What is ERISA and How Might it Affect My Long Term Disability Claim?

ERISA is short for Employee Retirement Income Security Act, established in 1974. It’s is a federal law under the US Department of Labor that “sets the minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in the plans.”  Unfortunately, it doesn’t always work that way.

What is ERISA and How Might it Affect My Long Term Disability Claim?

ERISA governs long-term disability policies and only applies to most private employers that offer benefits. It was created to ensure that plan administrators didn’t misuse pension and other employee funds. Public (governmental) or church employees (including church-owned hospitals) and private policies are excluded. ERISA only establishes minimum standards for employers who do offer benefits for their employees. It doesn’t require them to offer benefits.

ERISA And Long Term Disability Policies

A lot depends on what your company and the policy calls “disability.” Research your policy and find out exactly how yours defines it since it could determine if you can get LTD and for how long.

Some policies say “any occupation,” which means you’re unable to work at any job. “Own occupation” indicates that you can’t work in your current occupation, but you could work in a different one. (For instance, an injured construction worker who becomes a project manager.)  Some policies go from “any occupation” to “own occupation” after 24 months, meaning you could work another job, even if you can’t work in the one you had before.

Claim denials are common for even the most legitimate disability cases.

ERISA means that if your LTD plan is employer-funded if you should need to file suit, you will:

  • Have a hearing with judge, but no jury
  • Not be awarded attorney’s fees
  • Not be able to recover any damages
  • Likely to be ruled against in a court proceeding

Plan administrators are given considerable leeway in the administration of a plan.

How ERISA Can Keep You From LTD

It was intended to “protect” your rights, but ERISA ends up protecting the rights of the insurance companies. ERISA preempts most state law “bad faith” lawsuits, denying you the right to sue your insurance company should your claim be denied. Unlike a personal injury suit, where you can sue for damages, attorney’s fees and other compensation, ERISA prevents you from doing that. The most you can receive from a lawsuit would be the monies you were originally due when the insurance companies denied your claim to begin with. In the administrative hearing, the judges can only determine if the insurance company committed an “abuse of discretion.”

ERISA has complex rules and regulations that must be followed exactly, and deadlines that must be met without exception. Miss one deadline, or make one mistake in your claim, and the claim will be quickly denied without any opportunity to appeal or reopen your case.

Your employer may have additional requirements, with deadlines, for you to follow before you can access LTD. Ask for any and all related documentation so you can review it yourself. Deadlines and other requirements should be detailed in these documents, so read them carefully and take note of all deadlines you need to be aware of.

Your Doctor

When submitting your LTD claim, you’ll need to prove your disability. Before you file, you’ll need to have copies of all medical records, test results, X-Rays, your doctor’s communications with the insurer, and any other medical evidence related to your case. If you find errors in any of your records, write your doctor a letter and request that they be corrected.

If your doctor declines to help you in your disability case, find another one. A doctor who does support you in your claim can’t guarantee a successful outcome. But a doctor who doesn’t support you can easily sink your claim.

Submit All Evidence In Your Original Claim

Should your case proceed to federal court, you will NOT have the opportunity to submit additional evidence. The judge is limited to whatever is in your claim file. Neither you nor your doctor will be allowed to testify. Make sure that all relevant evidence—medical reports, testing, expert opinions, evaluations, etc.—is included in your claim. Include more favorable evidence than you think you need while the claim is open to ensure it’s complete.

Deadlines Count

Insurers have specific deadlines for filing claims as well as appeals. ERISA appeals are complex and detailed.

The Herren Law Firm can help you with your application, appeals and help you get the long-term disability benefits you need. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation and no up-front fees.  We only collect if we win your case.

A First Look At 2018 Veterans Disability Rates

If you’re receiving VA disability payments, you’re getting a raise. Check out the new veterans disability rates below.

Veterans who rely on disability benefit payments saw only a small increase of .03 percent in 2017, and there were no increases in 2016. But in 2018, veterans will see full 2% increase (called cost-of-living adjustment, or COLA) in their monthly disbursements.

A First Look At 2018 Veterans Disability Rates

House Bill 1329, titled the Veterans’ Compensation Cost-of-Living Adjustment Act of 2017 authorized this increase. The president signed it into law on November 2nd, 2017.

This is the largest increase in VA disability benefit payments since 2012.  The new, increased rate became effective on December 1, 2017, and will appear in payments issued beginning on December 31, 2017.

If you are a retiring veteran this year, you’ll also see a temporary COLA increase from the increase in active duty military pay given in January.

COLA Calculations

Cost of living adjustments are computed by examining the Consumer Price Index (CPI-W) from the US Bureau of Labor Statistics. Using the CPI-W from the third quarter of both the current year and the previous year (July, August and September), the COLA is based on the increase percentage from the 2016 third quarter to the third quarter in 2017.

This year’s weather disasters in the southern US may have contributed to the assigned increase as well, due to higher gas and other consumer prices  as well as other inflation-related items.

How Much?

If you’re at 10% disability and have no dependents, you’ll receive an additional $136.24 per month, or $1,634.88 for the year.

If you’re at 20% disability without dependents you’ll see an increase of $269.30 per month, or $3,231.60 for the year.

These ratings have no other adjustments for spouses, parents or children. However, things get a bit more complicated with higher ratings.

If your rating is between 30% and 60%, and you’re alone, you’ll receive $417.15 for 30% to $1083.52 for 60%. The rates increase with a spouse, a parent, spouse and parent (one or two), and an additional stipend for a spouse who needs “aid and assistance” (listed as a/a) as well as veterans with children.

For veterans rated 70% to 100% disabled with no dependents, the increased amounts start at $1365.48 for 70% disabled to $2937.96 for 100% disabled. With a spouse, dependent parents and/or children, there are also upward adjustments for each.

Your ratings consist of a single number for any and all conditions that rate you as “disabled.” You can review the complete breakdown of increase amounts here.

As A Reminder

VA disability payments are not listed as “gross income” on tax returns, since it is non-taxable.

Need Help?

If you’re applying to the VA for disability benefits, but can’t seem to get anywhere, call The Herren Law Firm. We’ve helped over 4,000 Houstonians navigate the VA’s complicated application and appeals process to get the benefits they deserve. Call us today at 713-682-8194 to schedule your free consultation. There’s no obligation, and we’ll take your case on a contingency fee basis, with no up-front charges.