Many of the disability claims cases in our law office are on behalf of Texas claimants. As the second most populous state in the nation, Texas is home to many American corporations, energy companies, agricultural corporations, and high-tech industries. In 2010, Austin, Texas was ranked as one of “America’s Most Innovative Cities” by Forbes. It came second only to Silicon Valley in California. The most notable employers in Austin include Dell Technologies, IBM Corp., Tesla, Indeed, and Whole Foods Market.
Whether workers are in clean rooms assembling semiconductors, riding herd on Texas long-horns, or wildcatting an oil rig, a serious injury or illness that leaves an employee unable to work means that they are dependent on long-term disability insurance policy benefits. Based on the experience of Justin Frankel, the first thing any individual should do is locate their original disability insurance policy. This is not as easy as it sounds, but it is very important.
When you purchase a disability insurance policy privately or as a part of your employee benefits package (known as group or ERISA), you are essentially signing a contract between yourself and the disability insurance company. Like any other contract, the agreement states the responsibilities of the involved parties:
Like most products, insurance policies change over time. The same types of generous disability policies sold during the 1970s and 1980s are nothing like the disability insurance policies that are sold today. If you have a policy that was sold years ago, chances are that your level of benefit payments is higher, and the restrictions are not as severe.
Unfortunately, many people are not as careful as they should be about their paperwork. Relying on the insurance company to have an exact copy of the contract that you were sold can be problematic. If you are not able to locate original policy, contact either the insurance agent who sold the policy or the human resources department of your company. The HR department will likely have to contact the insurance company to obtain a copy of the policy.
However, you will need the original policy to determine your rights before you can successfully fight a denial or a delayed claim. It is best to have this policy reviewed by an experienced Texas disability lawyer before filing a claim. Your attorney will be able to explain exactly what your obligations are, what your benefits should be, and point to potential problems that may arise.
If you are at any stage of the disability insurance claim process and you are concerned about a possible denial or benefits, please call our office to learn how our team can help.
The Texas Department of Insurance adopted Article 21.21, a ban on discretionary language in insurance policies. The law states that no person shall engage in this state in any trade practice which is defined in this Act as, or determined pursuant to this Act to be, an unfair method of competition or an unfair or deceptive practice in the business of insurance. This may be helpful in not permitting insurers to rely upon a more favorable standard of review and be claimant-friendly. It would seem this law would find Texas to be a claimant-friendly place for long-term disability insurance, but this is not necessarily the case. Texas is home to the Fifth Circuit Court of Appeals, a federal circuit which can be more challenging than other circuit courts. This is another reason you’ll want an experienced Texas long-term disability insurance attorney to fight for your disability benefits. If you are at any stage of the disability insurance claim process and you are concerned about a possible denial of benefits, please call our office to learn how our team can help. A consultation concerning your issues could be very helpful to better understanding the process and what is occurring with your claim.
ERISA is a federal law that was created to protect employee benefit plans. It is named after the law that put it into place, the Employee Retirement Income Security Act of 1974. It is important to note that while individual disability benefit plans fall outside the domain of the Employee Retirement Income Security Act, group plans are going to be subject to it and the federal courts.
If you are part of a group plan for your long-term disability insurance, ERISA is going to impact your claim in Texas.
The most important factor to keep in mind is that ERISA overrides state laws. If a state law is more generous to you, ERISA will override it, leaving you subject to federal regulations and all of the restrictions imposed by ERISA.
State laws tend to offer the best protection against wrongful behavior by long-term disability insurance providers when it comes to disability benefits, but ERISA overrides these protections by prohibiting you from suing the insurer for bad faith. All you can do is fight for the benefits that your insurer should have been paying you in the first place.
If you are seeking to make an appeal under ERISA regulations, you must follow their strict appeals procedure rather than taking proactive legal recourse against the insurance company directly. You must exhaust all internal remedies prior to court. The deadlines tend to be stricter in the appeals process, so you will want to have help from a Texas disability lawyer to navigate the process properly.
Additional factors to keep in mind regarding ERISA claims include that you only get a single opportunity to appeal. Additionally, a jury trial is not allowed in ERISA cases, with everything being decided by a judge instead. Plus, the discovery process is generally not allowed or as expansive, so you cannot submit any new information. Thus, your appeal must be prepared with as much relevant information as possible to give you the best chance at success.
Before filing your claim, always make sure you know whether or not it is an ERISA case. A free consultation with a Texas long-term disability lawyer can help you figure this out.
The time frame for long-term disability claims can vary based on the details of your specific contract. Some plans require that claims be submitted as little as 30 days from when your disability began, while other plans allow for up to 180 days to file from the date of your disability. Whichever the case is for your plan, it is essential that you meet the deadlines. ERISA plans don’t offer second chances if you are ever late, with unforgiving deadlines.
If you are looking to appeal a denial under ERISA, generally, you will have 180 days from when you receive the denial to file your appeal, but you must review your original disability policy to determine the exact timeline, as many policies have different language and timeframes. Anything after that and you lose all rights to your long-term disability benefits. It is critical that you file all your claims on time, and a Texas disability lawyer can help you along the way. It all begins with a free consultation.
Many conditions can qualify you for disability in Texas. Remember that conditions that qualify as disabilities are those that create functional limitations and not a diagnosis of a particular condition. A detailed list can be found here, but these are a few of the most common disabling conditions and medical conditions that could qualify you for disability.
The first step in a long-term disability claim procedure is to give notice of your intention to file a claim. This must be done within a certain time period that is outlined in your specific policy. In response, you should be provided with a form or web address that you can use to file the claim. When you are completing the form, note that while most of it is up to you to complete, there are also portions to be completed by your employer and your doctor.
You will need help from an attorney if you want to make your claim as strong as possible before filing. While doctors can certainly help you with any medical issues, they are not trained to word their medical reports in a way that will appeal to insurers and satisfy the necessary proof. Your Texas disability lawyer can help them with that part. After everything is ready, you can file the claim and wait for a response.
If you get a positive response, you receive your benefits. If the claim is denied, however, the insurer must provide a reason as to why it was denied. With this reason, you can determine the proper way to appeal the denial.
As mentioned, from the date you receive the denial, you have 180 days to appeal. A free consultation with a Texas long-term disability lawyer can help you determine how to proceed.
Claim denials occur for a variety of reasons. Here are some of the most common reasons why an insurer may deny your disability benefits claim.
A major aspect of your claim is demonstrating that you have a disability. This will require plenty of evidence, so it is always best to make sure you gather all the information possible before actually filing your claim. A wide range of medical records and evidence may be necessary, such as blood tests, X-rays, treatment plans, and more. This is also where a narrative from your doctor can be critical. If the evidence you submit is not enough to justify your claim of disability, it is likely that your disability insurance benefits claim will be denied.
The definition of disability is very specific in most insurance policies, and you may get denied if the insurer believes your condition does not meet the definition. They may say that you are able to work some kind of job or present another reason that they believe disqualifies you from benefits. Review your disability coverage policy to ensure that your claim is framed around their definition of disability.
If you are able to work at all, it is possible that your claim will be denied. While someone may still require disability benefits to make ends meet despite being able to work a job that severely lags behind their previous income, insurers may use it as a reason to deny you benefits altogether. See what kind of working requirements are in place in your unique policy.
If an insurer thinks you are faking your disability or otherwise committing fraud, they are going to deny your claim. This is why it is so important to submit as much evidence as possible to corroborate your claims. Submitting to an independent medical examination (IME) will go a long way toward disproving accusations of fraud.
The deadlines for disability claims are fairly set in stone. If you miss one of the deadlines, you are going to be denied by default. Always get in touch with a disability lawyer as soon as possible after the onset of your disability to help maintain compliance with all the strict deadline requirements. Keep in mind that the deadlines are not always consistent among different policies, so double-check what your unique policy requires. A Texas long-term disability lawyer can help with deadlines.
This is a decision that should be made only after speaking with a long-term disability insurance attorney. Whether you should appeal a long-term disability claim denial depends on many factors. If you missed a deadline or have run out of appeal opportunities under ERISA regulations, there may be options, but the attorney will know based on their experience with the disability insurance company and your situation. That is why it is best to avoid these scenarios altogether. If you truly believe that your denial was unjust, you can begin the appeal process for your LTD claim.
In most disability cases, the appeals process is quite lengthy. At best, you will get your answer within 90 days, which is how long insurance companies have to reply to your appeal. If your case goes to court, however, the process is going to be much longer. Remember that if you make it as far as a trial, you will most certainly need a long-term disability lawyer by your side to help you through the process.
If you do go to court the nature of that trial will depend on whether you have an ERISA case or not. Remember, ERISA regulations prohibit you from an actual jury trial. Instead, you will be presenting your case to a judge. An individual policy outside of ERISA jurisdiction, however, could involve a jury trial. The trial will mostly center around whether the insurance carrier abused its discretion when denying your benefits. A free consultation with a Texas long-term disability lawyer can offer more details.
Long-term disability benefits in Texas vary from policy to policy. Some private policies pay for the lifetime of the claimant, while others end at age 65. A review of your policy with a long-term disability attorney will clarify this issue.
Living with a disability is hard enough on its own, and you should not have to worry about navigating the legal complexities of the claims process, as well. Instead, you can focus on getting the most out of your life while the Law Office of Justin Frankel, PC handles the legal issues for you. From a free consultation to drafting your initial claim to making sure you keep getting payments for years to come, our law firm will be at your side every step of the way with legal advice throughout Austin, Dallas, Houston, San Antonio, Fort Worth, and the rest of the state of Texas.
We believe in a proactive attorney-client relationship, which is why all of our clients get to work directly with Justin Frankel, our experienced attorney. You can begin with a free consultation and case evaluation that can help you get an idea of how the process will proceed and how our long-term disability attorneys can help with legal representation. Get in touch with our Texas long-term disability lawyers today by calling 888-583-4959 or filling out our online contact form.