Alameda is one of the most populous counties in California, with about 1.7 million residents. Almost half of all Alameda County residents are college graduates, 10 percent more than the state average. The U.S. Census Bureau estimates that about 6 percent of all Alameda County residents suffer from a disabling injury or illness. That’s about 100,000 people, and if you’re reading this, there’s a good chance you’re one of them.
Many disabled Californians suffer from painful musculoskeletal conditions, including back pain, neck problems, and arthritis. Chronic conditions may easily become disabling with time. Heart disease, HIV/AIDS, cystic fibrosis, certain cancers and their treatments can slowly grow worse, eventually making impossible the reliable performance of the important duties of your occupation.
Other disabling illness and injuries are traumatically induced, such as brain injuries from car accidents. Traumatic injuries often necessitate emergency surgeries, extended hospital stays, extensive rehabilitation, pain, and mental anguish. Even if you do everything right, a disabling injury or illness can leave you in need of significant financial assistance.
Individual and group long-term disability insurance exists to replace income lost as a result of these and many other conditions. You may qualify to claim individual or group long-term disability benefits if you enrolled in a long-term disability plan or bought a policy from your agent or broker and suffer from an injury or illness that prevents you from performing the important duties of your occupation.
For-profit disability companies issue most individual and group long-term disability policies, and they are looking to boost their bottom lines by wrongfully delaying, denying, or terminating your long-term disability benefits.
Don’t let your individual or group long-term disability carrier wrongfully delay, deny, or terminate your long-term disability benefits. If you were denied individual or group long-term disability benefits in Alameda County, including Oakland and Berkeley, call America’s top-rated long-term individual disability lawyers and nationally respected group ERISA attorneys at DarrasLaw today at 800-898-7299, or contact us online. Led by award-winning ERISA attorney Frank N. Darras, DarrasLaw offers a completely free disability policy analysis and a free claim consultation. No case is too big or too small for DarrasLaw’s compassionate and knowledgeable legal team.
Understanding Long-Term Disability Insurance
California is one of a handful of states that requires employers to provide certain minimum disability benefits. These benefits are designed to replace a portion of income lost as the result of a disabling illness or injury. Most California employers must withhold and/or pay California State Disability Insurance (SDI) contributions, which provides as many as 52 weeks of disability benefits.
California doesn’t provide disability benefits that extend beyond one year. Instead, Alameda County’s major employers often provide their employees with group ERISA long-term disability insurance. Some examples of large employers in the area that may provide certain employees with long-term group disability insurance include:
- University of California – Berkeley
- Johnson & Johnson
You or your employer will have to pay a premium to an individual or group long-term disability insurance company. Disabled employees can then apply for individual or group long-term disability benefits after their stated elimination/waiting period is exhausted. Your individual or group long-term disability insurer, not your employer, pays your long-term disability benefits, which covers a percentage of your income. For example, if your individual or group long-term disability policy covers 60 percent of your income, and you make $5,000 per month, you’d qualify for $3,000 per month in benefits, subject to offsets for group coverage. Some individual or group long-term disability insurance policies provide benefits until normal retirement age, at which point you’re eligible for Medicare and Social Security benefits. Other individual or group long-term disability insurance policies limit your benefits by time or condition, such as two years of benefits for musculoskeletal back pain without radiography, an EMG or a nerve conduction velocity (NCV) test and an MRI.
Types of Long-Term Disability Insurance
Certain types of long-term disability insurance policies are subject to a complex set of unforgiving federal laws called the Employee Retirement Income Security Act (ERISA).
You need an experienced ERISA attorney from DarrasLaw on your side who understands both your legal rights under ERISA and its inherent limitations before claiming ERISA pre-empted long-term group disability benefits. Otherwise, you could easily make fatal claim mistakes and forfeit your legal right to long-term group disability benefits.
There are two main types of long-term disability insurance other than federal Social Security Disability Insurance (SSDI) or SSA benefits. The first is group or employer-sponsored disability insurance. The second is individual long-term disability insurance.
Employer-sponsored long-term disability insurance is the most common type of group disability policy. Your employer may offer group long-term disability policies to its employees. These policies cover you while you work for your employer. Accordingly, if you leave your job before claiming group disability benefits, you’ll lose your long-term group disability insurance. ERISA generally governs employer-sponsored group plans.
Individual long-term disability insurance is similar to purchasing homeowner or automobile insurance. You search the open market for an individual policy that fits your needs and pay your own premiums. Self-employed individuals, independent contractors, or those who financially plan well, may purchase an individual long-term disability plan from an agent or broker. These policies follow you, not your job, and if you paid the premiums, the benefits flow tax-free.
ERISA does not generally govern individual long-term disability insurance policies. This means that individual long-term disability insurance policies give you greater legal rights and outstanding consumer protections.
Most Common Conditions Covered by Individual or Group Long-Term Disability Benefits
Your eligibility for individual or group long-term disability benefits depends on your occupation and the nature of your disabling injury or illness. Almost any injury or illness can cause a disability under the terms and conditions of your individual or group long-term disability insurance policy if it prevents you from performing the material and substantial duties of your occupation.
Employees in physically demanding occupations are more likely to need individual or group long-term disability benefits. For example, a serious knee injury and replacement may disable a construction worker for more than a year. This may not be true for a counselor or someone who sits most of the day.
The following conditions commonly cause disabling conditions:
- Lupus – This autoimmune disease attacks your lungs, kidneys, blood cells, nerves, and joints. There is no cure for lupus, and most patients must suppress their immune systems with powerful drugs that often cause serious side effects. The treatments and medications themselves often cause disabling symptoms such as confusion, restlessness, nausea, and debilitating headaches.
- Multiple sclerosis (MS) – This degenerative condition causes the immune system to attack the nerve cells in your central nervous system. This can lead to pain, inability to walk, blindness, weakness, and severe muscle spasms. Most nerve cells do not regenerate, so MS causes permanent damage. You may not recover your ability to perform the important duties of your occupation once MS damages these cells.
- Inflammatory bowel disease (IBS) – IBS occurs when your immune system attacks the lining of your intestines, causing diarrhea, bleeding, and loss of bowel control. It can also result in fever, pain, and weight loss. Serious forms of IBS may include Crohn’s disease. If not properly managed, Crohn’s can prevent you from working in a traditional office environment. The difficulty with claiming individual or group long-term disability benefits with IBS is that it’s often cyclical. You may be able to work one day, but suffer the next. Long-term individual and group disability insurers often wrongfully delay, deny, or terminate disability benefits for conditions categorized by flare-ups that aren’t totally disabling symptoms.
- Panic attacks – This is not only an anxiety disorder, but it can occur in combination with mental health disorders such as phobias or post-traumatic stress disorder. It differs from single episodes of legitimate fear because the panic sets in usually as disproportionate to the situation. You may find yourself terrified with a pounding heart within minutes. Victims may find panic attacks difficult to anticipate and control effectively.
- Hip and knee replacements – Each year more than one-million Americans undergo a hip or knee replacement. This is often due to age-related degeneration, a broken hip, or an injury. It can take you time to properly recover from knee or hip surgery, especially because these areas of your body bear the most weight. Hip and knee replacements can prove especially disabling in physically demanding occupations and sedentary occupations as well.
The type of long-term disability coverage you have may dictate whether you can successfully claim individual or group long-term disability benefits for an injury or illness. “True own occupation” coverage kicks in if an injury or illness prevents you from doing your occupation as you perform it on a daily basis. General “any occupation” coverage only provides benefits if you are unable to work in any occupation by which you are trained, educated, or suited, taking into consideration your station in life.
For example, a surgeon with a broken dominant hand and “true own occupation” coverage would likely qualify for individual or group long-term total disability benefits. The same surgeon with general “any occupation” coverage would likely NOT qualify for individual or group long-term disability benefits, as that person could potentially teach or still consult.
The following injuries and illnesses may also qualify you for individual or group long-term disability benefits depending on the terms and limitations of your coverage:
- Tennis elbow
- Cubital tunnel syndrome
- Car accident injuries, including whiplash
- Cancer, chemotherapy, and radiation
- Back pain, sciatica, ruptured discs, and scoliosis
- Pregnancy complications
- Surgical recovery
- Broken bones, fractures, and dislocations
- Depression, PTSD, anxiety, and other mental, emotional or cognitive conditions
- Substance abuse
- Traumatic brain injuries
- Migraines, chronic fatigue
- Spinal cord, neck, and thoracic problems
- Lyme disease, Rocky Mountain spotted fever, alpha-gal allergies, and other tick-borne illnesses
Always consult an experienced individual long-term disability lawyer or seasoned group ERISA attorney from DarrasLaw regarding your eligibility for individual or group long-term disability benefits.
Consult a Stellar Long-Term Individual Disability Lawyer or Premier Group ERISA Attorney at DarrasLaw at the Onset of Your Case
Don’t wait to contact one of DarrasLaw’s top-rated long-term individual disability lawyers or skilled group ERISA attorneys until after your insurer has wrongfully delayed, denied, or terminated your individual or group long-term disability benefits.
If you think that your individual or group long-term disability insurance company is about to wrongfully delay, deny, or terminate your benefits, look for the common warnings signs. Your long-term disability carrier may start requesting additional, duplicative medical records, treating physician narrative reports, witness statements, and employment forms even after you’ve submitted compelling medical evidence and convincing proof of your disability. It may begin to demand occupational information, income verification, and unlimited medical record authorizations. It often does this when it’s trying to find a reason to wrongfully delay, deny, or terminate your individual or group long-term disability benefits.
For example, you may have applied for individual or group long-term disability benefits for a neck injury. Your insurer may then find in past medical records that you injured your neck in a car accident. Even though this wasn’t a serious injury and it healed, your individual or group long-term disability insurance company may take the old records and claim in bad faith your current condition is “pre-existing,” cutting off your legitimate long-term disability benefits.
If you have a group long-term disability policy, ERISA generally governs your claim. Under ERISA, you do not have the same rights as an individual policyholder. A wrongful delay, denial, or termination of disability benefits under an ERISA plan means you must file a timely administrative appeal with your insurer. You can only bring a case in federal court for a wrongful denial of group disability ERISA benefits after you timely file an administrative appeal. There, you often have the burden of proof to overturn the denial. You must prove the denial was based on an arbitrary and capricious standard of review. Remember after your appeal is closed ERISA prohibits you from submitting additional evidence to prove your case. In a federal ERISA lawsuit, you can only use the medical records, statements, and documentation you and your carrier used in the underlying claim and during your group administrative appeal. The federal judge will only review the underlying administrative record that led to the denial and what was submitted on appeal.
It’s often difficult to succeed in a federal ERISA lawsuit, but the preeminent ERISA group lawyers of DarrasLaw have the skill, litigation and national claim experience to do so. Having a top-rated long-term group ERISA disability attorney from DarrasLaw on your side early in the disability claims process can help protect your legal rights. We know how to make your disability case strong before, during, and after the denial and the administrative appeal.
If You’re Disabled in Alameda County, California, Call the Nationally Renowned Long-Term Individual Disability Attorneys and Prominent National Group ERISA Lawyers at DarrasLaw Today
Frank N. Darras, America’s top-rated disability lawyer, knows the individual and group disability insurance companies’ tricks. He and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits. Whether your individual or group long-term disability benefits were wrongfully delayed, denied, reduced, or terminated, call DarrasLaw. Schedule your completely free disability policy analysis and free claim consultation with us today by calling 800-898-7299 or contacting us online. We’re here to protect your legal rights in Oakland and the rest of Alameda County.