Fighting for Phoenix’s Disabled Who Have Received a Wrongful Denial of Disability Benefits
According to the most recent figures available from the U.S. Census Bureau, one in five Americans suffers from some kind of disability. In Phoenix, the number is lower—7.6 percent of Phoenix residents are disabled due to some kind of injury or illness.
These aren’t just abstract numbers. In the right context, almost any injury can result in a disability. From heart disease to a broken bone, illnesses and injuries can leave you unable to perform the important duties of your occupation, or in some cases, any occupation by which you are trained, educated, or suited, taking into consideration your station in life. For most people, the inability to earn a living is a frightening prospect.
Most of Phoenix’s major employers, including the state of Arizona and Banner Health, offer long-term disability insurance benefits to their employees. As a result, you may be entitled to individual or group long-term disability insurance benefits if you are suffering from an illness or injury that prevents you from performing the important duties of your occupation. Unfortunately, getting coverage is the easy part. Making a valid individual or group disability claim and receiving your individual or group long-term disability benefits in the event of disability is a much greater challenge.
Almost all long-term disability insurance policies are provided and administered by private, for-profit insurance companies that are focused on maximizing profits for their shareholders. Private insurance companies are therefore incentivized to wrongfully delay, deny, or terminate your coverage if your valid long-term disability claim eats into their corporate bottom lines.
If you live in Phoenix and are worried that you can’t perform the important duties of your occupation due to injury or illness, call the top-rated long-term disability lawyers or experienced ERISA attorneys at DarrasLaw today. We have over 100 years of litigation and claim experience fighting long-term disability insurance companies for your legal right to disability benefits, and we win. To schedule your completely free disability case analysis and free disability claim consultation, contact us today at 800-898-7299 or online.
Long-Term Disability Insurance in Phoenix 101
While they may differ in significant ways, every individual or group long-term disability insurance policy is designed to meet the same need by replacing at least some of your income if you become disabled and are therefore unable to perform the important duties of your occupation.
The most important part of any long-term disability policy is how the policy defines a disability. This definition will form the key to claiming individual or group long-term disability benefits if you get injured or sick. For example, some policies severely limit mental health benefits to 9, 12, 18, or 24 months as qualifying disabilities even if they prevent you from performing the important duties of your occupation. Other policies consider you disabled and provide coverage if you’re disabled from “all work,” not just your specific job. Please note, however, that policies may also limit combat-related injuries, self-reported claims, and most policies exclude claims for injuries sustained while intoxicated or while committing a felony.
After analyzing how the policy defines disability, be aware that different policies provide different amounts of coverage, and those amounts can vary widely from policy to policy.
The following is an overview of the basic types of disability insurance policies that pay long-term disability benefits:
- Group long-term disability policies – Employers or unions typically offer these policies and cover a group of qualifying individuals, such as employees or union members. You must be an employee or member of the group to qualify for group disability benefits, and they typically only protect the income from that employer, not income from other jobs.
- Individual long-term disability benefits – If your employer doesn’t offer group coverage, or the coverage isn’t sufficient, you can purchase an individual long-term disability plan from an agent or broker. This is similar to purchasing auto or homeowner’s insurance. These plans are beneficial if you are self-employed, have multiple sources of income, or the group benefit amount is insufficient or taxable.
- Social Security Disability Insurance (SSDI) – SSDI is a tax-supported, government-sponsored disability benefit. If you pay your taxes and have worked for a sufficient number of qualifying quarters, you’re eligible to apply for SSDI if you become disabled. These federal benefits run concurrently with your private disability plan, meaning that you may be able to claim benefits under both your private disability policy and SSDI, albeit with some offsets that may reduce your monthly benefit.
Even though almost everyone qualifies to pay into SSDI, group and individual long-term disability policies are attractive for a couple of reasons. First, SSDI provides only very limited benefits and bases those benefits on your average earned income. Second, you have to be totally disabled and unable to engage in any meaningful work to qualify for SSDI benefits. Individual and group long-term disability policies provide benefits that cover the shortcomings of SSDI.
Common Injuries and Illnesses That Lead to Disabilities
We mentioned earlier that under the right circumstances, almost any injury or illness can qualify you for individual or group long-term disability benefits. Some of the most common injuries and illnesses that our clients have faced include:
- Neck and back pain, including strains, herniated discs, or degenerative problems
- Bunion surgery
- Tennis elbow
- Carpal or cubital tunnel syndrome
- Knee and hip injuries and replacements
- Heart attacks, strokes, coronary artery disease and aneurysm
- Pregnancy complications, postpartum depression
- Chronic pain
- Broken bones, fractures and dislocations
- Pneumonia, COPD, asthma and lung conditions
- Migraines, chronic fatigue, fibromyalgia
- Cancer, chemotherapy and radiation
- Arthritis, lupus and other autoimmune disorders
Almost any illness or injury can leave you disabled, provided that it prevents you from performing the important duties of your occupation. For example, asthma that you can easily and safely control with an inhaler likely won’t prevent you from working in your office. On the contrary, if you are a secretary, carpal tunnel syndrome could leave you unable to type and therefore unable to perform the important duties of your occupation.
Some injuries and illnesses are so severe that you can’t perform the important duties of your occupation at all. Below are some common disabilities where we’ve helped our clients get the individual or group long-term disability benefits they deserved:
- Renal (kidney) failure – Kidney failure is a serious illness that leads to a build-up of waste in your body. Treatment options may include dialysis or a kidney transplant. Dialysis treatment can significantly impair your ability to perform the important duties of your occupation, and a kidney transplant may require months of recovery.
- Traumatic brain injuries (TBIs) – TBIs can consist of anything from a mild concussion to a vegetative state. Brain injuries typically damage your memory, focus, and problem-solving skills, thus making the performance of the important duties of any occupation extremely difficult.
- Cancer – Cancer often results in a valid disability claim due to the suffering caused by chemotherapy and radiation treatment. Fatigue, bruising, bleeding, infections, confusion, nausea, weight loss, and bowel dysfunction make it extremely difficult, if not impossible, for people to reliably perform the important duties of their occupation.
- Spinal cord injuries – Even seemingly minor spinal cord injuries may result in paralysis. Major spinal injuries can result in permanent disability, with severe restrictions on your mobility. Most people who suffer spinal cord injuries wind up filing a valid disability claim.
- Mental health conditions – While certain mental health conditions are situational or temporary, some mental illnesses are chronic. Regardless of the severity or duration, mental health conditions can leave someone unable to perform the important duties of their occupation. Unfortunately, it can be very difficult to get individual or group long-term disability long-term benefits for these conditions, and insurance companies may limit the benefits to 9, 12, 18, or 24 months.
If you received a diagnosis of a disabling condition that prevents you from performing the important duties of your occupation, you may be entitled to claim individual or group long-term disability benefits. Just be aware that your individual or group long-term disability insurance provider has to accept the claim before they start paying benefits, and they may delay, deny, or terminate your valid claim in bad faith.
Phoenix Long-Term Disability Insurance: What it Covers
Remember, the basic idea behind individual and group long-term disability coverage is to replace lost income. Unfortunately, long-term disability insurance won’t cover all your income, and you may need a skilled long-term disability attorney or stellar ERISA lawyer from DarrasLaw who understands how this coverage works to maximize your recovery.
As a general rule, almost all individual and group long-term disability insurers will replace 60 percent of your lost income, with some exceptions depending on your level of coverage. At first glance, this seems simple, but it’s much more complicated than it appears. While your long-term disability insurance policy says you are entitled to 60 percent of your total income, it doesn’t mean all of that money has to come from your long-term disability insurer.
Employer-provided group long-term disability policies can prove especially confusing. For example, let’s say that you make $5,000 per month when you become disabled. Because you have a group long-term disability policy in place, you’re entitled to 60 percent of your monthly income, or $3,000 per month. That’s your maximum coverage. It won’t cover other sources of income, and it won’t allow you to collect more than 60 percent of your income. In fact, your group long-term disability policy can probably use additional sources of income to offset your long-term disability monthly benefit payouts.
Here are some examples of income sources that your group disability insurance will use to offset and reduce your monthly disability benefit:
- Personal injury settlements, third-party settlements, or judgments
- SSDI for your dependents under age 19
- Workers’ compensation benefits for temporary total disability
- State disability benefits
- Wrongful termination settlements
- Other group disability coverage
- V.A. benefits or pensions
- Social Security or SSI benefits
- Pension contributions
In addition to your $5,000 pre-disability monthly income above, let’s say that you receive $800 per month from a military pension and you’re receiving another $700 in SSDI benefits. As a result, your long-term disability insurer may only pay $1,500 per month in coverage—$3,000 minus the $1,500 in additional income and benefits that you are receiving.
Your monthly disability benefit is subject to increase if the other offsettable income dries up or stops, but the bottom line is that group long-term disability insurance provider only has to ensure that you were eligible to receive 60 percent of your covered income.
Individual long-term disability insurance works differently because it protects you personally, not just the income from one job. If you pay for a private individual long-term disability insurance policy, you can claim a certain percentage of any and all lost income as a result of your disability, and your benefits should flow to you tax-free.
Making a Long-Term Disability Claim
Of course, you can’t just claim a disability and expect to receive individual or group long-term disability benefits. Your insurance company is going to require you to submit an onerous amount of occupational, financial, and medical documentation.
You will first need your treating doctor to carefully document your disability and certify that your illness or injury will not allow you to reliably perform the important duties of your occupation.
The key question is whether your disabling illness or injury substantially prevents you from performing the important duties of your occupation. For example, a receptionist with a broken leg can probably still perform the important duties of her occupation. Chronic migraines, however, may prevent that same receptionist from constantly performing the important duties of her occupation.
The Legal Framework
Different laws apply to individual and group long-term disability plans. A complex set of federal laws called the Employee Retirement Income Security Act (ERISA) generally governs group long-term disability insurance policies provided by employers. Furthermore, each federal district may interpret ERISA slightly differently. Phoenix is in the Ninth Circuit and DarrasLaw understands and litigates ERISA cases here with local counsel.
ERISA places strict, unforgiving limitations on your ability to fight wrongful delays, denials, and terminations of benefits. People who purchased individual disability policies generally aren’t subject to these limitations and enjoy greater consumer remedies and freedom in challenging their insurer’s decisions.
Consult an experienced long-term disability attorney or premier ERISA lawyer at DarrasLaw, if you cannot perform the important duties of your occupation. Don’t risk your disability benefits and your future by assuming that your insurer will help you.
Have a Expert Long-Term Disability Lawyer Evaluate Your Case Before You File Your Claim
Group long-term disability insurance companies want you to believe that they are on your side, right up to the moment they deny your valid claim. Once they deny your valid claim, the clock starts ticking. ERISA, which governs most group long-term disability plans, imposes harsh restrictions on challenging the insurance company’s decision. If you do not follow the process correctly, you could jeopardize your valid claim and find yourself unable to recover any benefits at all. The process is not easy for most lawyers and serves to benefit the insurance companies.
Don’t make a fatal claim mistake and apply for long-term group disability benefits alone. Call a top-rated long-term disability attorney or nationally prominent ERISA lawyer from DarrasLaw before you find yourself fighting a wrongful denial of disability benefits.
If You’re Disabled in Phoenix, Call the Award-Winning ERISA Attorneys at DarrasLaw Today
The top-rated ERISA lawyers and award-winning long-term disability attorneys at DarrasLaw know how to get our clients the benefits they deserve. America’s top-rated long-term disability lawyer, Frank N. Darras, and his firms have recovered nearly $1 billion in insurance benefits. No case is too large or venue too far for DarrasLaw’s experienced long-term disability attorneys and seasoned ERISA disability lawyers. To schedule your completely free disability policy review and free case analysis in Phoenix, call us at 800-898-7299 or send us an email.