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ERISA • Employment Law

5 Things to Know About Disability Insurance Claims

26 Jan 2021

If you are sick or have been injured and have a long-term disability policy, you may be able to receive benefits under your policy. In the U.S., if the policy was provided through your job with a private-sector employer, these disability policies are almost always governed by a law called ERISA. Before you file your claim, you should understand these five things both about your individual policy and the law.

A “Disability” Is Not the Same for Each Policy

You would receive benefits when you have a disability, but each policy may define the word “disability” differently. Some may have a more expansive definition than others. For instance, some policies may require you to be unable to do any work, while other policies may give you benefits if you are unable to perform your own job. Make sure that you closely read the terms of your own policy before you file a claim.

Your Benefits May Be Taxable

Whether your disability policy benefits are subject to federal and state taxes depends on the type of plan that you have. Usually, benefits through your employer come out of pre-tax dollars, and the benefits are taxable. However, if you buy a disability plan on your own from after-tax dollars, your benefits may be tax-free.

Someone May Be Watching You

If you feel like someone else is following you after you filed for your claim, it could be because the insurance company has hired an investigator to verify that you are actually disabled. There is even more of a chance that an investigator may be tailing you if you are claiming based on a disability that is not easily proven through medical evidence.

The “No” Is Not Final

It is a fact of life that insurance companies deny claims. They will be the ones making the initial decision whether your claim is approved. However, you have the right to appeal the denial internally to a higher level within the company. If the answer is still a denial, you can file a lawsuit in court, and a judge will make the final decision about your benefits based on the record of your claim.

Your Medical Records Will Carry the Most Weight

Once you file a claim, your insurance company is going to ask your physician for your medical records. They will also give your doctor forms to complete and will request their opinion about whether you are disabled. It is critical that the file that your physician sends is as complete as possible. If the denial ever went to a judge, the judge may only decide the claim based on the record that the insurance company considered.

Philadelphia Long-Term Disability Insurance Attorneys

Contact the Philadelphia long-term disability insurance attorneys at the Garner Firm for help with both filing your disability claim or appealing a denial. Contact us to set up your free initial consultation to learn how we can help you as you file for the benefits that you need.

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Mr. Garner is an ERISA employee benefits and employment attorney with over a decade of experience. The laws governing employee benefits, the employment relationship, and the workplace are complex.

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