Texas Long Term Disability – Frequently Asked Questions
My doctor has told me I am disabled. Why did the insurance company deny my claim?
An insurance company does not have to accept your doctor’s conclusion that you are unable to work.
What does ERISA mean?
ERISA stands for Employee Retirement Income Security Act. The law was passed by Congress in 1974 and since then has been construed by federal courts in such a way that LTD claimants are at a serious disadvantage in enforcing their claims. So don’t be confused by the name of the Act. It does not provide “security” for the individual but it does provide many avenues for your insurance company to avoid paying you. Giant insurance companies have handily succeeded in using the Act to avoid paying claims, thus transferring huge sums of money from disabled workers to insurance executives.
Can I sue my insurance company for punitive damages?
No. At best you can obtain the benefits owed to you in the first place. This is one reason that your insurance company does not hesitate to deny your claim.
I know that the insurance company will deny my claim on appeal. What is the sense in appealing?
You must do the internal appeals even though you are appealing to the same insurance company that denied your claim in the first place. Otherwise you cannot have your case heard in court and will result in a loss of your claim without regard to the merits.
I have missed an appeal deadline. Must I give up on my case?
Not necessarily. Consult a lawyer experienced in handling LTD cases.
How soon should I consult a disability lawyer for my LTD case?
Sooner is definitely better. Your case will likely need to go to court eventually, however, by that time it will be too late to get necessary documentation into your claim. A lawyer experienced with LTD claims will attempt to get sufficient medical and other documentation into the administrative record. Otherwise the court will not allow the documentation on appeal.
Do I have to apply for Social Security benefits?
Most policies require that the claimant apply for Social Security benefits. The LTD benefit is typically offset by the Social Security benefit.
Is my LTD case automatically approved if my Social Security case is approved?
No. The Social Security decision is relevant to the LTD claim, but the United States Supreme Court has stated that it is not binding and your insurance company will not honor a favorable SSA decision (but will use a denial against you). Generally a disabled person will receive better treatment from the Social Security Administration than she will from her insurance company.
I am not working. How do I pay a disability lawyer to help me?
Some law firms will represent LTD claimants on a contingent fee basis. At Herren Law, we work on a contingent basis. This means that you don’t pay a penny unless we are successful. Aside from fees, Herren Law prides itself on the capability and experience of our disability attorneys. We have helped more than 4,000 clients over 30 years, and with widespread resources, we can give you a full-service representation that ensures the protection of your rights.
