Fighting Wrongful Delays, Denials, and Terminations of Disability Benefits Throughout California
About 9 percent of all Sacramento residents younger than 65 report suffering from a disability. This is about the national average, but it is much lower than in surrounding counties. Lake, Yuba, Alpine, and Calaveras Counties all report disability rates among those younger than 65 at about 15 percent. Perhaps this is because Apple, AT&T, Bank of America, and Intel are the largest employers in Sacramento County, and employees are afraid of losing job opportunities if they file a claim for individual or group long-term disability benefits.
One of the upsides of working for a major corporation, however, is that large companies almost always offer employer-sponsored long-term disability insurance coverage. If you’re suffering from an injury or illness that prevents you from performing the important duties of your occupation, the help of an award-winning long-term disability lawyer or nationally acclaimed ERISA attorney from DarrasLaw may help you take advantage of these individual or group disability benefits.
Private, for-profit companies control long-term disability insurance plans. Your individual or group long-term disability insurer is in the business to make money. Accordingly, you may find yourself faced with a wrongful delay, denial, reduction, or termination of your individual or group long-term disability benefits.
If a disabling illness or injury prevents you from working in your occupation in Sacramento, consult the top-rated individual and award-winning group ERISA long-term disability lawyers at DarrasLaw. Our experienced disability lawyers and seasoned ERISA attorneys will conduct a free disability policy analysis and free claim consultation. Our founding partner, Frank N. Darras, and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits, and we may be able to help you. To schedule your completely free disability consultation, call us today at 800-898-7299 or contact us online.
Individual and Group Long-Term Disability Insurance in Sacramento
Individual and group long-term disability insurance acts as an income replacement plan if you suffer from an injury or illness that prevents you from performing the important duties of your occupation. Depending on your plan, it provides a percentage of your lost wages.
Most individual and group disability insurance policies also contain a mountain of exceptions and exclusions to coverage, such as combat-related injuries, self-inflicted injuries, and injuries sustained while intoxicated or while committing a felony. Intentionally misleading questions on your claim application may fool you into stating that your injury or illness resulted from an excluded activity. Make sure you contact DarrasLaw to find out how to properly answer these tricky disability claim questions.
Most corporate long-term disability insurance policies are group disability plans. This means a private insurer contracts with your employer to cover a group of eligible employees.
Individual long-term disability insurance policies are purchased from an agent or broker in the same way you would buy automobile or homeowner insurance. These policies follow you, not your job. If you’re self-employed, an independent contractor, or have planned carefully, you may have purchased an individual long-term disability policy that pays tax-free benefits if you paid for the policy personally.
Social Security Disability Insurance offers another type of long-term disability coverage. If you’ve paid sufficient taxes during a certain eligibility period, and you are totally disabled from the workforce, you may qualify for SSDI. If so, your group long-term disability insurance company will typically subtract SSDI payments and those payments to your eligible dependents from your group disability payments. This is called an offset.
Other offsets include:
- Personal injury settlements, third-party settlements, or judgments
- SSDI for you and your dependents under age 19
- Workers’ compensation benefits
- State disability benefits
- Wrongful termination settlements
- Other group disability coverage
- Retirement benefits funded by your employer
It’s important to distinguish between the different types of long-term disability insurance policies because special laws cover these different types of policies. This means the laws applicable to a potential individual or group disability case differ based on the type of plan you have and even the part of the county you live in.
If you have a group-sponsored disability policy, such as a plan through an employer or union, it’s generally governed by a complex set of federal laws called the Employee Retirement Income Security Act (ERISA). The laws and regulations under ERISA can seriously hinder and often limit long-term disability insurance litigation, but these laws don’t apply to individual policyholders.
DarrasLaw’s top-rated individual disability attorneys and award-winning ERISA lawyers have more than 100 years of insurance claim and litigation experience handling individual and group disability insurance claims. Unlike many attorneys, who don’t have our decades of litigation and national claim experience, we know which laws apply to which situations. We understand the vastly different procedures needed to successfully litigate and win the toughest cases involving individual and group long-term disability insurance claims.
Most Common Disabling Conditions in Sacramento
What disables one employee from a particular occupation may not disable someone in another occupation. For example, a back injury to a warehouse worker may prevent her from performing the important duties of the occupation, such as lifting boxes, while the same back injury may not impair an IT worker who might still be able to sit comfortably for an eight-hour day.
The following are some of the most common disabling injuries in California:
- Cancer: Cancer is a general term for a disease characterized by the rapid mutation of abnormal cells within your body. The type of cancer you have depends on where the cells mutate, and if your treating doctors don’t catch the cancer early enough, it can spread to other areas of your body. Skin, breast, prostate, lung, colon and bladder cancers are among the most common cancers in the United States. Sometimes the treatment is worse than the disease itself. Many Californians live and work with cancer for years, and working may even improve their mental health. However, there comes a point where you may require a break from work to receive the proper treatment and much needed rest.
- Heart disease/heart attacks: This is the leading cause of death in the United States for both men and women. Sometimes heart disease is genetic, such as if you’re born with a congenital heart defect like mitral valve prolapse or a circulatory condition such as Raynaud’s disease. On the other hand, lifestyle choices such as poor diet and limited activity often cause or contribute to heart disease. This can cause plaque to build on the walls of the arteries leading to your heart, and it can limit blood flow to or from the heart itself. When blood flow is almost completely restricted, a heart attack, which can result in death if not treated, may result. The nature of your cardiac surgery, whether an open-heart bypass procedure or angioplasty, will often determine your disability recovery period and whether the risk of relapse is too great to safely return to work.
- Diabetes complications: Type 1 and Type 2 diabetes are treatable but can result in serious consequences if not monitored daily. A significant drop in your blood sugar can cause you to lapse into a diabetic coma, which is often fatal. According to the Mayo Clinic, the following injuries and illnesses result from diabetic complications: heart disease, nerve damage, eye damage, skin conditions, hearing impairment, kidney issues and damage to feet and limbs. Both underlying diabetes and the resulting complications can form the basis of a valid long-term disability claim.
- Car accident injuries: Car accidents can cause anything from whiplash to death. Car accidents can result in the most traumatic brain injuries, and if you sustain one, you may lose your ability to focus or think critically. The most common injuries caused by car accidents are spine and neck dislocations. Age-related degeneration may worsen these problems. Judgments and settlements from personal injury lawsuits stemming from car accidents may be offset from your group long-term disability benefits.
- Paralysis: Both injuries and illnesses can cause nerve damage and paralysis. Paralysis is the loss of control and strength in a certain area of your body. While it can occur in the face (Bell’s Palsy), it often occurs after damage to your spinal cord. This means the brain can’t get signals to the area of your body you want to move, such as your legs. Paralysis is almost always a permanent disability, but in some cases, as the underlying injury starts to heal and the spinal swelling goes down, it can prove temporary.
While these are all serious health conditions, your injury or illness doesn’t need to threaten your life for you to qualify for individual or group long-term disability benefits. As long as the injury or illness prevents you from performing the important duties of your occupation, you may qualify for individual or group disability benefits. These conditions often include:
- Knee injuries, arthroscopic surgeries and total knee replacements
- Tennis elbow and cubital tunnel syndrome
- Carpal tunnel syndrome
- Bunion removal
- Substance addiction
- Depression, PTSD, anxiety, and other mental and emotional health issues
- Broken bones, sprains, and strains
- Crohn’s disease, IBS, and bowel dysfunction
- Pneumonia, asthma, COPD, and other lung diseases
- Lyme disease, Rocky Mountain spotted fever and other tick-borne illnesses
- Fibromyalgia, migraines, chronic fatigue, and other self-reported issues
- Arthritis, lupus, and other autoimmune disorders
Obtaining individual or group long-term disability benefits is often difficult. The key is articulating how your injury or illness limits or prevents your ability to perform the important duties of your specific occupation. To further complicate matters, your occupation’s duties are often defined by how your work is performed in the national economy, not by what you do specifically at your actual job.
Don’t try to file a claim for individual or group long-term disability benefits alone. Instead, contact the experienced long-term disability attorneys at DarrasLaw today for help and guidance and to prevent fatal claim mistakes.
Consulting a Top-Rated Individual or Nationally Acclaimed Group ERISA Long-Term Disability Attorney at the Onset of Your Case Makes All the Difference
If you bought an individual disability policy, you may generally take your bad-faith denial straight to the courts without filing an administrative appeal. There, you may submit evidence, use discovery to get insurance company documents, call witnesses on your behalf, cross-examine the insurance company’s claim and medical personnel, and try your case before a jury. In addition, you may seek emotional distress and punishment damages along with attorney fees with your trial before a jury here in California. If you paid the premium yourself, the disability benefits flow to you tax-free.
ERISA generally imposes serious prerequisites to litigation in cases involving group and employer-sponsored long-term disability policies. With group long-term disability plans, before you can file an ERISA federal lawsuit for a wrongful delay, denial, or termination of benefits, you must generally timely file an administrative appeal with the insurance company.
While a new claims adjuster and, if applicable, a new company doctor (who may lack the proper training or specialization to evaluate your condition) must review your denied group claim, they’ll seldom overturn a wrongful denial or termination. Your group long-term disability insurer is trying to stem the flow of benefits, not reinstate them.
The second hurdle with an ERISA plan comes if your group long-term disability insurance company does not overturn your wrongful denial or termination. If you decide the file an ERISA case in federal court, ERISA limits your case to the underlying documents and records submitted on appeal.
In other words, you generally can’t submit any new evidence to the court that you didn’t submit to your insurance company in the underlying claim denial and your group administrative appeal. If you didn’t submit everything the judge will need to rule in your favor—including witness affidavits, accident reports, your treating physician’s chart notes, complete medical records and testing, pharmacy records, and your treating doctor’s detailed opinion on why you are unable to work—you can’t go back and do so in federal court. This is one of the primary reasons to get an experienced long-term group disability lawyer and award-winning group ERISA attorney from DarrasLaw on your side early in the disability claims process. By helping you file a legally sufficient administrative appeal, we can position your case for its best chance of success should you later need to file an ERISA federal lawsuit.
Once you do get to federal court with your group ERISA case, you don’t have the same legal rights or consumer protections as individual disability policyholders. You also have the burden of proving you’re entitled to long-term disability benefits under the terms and limitations of your group disability plan. The judge will review the record and will only overturn the insurer’s decision if it was arbitrary and capricious.
Call America’s Premier ERISA Attorneys at DarrasLaw Today
While the prospect of fighting a wrongful delay, denial, or termination of individual or group disability benefits is daunting, the top-rated ERISA lawyers and nationally renowned individual disability attorneys at DarrasLaw know how to do it. In fact, our founding partner, Frank N. Darras, and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits.
With more than 100 cumulative years of litigation and claim experience in the field of disability insurance law, the award-winning team of individual and ERISA group disability lawyers at DarrasLaw are led by the nation’s top disability attorney, Frank N. Darras. He and his team know ERISA inside and out, and the bad faith that comes with an individual disability denial.
To schedule your completely free disability policy review and free case analysis, call us today at 800-898-7299 or contact us online.