Long Term Disability & ERISA: What You Need To Know

What is long term disability and how does it interact with ERISA (the Employee Retirement Income Security Act)? To find out, we asked Ron Dean, a California attorney who has been engaged in employee benefits litigation primarily on behalf of participants for over 30 years. Here’s what he told us:

If you work for a private employer and that employer sponsors your long term disability insurance, whether it’s the employer’s cost or the employee’s cost, then your claim under that disability insurance policy is going to be covered by ERISA. That’s because ERISA regulates employee benefits and the long term disability policy will be considered an employee benefit.

Work and non-work related injuries generally covered

We asked Dean whether the injury that would precipitate a long term disability claim has to have occurred at work for someone to be compensated. He told us that it does not and explained, “Any kind of disability for whatever reason is usually covered. Once in a while, we’ll run across a disability policy that excludes disabilities from work related accidents or injuries because the employer feels those are covered by workers’ compensation.”

ERISA has become less employee-friendly

Dean says that although claims may be covered, nonetheless, he’s seen ERISA become less employee-friendly over his 30 years of practice. He provided the following examples of changes that have occurred throughout the years:

• The courts did away with jury trials in ERISA cases and let the judge decide the case. Since many judges over the years have been appointed from a pool of corporate interests, this is not a good thing.
• It was decided that all these cases should be in federal court instead of state court. Fewer lawyers who represent employees instead of employers are familiar with federal court.
• They did away with “trials” and now most cases are decided just on the evidence that was given to the insurance company during the claims process, even before a lawsuit was filed.
• They decided that efficiency was more important than fairness, so instead of getting a level playing field in court, you would only win your case if you showed the denial of your benefits was not just wrong or unfair, but you had to show it was ridiculously wrong or ridiculously unfair.
• They decided that, even if you win, you couldn’t recover any damages you suffered as a result of the wrongful denial.
• They did away with “punitive” damages – so no matter how unreasonable the denial, no matter how greedy the insurance company gets, all you can get are the benefits and sometimes a portion of the attorney fees you’ve paid.

If you’ve been denied valid long term care benefits, consult with an experienced ERISA attorney to discuss your situation and evaluate your options. Consultations are free, without obligation and strictly confidential.

Case Studies: Long-Term Disability & ERISA

Case Study 1: Denial of Long-Term Disability Benefits

In this case, Sarah, a sales manager for a private company, suffered a debilitating back injury that prevented her from working. She filed a claim for long-term disability benefits under her employer-sponsored insurance policy. However, her claim was denied by the insurance company, citing insufficient medical evidence.

Case Study 2: Work-Related Injury and Long-Term Disability

John, a construction worker, sustained a severe work-related injury that left him permanently disabled. He filed a claim for long-term disability benefits under his employer’s policy, expecting to receive compensation. However, the insurance company denied his claim, arguing that the injury fell under workers’ compensation coverage. John consults with an ERISA attorney to explore the best course of action.

Case Study 3: Evolving Employee Protections under ERISA

In this case, Emily, an office manager, was diagnosed with a chronic illness that rendered her unable to work. She submitted a claim for long-term disability benefits, relying on her employer-sponsored insurance plan governed by ERISA. However, Emily encounters difficulties in navigating the changing landscape of ERISA regulations, which have become less employee-friendly over time.