Disneyland, Laguna Beach and Angel Stadium are only a few of the many attractions Orange County has to offer. Known for its spectacular beaches and even better weather, Orange County, California, is an incredible place to live and work. In fact, many of the nation’s largest corporations have a presence in Orange County. Disney and the University of California-Irvine employ many Orange County residents, and the following major employers also operate in the area:
- Bank of America
- Wells Fargo
- The Home Depot
- UnitedHealth Group
California has a relatively low working-age disability rate compared to the rest of the country—about 8.5 percent. Unfortunately, a disabling illness or injury can leave a disproportionate impact on the lives of people living in Orange County. The cost of living in Orange County is about 87 percent higher than in the rest of the country. Housing is also a huge problem, with homes selling for more than three times the national average.
Luckily, many major employers in Orange County offer and pay for group long-term disability coverage to qualifying employees. Unfortunately, individual and group long-term disability insurance companies don’t like to pay valid claims.
You need the assistance of America’s premier long-term individual disability attorneys and renowned group ERISA lawyers at DarrasLaw if an injury or illness has left you unable to perform the important duties of your occupation in Orange County. Your individual or group long-term disability insurance may help cover a portion of your lost income, providing valuable dollars for housing and other medical essentials.
Don’t let your individual or group long-term disability carrier wrongfully delay, deny, or terminate your long-term disability benefits. Led by the nation’s top disability attorney, Frank N. Darras and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits worldwide. Call the top-rated long-term disability lawyers and award-winning group ERISA attorneys at DarrasLaw today at (800) 458-4577 or contact us online.
Do I Have Individual or Group Long-Term Disability Insurance?
Individual and group long-term disability insurance pays a portion of your income if a disabling illness or injury renders you unable to perform the import duties of your occupation for an extended period of time.
California is one of only five states that require employers to provide disability benefits. Most California employers must withhold and/or pay California State Disability Insurance (SDI) contributions. You may claim SDI benefits if you’re unable to perform the important duties of your occupation due to an injury or illness, pregnancy included. However, SDI only provides 52 weeks of benefits at a maximum of $1,216 per week. So what happens if your SDI benefits expire, but you still can’t return to work? This is what individual and group long-term disability benefits are for. Most long-term disability insurance policies fall into three categories:
- Group long-term disability insurance – This is the most common type of long-term disability insurance, and many employers often offer it as an employee benefit. Your employer or organization, like a union, typically offers group long-term disability policies. These policies generally cover you while you’re working at a specific job, so if you leave your job or union, you’ll generally lose your group benefits. Your employer will typically cover all or part the premiums for these group disability policies.
- Individual long-term disability insurance – If you’re self-employed, an independent contractor, or your employer doesn’t offer disability insurance, you can buy an individual long-term disability policy from an agent or broker. These policies follow you, not your job. The benefits flow tax-free if you paid the premiums.
- Social Security Disability Insurance (SSDI) – Unlike California state-based short-term disability benefits, SSDI and SSA are government benefits based on need or quarters of their earnings. This insurance overlaps with group and individual long-term disability insurance, but it may also provide disability benefits if you don’t have other coverage. Working Americans who have paid into SSDI through their taxes for a qualifying period of time can apply for SSDI. SSDI, however, only covers total disabilities, making it extremely hard to qualify for benefits.
Knowing which type of long-term disability policy you have is essential to properly claiming benefits. Long-term group disability policies are generally subject to a complex set of unforgiving federal laws called the Employee Retirement Income Security Act (ERISA), while individual long-term disability insurance benefits generally are not. You may be easily duped and forfeit your legal right to long-term disability benefits under a group ERISA plan without an experienced ERISA attorney from DarrasLaw on your side.
What Are the Benefits of Long-Term Disability Insurance?
Group long-term disability insurance primarily offers income replacement benefits subject to certain offsets. These offsets are used to reduce your group monthly disability benefits to a minimum amount and may include:
- Workers’ compensation benefits for temporary total disability
- State disability benefits
- Personal injury settlements, third-party settlements, or judgments
- SSDI for your dependents under age 19
- A. benefits
- Social Security or SSA benefits
- Wrongful termination settlements
- Other group disability coverage
- Pension contributions
The amount of benefits you’re entitled to depends on the nature of your group long-term disability policy and its offsets. For example, if you make $4,000 per month and carry a 70 percent income replacement policy, you’ll receive $2,800 worth of group disability insurance benefits—minus whatever offsets you are eligible to receive or you actually receive. If you receive $800 per month from the V.A. or Social Security, you’ll receive $2,200 from your individual or group long-term disability insurance company.
The complex language of your individual or group long-term disability policy will enumerate its many benefits and limitations, including group offsets. At DarrasLaw, we offer a completely free disability policy analysis and free claim consultation. Call us today for help interpreting your policy.
Common Disabling Conditions Covered by Individual and Group Long-Term Disability Insurance
An injury or illness doesn’t need to threaten your life for you to qualify for individual or group long-term disability insurance. An injury or illness need only prevent you from performing the important duties of your occupation. For example, a broken wrist may preclude a surgeon from performing the important duties of a surgeon, but won’t stop a person who is a video surveillance monitor from watching a screen.
The type of individual or group long-term disability coverage you have also is very relevant to your eligibility. “True own occupation” coverage will provide benefits if you can’t perform your occupation as you do it daily. General “any occupation” coverage only provides long-term disability insurance benefits if the injury or illness renders you unable to perform the important duties of any occupation by which you are trained, educated, or suited, taking into consideration your station in life. A surgeon with “any occupation” disability coverage might still be able to teach or consult, and may not qualify for individual or group long-term disability benefits for a broken wrist.
A nationally respected long-term individual disability attorney or stellar group ERISA lawyer from DarrasLaw needs to analyze your disability policy and the specific facts of your case, but the following conditions commonly cause qualifying disabilities:
- Musculoskeletal pain – Back and neck pain are the most common disabling conditions in the world. Many of us work with neck and back pain, but it can become unbearable if you’re required to sit or work on a computer all day, or lift and carry heavy boxes. Some individual or group long-term disability policies severely limit general back pain claimants from receiving benefits, but you may have an underlying condition, that might qualify. Rheumatoid arthritis is an autoimmune disorder, not a non-disabling age-related condition, and can cause disabling joint pain.
- Heart disease – Cardiac conditions are the number one killer in America. A heart attack occurs when one or more of the arteries that pump blood in and out of your heart become clogged with plaque. It only takes a few minutes for a heart attack to do its damage. You can suffer from a traumatic brain injury if your brain is deprived of oxygen-enriched blood from the heart for more than a few moments. Your treating doctor may also certify you’re disabled if you’re in grave danger of suffering from a major heart attack and need immediate treatment. If you suffer from high blood pressure and cholesterol, you may be in danger of suffering from a heart attack. Some childhood diseases also cause heart damage. Scarlet fever can destroy your heart valves and weaken your heart, which may later in life deteriorate and cause disability.
- Pregnancy complications – Pregnancy is not an injury or illness, but your individual or group long-term disability insurance policy may entitle you to maternity benefits. Pregnancy can result in prenatal diabetes and coma, while some women incur permanent nerve damage during delivery. Women may suffer from postpartum depression after birth or difficulty healing from a C-section. Women put on bed rest early in their pregnancies who also suffer from post-birth complications may also qualify for individual or group long-term disability benefits.
- HIV/AIDS: Modern medicine has drastically changed how we think about HIV/AIDS. With early intervention, most patients with HIV have a relatively average lifespan. However, later-stage HIV and full-blown AIDS can leave you susceptible to a plethora of opportunistic disabling infections. The HIV virus destroys your immune system, so even the common cold can quickly turn into a deadly condition. This may hurt your ability to reliably work in a traditional office environment, which can qualify you for individual or group long-term disability benefits.
These are only some of the more common or serious conditions associated with valid individual and group long-term disability claims. If your disabling illness or injury doesn’t fall into one of these categories, you may still qualify for individual or group long-term disability insurance benefits. Any of the following conditions may also qualify you for individual or group long-term disability benefits if they prevent you from performing the important duties of your occupation:
- Fibromyalgia and other self-reported conditions
- Substance abuse
- Depression or PTSD, anxiety, and other mental, emotional or cognitive conditions
- Traumatic brain injuries
- Back pain, sciatica, ruptured discs, scoliosis, and nerve injuries
- Cancer, chemotherapy, and radiation
- Tennis elbow
- Carpal and cubital tunnel syndrome
- Arthritis, lupus, and other autoimmune disorders
- Migraines, chronic fatigue
- Pneumonia, COPD, asthma, and lung conditions
- Crohn’s disease, IBS, and bowel dysfunction
- Hip and knee replacement surgery
Consult a Long-Term Disability Lawyer Early in Your Case
Individual and group long-term disability insurance claim applications are intentionally vague and misleading. A for-profit disability company administers your individual or group long-term disability policy and is always looking for ways to delay, deny, or terminate your disability payments.
Don’t wait to contact our award-winning individual disability lawyers or top-rated group ERISA attorneys until after a wrongful delay, denial, or termination of your individual or group long-term disability benefits. Let us help you from the beginning—at the claim application stage before any fatal mistakes are made.
That’s doubly true if you have a group ERISA plan. ERISA is an elaborate and extremely unforgiving federal legislative scheme that generally applies to group long-term disability claimants. You do not have the same legal rights under ERISA as an individual disability policyholder. After denial, you must first timely file an administrative appeal with your group disability insurer before bringing a valid claim for a wrongful denial of benefits in California’s federal courts.
The catch is that, if you’re wrongfully denied group long-term disability benefits after an administrative appeal, your entire federal ERISA lawsuit is limited to the medical records, statements, and documentation you and your carrier used in the underlying claim and during your administrative appeal. If your administrative appeal doesn’t include everything the judge will need to rule in your favor, you could easily commit fatal claim mistakes and not get paid.
If you have an individual disability policy, then you face a more traditional litigation process that may not require an administrative appeal.
Either way, don’t delay. Contact America’s top-rated long-term individual disability lawyers and nationally acclaimed group ERISA attorneys at DarrasLaw. We could literally save you from making a claim-ending mistake at no upfront cost to you.
Experienced Long-Term Individual Disability Lawyers and Top-Rated Group ERISA Attorneys Are Available Now to Serve Orange County Residents
The insurance industry is among the largest in California—but DarrasLaw is the David to the insurance company’s Goliath.
While many attorneys charge a fee just to meet with you and review your policy and claim information, DarrasLaw’s model is different. Our passion is helping you fight the insurance company while you’re struggling to get well. Even in complicated ERISA cases, we do not charge you to consult with our skilled national group disability lawyers. Our disability policy analysis is completely free. Our disability claim consultation is also completely free. We only collect a percentage of any settlement or judgment, plus costs, that we win for you after your denial or the reversal of an administrative appeal.
With more than 100 years of combined litigation and claim experience fighting for the disabled, Frank N. Darras and his firms have recovered almost $1 billion from the insurance companies worldwide. Residents of Orange County should contact us online or call us at (800) 458-4577 today.