Disability Lawyers Representing Claimants Throughout the San Francisco Peninsula
San Mateo, or the “Paris of the San Francisco Peninsula,” sits in the heart of the Silicon Valley. This area is home to many significant players in the technological and financial industries. Visa, Oracle, Franklin Templeton, Fisher, and the Department of the Interior are major employers in San Mateo. More than half of all San Mateo residents are in the workforce and the majority have college degrees. While the average income for a San Mateo family is $110,000, the average cost of living is also extremely high. The median price of a home on the San Francisco Peninsula is almost $900,000, making it difficult for many people to afford living here—even when they work full-time. Missing even a few weeks from work can have serious implications for many people living and paying steep rent or mortgages in the San Mateo area.
People might not know Silicon Valley for its physically intensive occupations, but disabilities are a reality for many Silicon Valley employees. Carpal tunnel syndrome, neck and back injuries, stress and strains, and chronic fatigue can all prevent you from reliably performing the important duties of your occupation with reasonable continuity and in the usual and customary way. You’re not alone if a disabling illness or injury prevents you from working in San Mateo. Taking advantage of your individual or group long-term disability benefits you purchased or ordered from your employer can replace a percentage of your lost income when a disabling illness or injury strikes.
Don’t wait to contact DarrasLaw, the nation’s premier disability attorneys and preeminent group ERISA attorneys today at 800-898-7299 or online. Our founding partner, award-winning ERISA attorney Frank N. Darras, and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits.
Understanding Your Individual or Group Long-Term Disability Benefits
California is among a small number of states that require employers to provide disability benefits. In particular, California employers and employees contribute to California State Disability Insurance, which provides limited disability benefits for one year. You may claim California state disability benefits if you’re unable to perform the important duties of your occupation due to injury or illness. This insurance covers a percentage of your income for 52 weeks while you recover from a temporary injury, illness, or pregnancy.
Individual or group long-term disability insurance is typically private. The Social Security Administration (SSA) offers long-term benefits to qualifying applicants, based on earnings or need, but government disability is often very difficult to obtain.
Different federal laws codified in the Employee Retirement Income Security Act (ERISA) apply to group policies, such as long-term disability insurance provided through your employer or union. Your employer or professional organization may offer group long-term disability policies as part of a benefits package and cover the cost of the premiums.
These group long-term disability policies cover only a portion, usually 50, 60 or 65 percent of the income from that job. Your employer-sponsored long-term disability insurance will not cover any income from a second job, no matter the amount.
This is where individual long-term disability insurance comes in. Individual long-term disability policies are purchased from an agent or broker and cover you, and the income from all of your jobs. You can also buy more disability coverage to supplement your group long-term disability benefits from work. For example, if your group benefits only pay 60 percent of your income, you could try and purchase more individual disability insurance. Or, you might purchase coverage to cover income from a weekend job that your disability prevents you from working. The benefits flow tax-free if you paid the premiums, and your consumer rights and remedies are terrific with individually purchased disability coverage.
ERISA does not generally govern individual long-term disability insurance policies. If you have individual disability insurance, and your disability insurer denies your valid claim, you may generally take your denial straight to court in most cases, without filing an appeal. In addition, you may seek emotional distress, extra contractual and punishment damages along with attorney fees, and a trial before a jury of your peers.
Typical Long-Term Disability Offsets
The primary purpose of individual or group long-term disability insurance is to replace income lost due to injury or illness. Your individual or group disability insurance company, however, is looking to save money, not spend it on your disability benefits. If you suffer from a severe injury or illness, an individual or group disability insurance company may offer you a lump sum settlement for a percentage of the present value of the future disability benefits.
A lump sum settlement may look attractive, but you will want a skilled individual disability attorney or group ERISA lawyer at DarrasLaw to review the offer before you accept it. Your individual or group disability insurance company is offering a lump sum because it will cost less than paying you for the life of the policy. You will also forfeit the legal right to further individual or group long-term disability benefits when you settle for a lump sum. In the end, the lump sum may be right for you and your family, but it will not fully cover the full monthly benefits for the duration of the contract.
In addition, a group disability insurance company may use the following offsets to reduce your monthly benefits:
- Any personal injury, third-party settlements, or judgments
- SSDI for you and your dependents under age 19
- Other group disability coverage
- V.A. benefits
- State disability benefits
- Wrongful termination settlements
- Workers’ compensation benefits for temporary total disability
- SSI benefits
Group insurance companies often bury offset and limitation language in long-term disability benefits contracts. At DarrasLaw, we offer a free disability policy analysis and free claim consultation to San Mateo’s disability claimants to ensure you’re receiving all the individual and group long-term disability benefits to which you’re entitled.
Common Disabling Illness and Injuries
Whether you qualify for private individual or group long-term disability benefits depends on whether your injury or illness prevents you from performing the material and substantial duties of your occupation, or in some policies any occupation by which you were trained, educated, or suited, taking into consideration your station in life. An accountant with a broken leg may find it difficult to get him or herself to work, but it won’t generally stop them from crunching numbers. On the other hand, carpal tunnel syndrome may completely prevent a programmer from typing and disable her from her occupation.
The following conditions commonly lead to long-term disabilities in the United States:
- Back and neck injuries: These are the most common disabling conditions in the world, but are often difficult to claim individual or group long-term disability benefits for. Many of us work with minor neck and back pain, but it can become unbearable as you age. Neck and back pain often develop from computer work, which constantly forces your body into an unhealthy static position. This can lead to serious disabling musculoskeletal injuries that manifest as you work. These injuries will get worse if you don’t treat the problems and allow your body to heal. Some individual or group long-term disability policies severely limit musculoskeletal conditions to just 24 months.
- Paralysis: Paralysis is a neurological condition leaving you unable to control and move certain parts of your body. Paralysis often results when physical damage disturbs the sensitive spinal nerves that send signals to the rest of your body, cutting off communications from the brain. Most types of paralysis qualify you for individual or group long-term disability benefits. Your level of disability may change with time. For example, a lawyer paralyzed from the waist down may eventually return to work after a lengthy rehabilitation and adjustment period. You may also qualify for partial long-term disability benefits if you voluntarily return to work part-time after a paralyzing injury.
- Cancer: The most common cancers in the United States are testicular, prostate, breast, pancreatic, and stomach. Unfortunately, doctors don’t often diagnose certain cancers, such as pancreatic, until they’re terminal or stage IV. Healthcare professionals classify cancer into various stages. The stages typically include Stage I through Stage IV, with IV the most severe. Terminal cancer patients—those with metastasized Stage IV cancer—may immediately qualify for individual or group long-term disability benefits if their disease interferes with work activity. Even though it’s a serious condition, whether you can claim individual or group long-term disability benefits depends on whether your cancer and the effects of your treatment prevent you from performing the important duties of your occupation.
- Heart disease: Heart disease is the number one killer in America for men and women of all races. It only takes a few minutes for a heart attack to do its deadly damage. You can also suffer from a traumatic brain injury if your brain is deprived of oxygen-enriched blood from the heart for more than a few moments, resulting in a secondary disability. Sometimes an underlying genetic condition causes a heart attack or cardiac disease. High blood pressure and cholesterol may result in serious or minor heart attacks. Some childhood diseases can also cause heart damage. Scarlet fever can destroy your heart valves and weaken your heart. Take care that you’re not wrongfully denied individual or group long-term disability benefits because the heart related condition was “preexisting.”
- Crohn’s disease: Crohn’s disease is a severe type of inflammatory bowel disease (IBS) leading to serious diarrhea, fatigue, pain, and malnutrition. There is no cure for Crohn’s disease, and the condition typically worsens with time. It can also result in infections, fever, cramping, blood in your stool, drainage, and mouth sores. Like many forms of IBS, Crohn’s disease often manifests in flare-ups. You may feel fine one day and completely unable to perform the important duties of your occupation the next. It’s more difficult to claim individual or group long-term disability benefits for these flaring conditions. For example, what if an insurance investigator sees you typing at a coffee shop for a few hours and then wrongfully denies or terminates your individual or group long-term disability benefits? You need an experienced San Mateo long-term individual disability lawyer or preeminent group ERISA attorney from DarrasLaw on your side if you suffer from IBS and hope to get paid.
- Diabetes: Type 1 diabetes occurs when your body can’t produce enough insulin to manage your blood sugar. You’re typically born with Type 1 diabetes, and physicians normally diagnose it in early childhood. You often cannot initially qualify for individual or group long-term disability benefits because Type 1 diabetes is often a preexisting condition. Type 2 diabetes, however, generally develops in adults and affects your body’s ability to control and use insulin. While people with diabetes can try to effectively manage it with diet and medication, certain manifestations of the disease cause permanent disabilities. These include hypoglycemia, leading to a coma, and neuropathy, which affects your arms and legs and hampers your ability to reliably walk or stand.
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:
- Carpal and Cubital tunnel syndrome
- Traumatic brain injuries
- Car accident injuries, including whiplash
- Fibromyalgia and other self-reported conditions
- Substance abuse
- Migraines, chronic fatigue
- Depression, PTSD, anxiety, and other mental, emotional or cognitive conditions
- Tennis elbow
- Back pain, sciatica, ruptured discs, and scoliosis
- Arthritis, lupus, and other autoimmune disorders
- Hip and knee replacement surgery
- Broken bones, fractures, dislocations, and severe sprains and tears
- Pregnancy complications
- Lyme disease, Rocky Mountain spotted fever, and other tick-borne illnesses
- Pneumonia, COPD, and lung disease or asthma
Any disabling injuries or illnesses that leave you unable to perform the important duties of your occupation may entitle you to individual or group long-term disability benefits with the help of a top-rated long-term disability attorney or award-winning group ERISA lawyer at DarrasLaw.
The Importance of Consulting a Top-Rated Long-Term Disability Lawyer or Nationally Respected Group ERISA Attorney at the Onset of Your Long Term Disability Case
California’s individual and group long-term disability insurance companies are always looking for ways to reduce their bottom lines by wrongfully delaying, denying, or terminating claimants’ long-term disability benefits. Carriers often get away with wrongful denials because of the complex federal laws that apply to group-sponsored ERISA disability insurance plans. Most disability claimants only contact our long-term group ERISA lawyers after a wrongful, delay, denial, or termination of group benefits, but it’s better to get in touch with us before you apply for group disability benefits if you have an ERISA-governed plan.
You do not have the same legal or procedural rights under an ERISA group disability plan as you would with an individual disability policy. With an ERISA policy, you must first timely file a comprehensive administrative appeal with your disability insurer before bringing a valid group disability lawsuit for a wrongful denial of group benefits in California’s federal courts.
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 can’t submit additional evidence, use discovery to get insurance company documents, call witnesses on your behalf, cross-examine the insurance company’s witnesses, or try your case before a jury in a group disability ERISA case. The federal judge will review the administrative paper record and will only overturn the insurer’s decision in most cases if the underlying decision was arbitrary and capricious or in some states, de novo.
These ERISA laws can drastically limit your ability to prove you have a legitimate disabling condition if you didn’t have an experienced ERISA lawyer from DarrasLaw on your side early in the process.
If you have a valid individual or group long-term disability claim, don’t delay in contacting America’s top-rated long-term disability attorneys or group ERISA lawyers at DarrasLaw immediately.
Contact the Experienced Long-Term Disability Lawyers and Group ERISA Attorneys at DarrasLaw Serving San Mateo, California, Today
The insurance industry is among the largest for-profit enterprises in California. At DarrasLaw, we’re passionate about helping you fight your disability insurance company after a wrongful delay, denial, or termination of individual or group long-term disability benefits. Our disability policy analysis and claim consultation are free, and you don’t pay after a denial unless we recover individual or group long-term disability benefits for you!
No matter the size of your case, we are here to help. With more than 100 years of combined litigation and claim experience fighting for your legal right to individual and group long-term disability benefits, our premier individual disability attorneys and skilled group ERISA lawyers want to bring your individual or group long-term disability claim to the best resolution possible. Residents of San Mateo and the surrounding counties should contact DarrasLaw online or call us at 800-898-7299 today to set up a free consultation.