual Disability Lawyer From DarrasLaw at the Onset of Your Case
The difference between ERISA-governed and individual disability insurance policies isn’t always clear when filing a disability claim. While ERISA requires providers to make certain financial disclosures and provide you with necessary claim information, the claims process is similar for most disability plans. It’s when you’re faced with an arbitrary and capricious delay, denial, or termination of long-term group disability benefits that ERISA comes into play.
If your disability benefits are wrongfully delayed or denied under your individual disability plan, you can generally take your case directly to court. There, you may demand evidence from your disability insurance company, call and cross-examine witnesses, hire experts to testify about your condition, and litigate your valid disability claim in front of a jury. In addition, the court may award you damages for emotional distress, punishment damages, and attorney fees.
Unlike individual disability insurance policyholders, ERISA policyholders generally do not enjoy these superior legal rights and consumer protections. Instead, once you face a wrongful delay, denial, or termination of group disability benefits, you must timely file an administrative appeal with your group ERISA disability insurance company. While this seldom results in reinstatement of your group disability benefits, it has another function: It sets the stage for, and disability can restrict, the evidence you can later present during a federal ERISA lawsuit.
If you file ERISA litigation after your administrative appeal, your entire disability case is limited to the administrative record. This generally restricts your case to the documents you submitted to your group ERISA disability insurance company during the administrative appeal and the records your disability insurer reviewed during your initial claim application and denial. Accordingly, one wrong move during your administrative appeal can result in a fatal ERISA claim mistake.
Most group disability insurance companies make the administrative appeal seem easy. They may encourage you to submit “only the documents necessary to support your claim,” knowing you may leave out key medical, vocational, or financial evidence that you would need to win a federal disability ERISA lawsuit.
To preserve the viability of your valid legal claim, you must consult a top-rated ERISA attorney or individual disability lawyer as early as possible. At DarrasLaw, our award-winning disability lawyers and ERISA attorneys can review your disability claim. We can guide you in gathering and submitting the evidence and documentation you will need to support your valid disability claim. We can explain the law and your disability insurance policy to help you maximize your chances during your individual case or your administrative appeal and any subsequent federal ERISA lawsuit.
Contact DarrasLaw for Help With Your Portland Disability Claim Today
Whether you live in downtown Portland, the Pearl District, Chinatown, Lloyd, or Williams, DarrasLaw is happy to evaluate your disability case. DarrasLaw has fought and defeated every major disability insurance company for wrongfully delayed, denied, and terminated individual and group disability benefits. Take advantage of our completely free policy analysis and free insurance claim consultation today. It costs nothing to speak with one of our experienced ERISA attorneys or accomplished individual disability lawyers, and we don’t get paid unless we help you win your rightful individual or group ERISA disability insurance benefits. To schedule your no-obligation, free insurance consultation, call us at (800) 458-4577 or contact us online.