Irrational Predispositions in a Workers’ Compensation Claim

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Reprinted by permission of the American Bar Association. Committee News, Workers’ Compensation and Employers’ Liability Law Committee, Winter 2007. IRRATIONAL PREDISPOSITIONS (The Fate of a Young Worker’s Claim under §51 of the Massachusetts Workers’ Compensation Act) By Terry A. Low We all know that most judges don’t want to hear cases. It’s a lot of work, mistakes can be made, … Read More

Private Disability Insurance Policies

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It has become more common for high-wage earners to purchase their own private disability insurance policies directly from insurance companies. Doctors and other professionals make this investment as a way of protecting their ability to perform their highly specialized, lucrative occupations. Some corporations also purchase private disability insurance coverage for high-level executives. Private disability insurance differs from employer sponsored ERISA … Read More

Disability Plans Not Subject to ERISA

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Disability Plans Not Subject to ERISA. The ERISA statute excepts five types of plans from coverage under the statute in the “Coverage” section found at 29 U.S.C. § 1003(b): (1) government plans; (2) church plans; (3) plans maintained solely for the purpose of complying with applicable workmen’s compensation laws or unemployment compensation or disability insurance laws; (4) plans maintained outside … Read More

Group Disability Plans Not Subject to ERISA

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The ERISA statute provides an exemption for certain categories of employers, including church plans and government plans. Employers that are exempt from ERISA generally provide disability plans through insurers in the same way that nonexempt employers do. As a result, the plans offered by exempt employers are typically identical to ERISA governed plans and are administered in the same way. … Read More

Pre-existing Conditions in ERISA Disability Plans

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Preexisting condition exclusion provisions in group short and long term disability plans are quite different from preexisting conditions as we typically understand them. Those with potentially disabling conditions may still be able to secure their income through disability insurance, depending on the preexisting condition exclusion contained in the plan. Here is a typical preexisting condition exclusion as it appears in … Read More

ERISA Disability and Social Security

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Most group long term disability plans require claimants to apply for social security disability benefits. In fact, administrators often offer to assist claimants by referring them to a company that will represent them. They do this because SSDI benefits are typically included as a ‘deductible source of income’ under most plans, meaning that administrators can reduce the amount of any … Read More

Reimbursement Rights in ERISA Plans

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In “ERISA Offsets Other Benefits” we explained how a claimant suing for disability benefits can end up losing and then owing money back to the insurer. In that example, the plaintiff sues seeking payment of her disability benefits and loses, and the ERISA disability payer countersues to collect money from the plaintiff’s retroactive social security disability check that is owed … Read More

ERISA Plans Offset Other Benefits

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ERISA plans offset other benefits, like SSDI benefits and workers’ compensation benefits, which can cause very unfortunate results for unweary claimants. An ERISA disability benefit plan is a contract, written by an insurer and chosen by an employer to offer as a benefit to employees. Employees who join the plan have entered into a contract. Insurers write into that contract … Read More

There is No Ordinary Discovery in ERISA Litigation

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The first thing to understand about the topsy-turvy world of ERISA disability benefits litigation is that the plaintiff has no right to take ordinary discovery after filing a complaint in federal district court. On its face, an ERISA disability case looks like a contract dispute between the parties: the claimant has sought benefits pursuant to the disability plan and the … Read More

ERISA Preempts State Law

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There are very few things as embarrassing for a lawyer as being at the wrong court. This is certainly true if it is 8:50 a.m. and you are wondering why your case is not on the list at the courthouse you drove to automatically while your were half asleep. It is equally true if you file a suit in state … Read More