Long Term Disability Claims

Long Term Disability benefit plans that are offered by employers are considered employee benefits.  As such, they are almost always subject to ERISA, a federal law designed to protect employee benefits.  But there are some plans that are exempt from ERISA because of the kind of employer offering them, including “church plans” and “governmental plans.” If you are planning to claim long term disability benefits in Massachusetts, you will certainly need the help of local lawyers who are knowledgeable on the subject.

Here are some basic guidelines:

If you bought your long term disability plan directly from an insurer, which many high wage earners like doctors and lawyers often do, then it is simply a contract between you and the insurer subject to state contract laws and regulations.  The ERISA statute does not apply to such plans.

If it is a policy you obtained through you employer and your employer is a typical business entity, then your policy is in all likelihood subject to ERISA.

If you work for a state or a municipality and that entity obtained the policy directly, then it is a governmental plan not subject to ERISA.  If the state or municipality created a commission or some other entity that in turn obtained the policy and offered it to you, then it may or may not be subject to ERISA depending on a number of factors.

With respect to church plans, again, if you work for a diocese that purchased a obtained a plan for its employees, it is likely exempt from ERISA.  But if you work for a hospital owned by a religious order, for example, you will need to seek legal guidance to determine what law governs your long term disability plan.

What does that mean for me?

If you have a Short or Long Term Disability policy through your employer subject to ERISA, you need to understand that the rules for applying for benefits and appealing denials are complex and unforgiving.  The employer or insurance company that will decide your claim is the same one that will have to pay your claim, and they have broad discretion to control your claim process.  You will not have a chance to have a trial or obtain evidence later; the time to substantiate your claim – or lose your right to years of benefits – is now.  Although the ERISA statute was supposed to help protect employee benefits, in practice ERISA LTD benefits claims are much more difficult to obtain and the remedies available if you are wrongly denied are much less friendly to the employee than the state laws preempted by ERISA.

How can Low & Canata help me?

Attorneys Terry Low and Anthony Canata have developed a unique approach to filing ERISA claims and fighting ERISA denials.  Unlike most attorneys, we both handle all of the major aspects of your claim as a team, working with you – and each other – to substantiate your claim. Moreover, we also work in other practice areas that  often arise along with long term disability claims, such as personal injury and workers compensation, giving us the skills to handle all of the legal issues relating to your injury or disability.  We are creative about gathering and submitting the most convincing evidence in a form that insurers cannot ignore and judges will readily recognize. Claimants in Massachusetts who want to submit a strong, professional claim for their long term disability benefits can count on us to provide the service they expect and need.