02 Jul Professionals’ Claims For ERISA Disability Insurance Benefits
PROFESSIONALS’ CLAIMS FOR ERISA DISABILITY INSURANCE BENEFITS
The Bushorn Firm, LLC can help guide clients through this confusing process. If necessary, we can write the appeal on behalf of the client. Individuals appealing a denial often do not realize that the appeal is their last chance to include any new information in their file before it is closed. As a result, the appeal must be detailed, complete, and persuasive because no new information can be presented, even in court. The mangled and complex rules associated with ERISA long-term disability insurance denials applies to everyone, no matter what your profession.
Yet common issues often arise in the representation of professionals, such as doctors, lawyers, those in the financial sector, engineers, etc. Some of these issues include:
- Salary calculation in determining benefit level;
- The definition of “own occupation”, which can, under certain policies, involve certain job duties;
- Issues related to transitioning the definition of disability from “own occupation” to “any occupation”, and whether “any occupation” may include positions unrealistic for the insured’s skill level.
ERISA long-term disability attorney Claire Bushorn Danzl has represented many professionals and is skilled in evaluating the relevant economic and professional factors in relation to the ERISA regulations.
PREPURCHASE POLICY REVIEW:
Seeking legal advice prior to selecting a long-term disability policy, usually for a medical group practice, is an important step to help avoid making a costly mistake. Although obtaining a policy may seem straight forward, not all policies are equal. There are many important differences in the definition of disability, the duration of benefits, the calculation of benefits, limitation on payments or offsets, the time for filing claims or bringing a lawsuit, etc. A pre-purchase policy review by The Bushorn Firm, LLC can prevent the purchase of a policy with hidden caveats and will help clients understand the policy terms as they relate to their profession.
PROFESSIONALS WITH A PRIVATE POLICY IN ADDITION TO A GROUP PLAN:
Almost all long-term disability policies include offset provisions, whereby certain types of other income may reduce the amount of an individual’s monthly long-term disability benefit. These typically include Social Security Disability Income, Workers Compensation benefits, some retirement benefits, etc. Depending on the terms of the plan, group policies generally do not offset a professional’s supplemental disability benefits offered through a private policy the individual purchased separately. Despite this, many insurance companies try to use those private individual long-term disability benefits as an offset even if the contract does not allow any such offsets. It is important to contact an ERISA long-term disability attorney who has experience reviewing policy language when determining the proper offsets that should be applied to your group long-term disability insurance benefits.
BONUSES AND COMMISSIONS AND THE EFFECT ON PROFESSIONALS’ LONG TERM DISABILITY BENEFIT CALCULATION:
Each long-term disability insurance policy describes the method by which a disabled individual’s monthly benefit is calculation. Most often, this is a certain percentage of the employee’s “pre-disability income”. Calculating the maximum monthly benefit permitted under the plan often depends on contract interpretation, how, how much, and when the employee was compensated prior to their disability. Many professionals’ income is a combination of several variables: salary, bonuses, commissions, shares, etc. If this is the case, it is advisable to contact an ERISA long-term disability attorney who can help you determine the maximum monthly benefit you are entitled to receive under your long-term disability policy. A related issue that frequently arises with professionals who are compensated by commission is determining the proper date of disability. If your income was a combination of variable bonuses, commissions, and a fixed income, it may be helpful to contact an ERISA lawyer to help determine the maximum monthly benefit you are entitled to receive under the applicable policy.
POLICY CHANGES FROM OWN OCCUPATION TO ANY OCCUPATION:
Professionals, such as nurses, who work in a specialized field their entire career in a position that is a “light duty” job often face the hurdle of being approved for long-term disability insurance benefits when the policy language changes the definition of disability from unable to work your “own occupation” to “any occupation”. At that time, the insurance company may say that you can work in a “sedentary” clerical position. There are many provisions in the law and the long-term disability insurance policy which can limit the insurer’s ability to force you to work in a position which is inconsistent with your disability and with your background, training and experience.
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Contact The Bushorn Firm, LLC today to speak with an attorney knowledgeable of the complications commonly arising in the context of professionals’ claims for ERISA long-term disability insurance benefits.