So You Think Your Long-Term Disability Policy Will Pay?
Some employers offer long-term disability policies as part of a benefits package to their employees. Employees see those policies as a sort of safety net . . . something to fall back on if they are ever unable to work. If you are lucky enough to have a disability policy through your work, congratulations! Your employer is attempting to provide you a useful benefit. BUT, what do you actually know about that long-term disability policy? Do you think your long-term disability policy will pay if you’re in a situation where you need it?
Long-Term Disability: Is It A Benefit?
Most employees who have long-term disability policies through their work never give the plan a second thought until they need to collect from it. Then, they are often surprised to find out that this “benefit” isn’t really so beneficial to them after all. In fact, many times they learn that the “Plan” really doesn’t cover much of anything.
Insurance Company’s Discretion
Many long-term disability policies are written with language which allows the insurance company to use its own discretion in determining whether you are entitled to benefits. Such language gives a HUGE advantage to the insurance company which gets to make its own rules for approving or denying long-term disability benefits. You can imagine that if an insurance company is permitted to make the rules for paying or not paying a disability claim, those rules are definitely going to make it easy for the claim to be denied!
Many times in these situations, a Judge who is ruling on a case can only overturn the insurance company’s decision to deny you benefits if he is able to find that the insurance company’s process in making the decision was unreasonable. This is a very tough standard to meet since if the insurance company spells out the process and it is not absurd, it can essentially be considered a reasonable process.
In one of these “discretion” cases, Piepenhagen v. Old Dominion Freight Line, Inc., 604 F. Supp.2d 778 (2009). the U.S. District Court out of Roanoke said an insurance company’s decision was “reasonable if it is the result of a deliberate, principled reasoning process and if it is supported by substantial evidence.” Because of the way to the policy language was written, the Piepenhagen Court was forced to find that the insurance company was not unreasonable in denying long-term disability benefits.
Each and Every Duty
Another policy language pitfall is when a long-term disability policy requires that you not be able to perform “each and every material duty of your occupation.” In these situations, it is nearly impossible for you to be disabled to the point that you can’t perform every, single part of your job. For instance, if you are a construction worker, your job duties might include carrying materials, using tools and equipment, and measuring wood and other materials. If you injure your back and can’t perform your construction job, you might be denied long-term disability benefits because you can still do at least one part of your job — measure materials. If measuring materials only requires you to use a tape measure and pencil, you can likely still perform that aspect of your job.
In Williams v. UNUM Life Ins. Co. of Am., 250 F.Supp.2d 641 (2003), the U.S. District Court out of Alexandria, Virginia, ruled in a case where the disability policy was written to define disability as being “limited from performing the material and substantial duties of your regular occupation due to your sickness or injury.” Because of the language in the policy, the Court was forced to rule that the disabled policyholder was not entitled to benefits from the long-term disability policy.
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 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.
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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