Riverside, California, is called the City of Arts and Innovation, and it’s one of the top cities for millennials in the United States. Riverside has won numerous accolades, including for popularity, safety, and graduate retention. The average age of Riverside residents is 32, younger than the rest of California.
Today’s young workers don’t always consider the importance of employee benefits, especially benefits designed to protect against long-term illnesses or injuries. Disabling illnesses and injuries aren’t a reality for many of California’s younger workers until they face a career-ending disability themselves. A serious car accident on I-215 or an unexpected injury at Huntington Beach can leave you disabled for years.
Most young Californians don’t have the savings necessary to sustain themselves after a disabling illness or injury leaves them unable to perform the important duties of their occupation. Fortunately, individual or group long-term disability insurance can help protect people who are unable to perform the major duties of their occupation.
You’re not alone if an unexpected disabling illness or injury prevents you from performing the important duties of your occupation in Riverside. You may find claiming individual or group long-term disability benefits difficult, even with a qualifying disability. Insurance is one of the largest for-profit industries in California, and you may face a bad-faith delay, denial, or termination of individual or group disability benefits even if you have great coverage.
Take advantage of your completely free disability policy analysis and free claim consultation with the nation’s leading individual long-term disability lawyers and nationally renowned group ERISA attorneys at DarrasLaw. Our founding partner, Frank N. Darras, and his firms have recovered nearly $1 billion in insurance benefits for clients worldwide. Call DarrasLaw at (800) 458-4577 or email us if you need help claiming a percentage of your lost income due to a disabling illness or injury.
California Long-Term Disability Insurance Policies
Many disabling illnesses and injuries are temporary. Surgical recovery, pregnancy, and pneumonia may take you out of work for months, but generally not for years.
California State Disability Insurance is a state-sponsored program that replaces a percentage of your normal income while you recover from a temporary injury, illness, or pregnancy. Employees are required to pay into this state-based program, and you’re entitled to 52 weeks of benefits while disabled from your occupation.
The three main types of long-term disability insurance policies include:
- Social Security Disability Insurance (SSDI) – SSDI provides federal long-term disability benefits. Most U.S. citizens (and qualifying children) who have paid into SSDI are eligible to apply for federal benefits. To qualify for SSDI, you must suffer from a terminal illness or be unable to perform the important duties of any occupation. Federal disability benefits run concurrently with individual or group long-term disability policies, which means you may claim individual or group long-term disability benefits from multiple sources. Most group long-term disability insurers require eligible claimants to apply for SSDI, which is used to reduce, or offset, your group benefits.
- Group long-term disability insurance – Employers, labor unions, and professional organizations may purchase group disability policies to cover qualifying individuals, such as employees or union members. Your employer may purchase group long-term disability insurance for a class of employees, and you may automatically qualify for coverage while employed. A private long-term disability insurer will conduct a risk-benefit analysis that weighs the total group premiums paid by you or your employer against potential claims. You can’t get group disability benefits unless you’re part of the covered group, and they only protect you while employed. Leaving your job or organization generally means losing your group long-term disability benefits unless your group coverage includes conversion rights.
- Individual long-term disability insurance -Riverside is known for its high number of small business owners and self-employed residents. Self-employed persons generally can’t participate in group-sponsored plans. Instead, you can purchase an individual long-term disability plan from an agent or broker. Individual plans cover you personally, meaning you can claim a percentage of all lost income after a disabling illness or injury. For example, if you work two jobs, you can recover a percentage of your total claimed income. Some claimants carry both individual and group long-term disability insurance. Individual policies paid for personally also provide tax-free benefits.
A complex set of federal laws called the Employee Retirement Income Security Act (ERISA) generally governs your long-term group disability policy. Claimants with group employer-sponsored policies are not entitled to the same legal, procedural, or consumer rights as individual policyholders.
ERISA dramatically limits your ability to fight wrongful delays, denials, and terminations of group benefits. An experienced long-term group ERISA disability lawyer from DarrasLaw can dramatically improve your chances of filing a successful claim application, administrative appeal, or federal ERISA lawsuit.
Understanding Your Individual or Group Long-Term Disability Insurance Benefits in California
Individual and group long-term disability insurance primarily functions as income replacement insurance in the event of a qualifying injury or illness. The level of income replacement depends on the nature and cost of your disability policy. The more expensive your disability policy premiums, the greater your level of individual or group disability benefits and protection.
The average claimant is entitled to about 60 percent of his or her lost income in a group policy, with certain guaranteed minimums. Your group ERISA long-term disability insurer will reduce your group benefits if you have an alternative income source, including:
- Pension contributions
- Wrongful termination settlements
- Other group disability coverage
- Personal injury settlements, third-party settlements, or judgments
- SSDI for your dependents under age 19
- A. benefits or pensions
- Social Security or SSI benefits
- Workers’ compensation benefits for temporary total disability
- State disability insurance benefits
These offset provisions and limitations are designed to reduce your group ERISA long-term disability benefits.
Common Disabling Conditions Covered by Individual and Group Long-Term Disability Insurance
To qualify for individual or group long-term disability benefits, you must:
- Suffer from a disabling injury or illness
- The injury or illness leaves you unable to perform the important duties of your occupation
- The disabling condition lasts for at least as long as your elimination period, as specified in your individual or group disability insurance policy
- The disabling limitation was not related to a preexisting condition
“True own occupation” disability coverage provides individual or group disability benefits if you can’t reliably perform the important duties of your occupation with reasonable continuity and in the usual and customary way. General “any occupation” disability coverage only provides individual or group disability benefits if you’re disabled from “any occupation” by which you are trained, educated, or suited, taking into consideration your station in life. Understanding this distinction is important when fighting for your rightful individual or group long-term disability benefits.
Keeping these provisions and limitations in mind, the following conditions commonly result in viable long-term disability claims:
- Car accident injuries: There is no limit to the damage car accidents can do. You may suffer no injury, minor whiplash, or find yourself disabled for life after a car accident. The most common injuries caused by car accidents are spine and neck dislocations, which already plague young workers in the Riverside area. Understand that most individual and group long-term disability insurers will offset your group long-term insurance disability benefits based on financial compensation recovered from a personal injury lawsuit.
- Paralysis: Paralysis is the loss of control and/or strength in a certain area or areas of your body. Car accidents often result in paralysis, as do many surfing and extreme sports accidents. Both injuries and illnesses can cause nerve damage leading to paralysis. While temporary paralysis can occur in the face, such as with Bell’s palsy, it often occurs after damage to your spinal cord. Spinal cord injuries prevent the brain from communicating with your body below the point of the injury, causing paralysis of that area. Paralysis almost always constitutes a permanent disability, but extensive rehabilitation can restore some functions. Take advantage of your individual or group long-term disability benefits if you’re recovering from a paralyzing injury or sickness.
- Mental health conditions – Californians of all ages have mental health concerns. Situational or temporary mental health issues may arise naturally after a divorce, childhood trauma, or losing a loved one. Some mental illnesses are more serious than others. Your individual or group long-term disability insurance policy may entitle you to benefits if a mental health condition prevents you from performing the important duties of your occupation. Most individual and group long-term disability insurers limit benefits to 12, 18, or 24 months for mental health and substance abuse conditions.
- Back and neck pain – These are the most common disabling conditions in the world and among working Californians. Many computer-based jobs cause neck and back pain, which can become unbearable as you age. Neck and back pain often develop in tech industry employees. This can lead to serious disabling musculoskeletal injuries that manifest as you work. These injuries and sicknesses will get worse if you don’t allow your body to heal. Some individual and group long-term disability policies severely limit the benefits that they will pay for general musculoskeletal pain to 18 or 24 months. You may have an underlying condition causing that back pain that qualifies you for individual or group long-term disability insurance benefits.
Almost any injury or illness can qualify you for individual or group long-term disability benefits if it prevents you from reliably performing the important duties of your occupation.
Additional conditions that may qualify you for individual or group long-term disability benefits include:
- Crohn’s disease, IBS, and bowel dysfunction
- Carpal and cubital tunnel syndrome
- Pregnancy complications
- Cancer, chemotherapy, and radiation
- Tennis elbow
- Bunion surgery
- Knee and hip injuries and replacements
- Broken bones
- Heart attacks, strokes, coronary artery disease, and aneurysm
- Migraines, chronic fatigue
- Fibromyalgia and other self-reported conditions
- Pneumonia, COPD, asthma, and lung conditions
- Surgical recovery
- Lyme disease, Rocky Mountain spotted fever, alpha-gal allergies, and other tick-borne illnesses
- Arthritis, lupus, and other autoimmune disorders
The award winning long-term individual disability attorneys and stellar national group ERISA lawyers at DarrasLaw can analyze your disability insurance policy to determine whether your individual or group insurer has wrongfully delayed, denied, or terminated your long-term disability benefits.
Consult a Premier Riverside Individual Long-Term Disability Lawyer or Nationally Preeminent Group ERISA Attorney at the Onset of Your Disability Case
You want a skilled long-term individual disability lawyer or top-rated litigation group ERISA attorney from DarrasLaw. Individual and group disability insurance companies are always looking for ways to reduce their bottom lines by wrongfully delaying, denying, or terminating your long-term disability benefits.
Unfortunately, most individual and group disability claimants only contact our award-winning long-term individual disability lawyers and top-rated national group attorneys after a wrongful denial of individual or group disability benefits. If you have an individual claim or group ERISA plan, you’re better off contacting DarrasLaw before you even file your valid claim. Often claimants make fatal mistakes filling out confusing forms, appearing at field visit requests, attending insurance company exams, or over performing at a functional capacity evaluations.
Group long-term disability insurance companies frequently manipulate ERISA’s often-complicated provisions to protect wrongful delays, denials, and terminations of group benefits.
You must first timely file an administrative appeal with your group disability insurer under an ERISA plan before bringing a lawsuit for a wrongful denial of group disability benefits in federal court. Your entire federal ERISA lawsuit, however, is limited to the medical records, statements, and documentation you and your carrier used in the underlying claim and your group administrative appeal. You cannot submit additional medical reports, witness statements, provide expert testimony, or anything additionally during a federal ERISA lawsuit. The federal ERISA judge will review the record and will generally only overturn the insurer’s decision if it was arbitrary and capricious.
Don’t delay. Consult America’s preeminent long-term individual disability attorneys and nationally respected group ERISA lawyers at DarrasLaw today. We know how to protect your legal rights under your individual disability policy and group ERISA plans.
Contact the Knowledgeable Long-Term Individual Disability Lawyers and The Top-Rated National Group ERISA Attorneys at DarrasLaw
At DarrasLaw, we’re passionate about fighting against California’s individual and group long-term disability insurance companies after they wrongfully, delay, deny, or terminate your long-term disability benefits. Our initial disability policy analysis and claim consultation are completely free, and we only get paid if we recover individual or group disability benefits for you!
No matter the size of your case, we are here to help. Schedule your completely free disability policy analysis and free claim consultation with our skilled individual disability lawyers and stellar national group ERISA attorneys at (800) 458-4577, or contact us online.