I’ve Been Denied Long-Term Disability Benefits

Many employers offer long-term and/or short-term disability policies to their employees as part of their benefits package.  Some employees, if even they know they have this coverage, think “this could come in handy some day.” When that some day comes, they often find their claims denied by the insurance company.  First, they never expected to be in a situation to file a disability claim.  And second, they certainly never expected their disability claims to be denied since this was part of their benefits package.  Read on to find out what to do if you’ve been denied long-term disability benefits.

If you have been denied long-term disability benefits, our disability team will review your denial letter for FREE.  Then, with no obligation and NO STRINGS ATTACHED, we’ll tell you our game plan for winning your case.

Long-Term Disability Rulings

Long-term disability cases are usually decided and appealed in our federal court system.  The federal appeals court for the states of Virginia, Maryland, West Virginia, North Carolina, and South Carolina is called the Appeals Court of the Fourth Circuit.  The Fourth Circuit Court of Appeals has discussed long-term disability cases in depth.  Here are some of the rulings:

Bilheimer v. Fed. Express Corp. Long Term Disability Plan

In this case, the long term disability plan had language which allowed a person who was disabled from a working at his or her most recent job to collect benefits for a maximum of two years.  However, someone who suffered a total disability from all employment was not subject to that two year limitation.

In Bilheimer, the Court addressed the meaning of “total disability.”  The policy’s language defined “total disability” as “the complete inability of a “Covered Employee, because of a medically-determinable physical or functional impairment (other than impairment caused by a mental or nervous condition or a Chemical Dependency) to engage in any compensable employment for 25 hours per week.”

The Bilheimer Court found that the phrase “prevented from engaging in every business or occupation” can’t be so narrowly construed that the disabled person must be so “utterly helpless to be considered disabled.”  The Court also said that nominal employments, such as selling peanuts or pencils which would only yield a pittance, does not constitute a business occupation.  So, when determining whether a person is entitled to long term disability, the court has to decide whether the person can perform “gainful employment in light of all the circumstances.”

Lewis v. Kmart Corporation

In yet another case, Lewis v. Kmart Corporation, examined the long term disability policy of Kmart Corporation which placed more severe restrictions on people with mental illnesses who were seeking long term disability benefits.

In 1984, Kmart hired Harold Lewis as a management trainee. Over the next eleven years, Lewis held various management positions at Kmart stores in Pennsylvania and Virginia. Lewis had suffered from bouts of severe depression since the late 1970s. By March 13, 1995, Lewis’ condition had worsened to the point that he took a leave of absence from his position as the store manager of the Kmart store in Front Royal, Virginia.

Kmart began offering a longterm disability plan as an option to its managers.  The staff members were required to pay the full costs of the plan if they decided to participate. At the time Lewis went out on disability leave on March 13, 1995, Kmart’s long-term disability plan capped disability benefits for mental disabilities at two years.  However, the same plan only capped disability benefits for physical disabilities when the benefits receiver turned 65. Despite these terms to the policy, Lewis elected to participate in Kmart’s long term disability plan and voluntarily paid his premiums.

When Lewis was on disability leave, he applied and started receiving benefits under Kmart’s long-term disability plan.  But, by the spring of 1996, he found out that Aetna had classified his condition as a mental condition. As a result, he was only entitled to two years of disability benefits.

Lewis then filed a charge of disability discrimination against Kmart with the Equal Employment Opportunity Commission (EEOC). The charge alleged that Lewis was discriminated against on the basis of his mental disability, because he was given less disability insurance coverage than a person with a physical disability. After receiving a right to sue letter from the EEOC, Lewis filed the present action on August 6, 1997, alleging that Kmart violated his rights under Title I, § 102(a) of the ADA to be free from discrimination on account of his disability in the terms and conditions of his employment.

The case was eventually appeals to the 4th Circuit Court of Appeals.  The 4th Circuit found that Title I, § 102(a) of the ADA does not require a longterm disability plan that is sponsored by a private employer to provide the same level of benefits for mental and physical disabilities.  So, a judgment was entered in favor of Kmart.

What Makes Ritchie Law Firm Different?

Many Virginia lawyers say they practice Social Security Disability law.  But, most of those lawyers don’t work with long-term disability or short-term disability insurance claims.  Before you hire any lawyer to handle your long-term or short-term disability claim, you should ask if he or she has been trained in handling or has handled ERISA claims before.  If that attorney can’t answer yes, he or she is probably not the right lawyer for you.

That’s what makes us different.  At the Ritchie Law Firm, we have a team of lawyers who have been trained to handle the complexities of long-term and short-term disability cases.  Sure, we also handle Social Security Disability cases.  But, ERISA long-term and short-term disability cases are a different beast.  And, we know how to handle them.

If you want your long-term or short-term disability case handled by a team of lawyers trained to handle this difficult area of the law that few lawyers know the first thing about, your search is over.  Whatever stage of applying for benefits you are in, whether you haven’t yet applied or you’ve been denied, we are happy to help.  We can even help if you live in states other than Virginia or West Virginia by associating with counsel local to the jurisdiction where you live.

We can help with denials from both ERISA and non-ERISA (private) disability plans.  Click here to give us some details about your case.

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