With a growing population of three million, Silicon Valley is one of the nation’s premier business locations and a popular hub for entrepreneurs. Various surveys and organizations have ranked Silicon Valley number one for business start-ups. San Jose has a relatively high per capita income compared to the rest of the nation, but it’s only average in California. The cost of living in San Jose, Palo Alto, and the surrounding areas is high, so most Silicon Valley residents rely on a steady income. Santa Clara and San Mateo Counties have relatively low unemployment rates compared with the rest of California and the United States as a whole.
So what happens if a disabling illness or injury renders you unable to perform the important duties of your occupation in San Jose? Do you have individual or group long-term disability insurance? If so, are you entitled to individual or group long-term disability insurance benefits?
Insurance is one of the largest and most profitable industries in California. Insurance is so ingrained in our lives that we may forget that it’s mainly a for-profit enterprise. Your individual or group long-term disability insurance is looking for ways to make money, increase profits, and cut disability payments and liabilities. It may consider you one of those liabilities if you suffer from a serious injury or illness that prevents you from performing the important duties of your occupation.
The top-rated long-term individual disability attorneys and award-winning group ERISA lawyers at DarrasLaw have more than 100 years of combined litigation and claim experience fighting insurance companies for wrongfully delayed or denied insurance benefits. We know your legal rights under California and federal ERISA group disability laws. DarrasLaw’s experienced long-term individual disability lawyers and premier national group ERISA attorneys can surely help you claim your individual or group long-term disability benefits.
Call the stellar long-term individual disability attorneys and skilled national ERISA lawyers at DarrasLaw today at (800) 458-4577 or contact us online if your insurer has wrongfully delayed, denied, reduced, or terminated your individual or group long-term disability benefits in San Jose, Sunnyvale, Palo Alto, Mountain View, Fremont, Redwood Shores, or Woodside. Our disability policy analysis is completely free. Our disability insurance claim consultation is also completely free. Call now.
Understanding Individual and Group Long-Term Disability Insurance and Your Benefits
Californians need to understand the difference between private, long-term disability insurance and California’s state-sponsored disability system.
California is one of a small number of states that provides short-term disability insurance for qualifying working citizens. Both employers and employees pay into the California state-based plan. This insurance replaces a percentage of your income to a maximum benefit of less than $4,500 a month for as long as 52 weeks if you’re unable to perform the important duties of your occupation due to a disabling illness or injury.
California state-based disability insurance is designed to cover temporary injuries and illnesses such as recovery from surgery, a broken bone, pneumonia, and pregnancy. It is not designed to cover injuries and illnesses lasting more than a year. Dialysis patients awaiting a kidney transplant, complicated neck or back surgery, and cancer patients must typically rely on private, individual or group long-term disability benefits.
Different laws and regulations control each of the three main types of long-term disability insurance:
- Group-sponsored disability insurance – These policies cover a group of qualifying individuals, such as employees or union members. You may automatically qualify for these group disability benefits while employed, and they are typically part of your employee benefits package. Your employer will generally cover some or all of your group long-term disability premium, and many employees don’t even realize that they have coverage.
- Individual disability insurance – Contractors and small business startups in Silicon Valley often turn to individual long-term disability insurance. People purchase individual disability insurance from an agent or broker. These plans cover you personally, and you’re generally responsible for paying your disability premiums but the benefits flow tax-free. However, this also means you can claim a percentage of all lost income after a disabling illness or injury. For example, if you work two jobs and wait tables on the weekends, you can recover a percentage of your total lost income. Some claimants carry both individual and group long-term disability policies.
- Social Security Disability Insurance (SSDI) – These are your federal long-term disability benefits. Working Americans (and qualifying children) who have paid into SSDI are eligible to apply for federal benefits. To qualify for SSDI, an injury or illness must leave you unable to perform the important duties of any occupation. This is not true of most individual and group plans. Federal disability benefits run concurrent to your private disability policy, which means you may claim long-term disability benefits from multiple sources. Your group disability insurance may force you to apply for SSDI, and if you qualify, it will reduce your group long-term disability benefits by the amount of you and your dependents SSDI benefits.
A complex set of federal laws called the Employee Retirement Income Security Act (ERISA) governs most long-term group disability insurance policies. Unfortunately for claimants, ERISA dramatically limits your ability to fight wrongful delays, denials, and terminations of group disability benefits.
Don’t make a fatal claim mistake. Consult one of the skilled nationally preeminent ERISA group attorneys at DarrasLaw as soon as you realize you need to file a group disability claim.
Examples of Common Disabling Conditions Covered by Long-Term Disability Insurance
Your individual or group long-term disability insurance policy will contain a myriad of limitations to coverage that the seasoned long-term individual disability attorneys and nationally respected group ERISA lawyers at DarrasLaw can help you navigate.
Some of the most common conditions that qualify claimants for individual and group long-term disability benefits in San Jose include:
- Cancer – Reports indicate that almost one in three Americans will develop cancer. Your age, gender, and family history may contribute to your risk of developing certain cancers, but many cases are unexplained. Breast, prostate, skin, and lung cancer are among the most common cancers in the United States. Patients can generally complete cancer treatment within a year, but the side effects of chemo and radiation therapy can leave you unable to perform the important duties of your occupation. Some patients need amputations, bone marrow transplants, or inpatient treatments while fighting cancer. You may need to claim individual or group long-term disability benefits to help sustain you during this disability period.
- HIV/AIDS – Modern medicine has substantially changed HIV/AIDS treatment. HIV patients who start treatments early can often live and work without limitation. It’s still challenging to treat late-stage HIV, also known as AIDS. HIV is a virus that attacks and destroys your immune system, leaving your body vulnerable to common illnesses. A healthy immune system can easily fight off these opportunistic infections, but not a patient with HIV. Common fungal infections and colds often lead to serious and even deadly lung infections and pneumonia. San Jose residents with late-stage HIV and AIDS may require years away from work due to recurrent illnesses. The potential for infection may render them unable to function in a traditional office or work environment.
- Traumatic brain injuries – Car accidents commonly cause brain injuries. A traumatic brain injury can range from mild, such as a concussion, to severe enough to result in a coma. The brain is complex, and the nature of your disability depends on the location and severity of your brain injury. An injury to the right side of your brain may damage left-side functions, while an injury to your frontal lobe may affect speech and personality. An injury or sickness involving your brain stem, including rare brainstem tumors, can even make moving or breathing difficult.
- End stage renal failure (Stage 5 chronic kidney disease) – Even the young, healthy, and famous can suffer from end-stage renal failure. Lupus is another serious autoimmune disorder that commonly causes renal failure. Toxins build up throughout your body when you’re in kidney failure. This build-up causes pain, swelling, and sometimes death. Your kidneys also help regulate your blood pressure. It’s nearly impossible to perform the important duties of your occupation in end-stage renal failure. You will need continued dialysis or a kidney transplant at this stage, and most patients on dialysis don’t have the time or strength to perform the important duties of their occupation.
Nearly any injury or illness can cause a disability. This depends entirely on how the injury or illness affects your ability to perform the important duties of your occupation. A carpenter with a broken hand may require months away from work, and the same injury may take a baseball player out for an entire season. However, a broken wrist probably won’t affect a lawyer’s ability to perform the important duties of the legal occupation unless it prevents keyboarding.
Depending on your occupation, any of the following injuries or illnesses can qualify you for individual or group long-term disability benefits:
- Heart attacks, strokes, coronary artery disease, and aneurysm
- Tennis elbow
- Carpal and cubital tunnel syndrome
- Bunion surgery
- Pregnancy complications
- Knee and hip injuries and replacements
- Fibromyalgia and other self-reported conditions
- Lyme disease, Rocky Mountain spotted fever, and other tick-borne illnesses
- Multiple sclerosis
- Substance abuse
- Depression, PTSD, anxiety, and other mental, emotional or cognitive conditions
- Neck and back pain
- Car accident injuries
- Migraines, chronic fatigue
- Rheumatoid arthritis
Certain injuries and illnesses make it impossible to reliably perform the important duties of your occupation. Recognize your need for individual or group long-term disability benefits before it’s too late. The experienced individual long-term disability attorneys and leading national group ERISA lawyers at DarrasLaw are here to help protect residents of San Jose, Palo Alto, and the rest of Silicon Valley from wrongful delays, denials, or terminations of individual or group long-term disability benefits.
Protect Your San Jose Disability Case—Consult an Award-Winning Long-Term individual Disability Insurance Lawyer or Top-Rated National Group Attorney Who Represents Clients in Silicon Valley
You may see warning signs before your individual or group long-term disability insurer wrongfully delays, denies, or terminates your benefits. For example, your individual or group long-term disability carrier may request additional medical records, witness statements, corroborating physician statements, a vocational examination, and additional employment forms even after you already submitted compelling medical evidence and proof of your ongoing disability. It does this when it’s trying to find a reason to wrongfully delay, deny, or terminate your individual or group long-term disability benefits.
You may have received individual or group long-term disability benefits for a neck injury related to a car accident, for example. However, your individual or group disability insurer may tire of paying you benefits and “find” in past medical records that you injured your neck in a bike accident several years ago. Your individual or group long-term disability insurer may take these old records and claim your neck injury was “pre-existing,” even though you fully recovered from your bike injury.
Group-sponsored disability insurance policies are subject to ERISA. A wrongful delay, denial, or termination of group disability benefits under an ERISA plan means you must timely file a comprehensive administrative appeal with your insurer. You can only bring an ERISA lawsuit in federal court for a wrongful delay, denial, or termination of group benefits after the conclusion of your administrative appeal.
Furthermore, you must shoulder the burden of proof in California’s federal courts for group ERISA claims. You’re not entitled to submit additional evidence to prove your ERISA disability case, only the medical records, statements, and documentation you and your carrier used in the underlying claim and your group administrative appeal are considered.
The federal ERISA judge will only review the administrative record that led to your wrongful denial and will generally only overturn the insurer’s decision if it was arbitrary and capricious.
It’s difficult to succeed in an ERISA courtroom, but having a nationally prominent group ERISA long-term disability attorney from DarrasLaw on your side early in the disability group claims process can help protect your legal rights. DarrasLaw’s knowledgeable long-term national group ERISA lawyers know how to make your disability case before, during, and after the administrative appeal.
Call Our Nationally Renowned Individual Long-Term Disability Attorneys and Group ERISA Lawyers at DarrasLaw Today if You’re Disabled in San Jose
Frank N. Darras, America’s leading disability attorney, and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits. His team of nationally preeminent individual disability lawyers and top-ranked ERISA attorneys know how to fight for the individual and group long-term disability benefits to which you are entitled.
If you believe your individual or group long-term disability insurer wrongfully delayed, denied, reduced, or terminated your disability benefits in Silicon Valley, schedule your completely free policy analysis and free claim consultation with DarrasLaw today by calling (800) 458-4577 or using our online contact form.