Detroit ERISA Lawyers

You worked hard and built your career in order to achieve a fulfilling lifestyle. But a serious health problem can quickly throw everything into disarray.

When you have long-term disability (LTD) insurance, you have protection against a health crisis that could lead to a financial crisis because you can’t work.

The income from LTD insurance can keep you financially independent.

Long-term disability insurance policies, however, are not all the same.

This kind of insurance comes in two major types:

  • Employer plans, usually governed by ERISA, the federal Employee Retirement Income Security Act
  • Individual plans, which you buy privately from an insurance agent and are subject to state laws, not federal ERISA rules

If your insurer denied your long-term disability benefits—or terminated benefits you already were receiving—your next steps will be shaped by the type of policy you have.

An experienced LTD lawyer, like those at Levine Benjamin Law Firm, can help you understand your options.

What would you like to do?

ERISA vs. Individual Plans

Differences between ERISA and individual LTD plans come in several areas:

  1. Your Premium Costs
  2. Your Benefit Amounts
  3. Definitions of Disability
  4. Your Avenues of Appeal
  5. Which Court Hears Your Case
  6. How Courts View Your Claim
  7. Taking Your Coverage with You
  8. The Taxes You Pay
Detroit ERISA Lawyers: Employer long-term disability plans are less expensive than individually bought plans.

Long-term disability plans that you get through your employer are less expensive than individually bought plans.

1. Your Premium Costs

Long-term disability coverage offered by your employer (under ERISA) is generally less expensive than individual plans you can buy privately. Your employer might even pay some or all of the monthly premiums.

Detroit ERISA lawyers: Employer long-term disability plans generally pay less than individual plans.

Employer long-term disability plans generally pay less than individual plans.

2. Your Benefit Amounts

When you have to make a claim because you can’t work, a group plan through your job generally provides smaller payments than individual plans—in the range of 50% to 75% of your salary

Individual plans usually pay more, and you can choose the amount of your coverage.

Detroit ERISA lawyers: Employer and individual long-term disability plans often have different standards for what qualifies as a disability.

Employer and individual long-term disability plans often have different standards for what qualifies as a disability.

3. Definitions of Disability

Long-term disability insurance categorizes disabilities in two ways: Health problems that prevent you from doing your own job and health problems that prevent you from doing any job.

It’s harder to win benefits if you have to prove you can’t do any job that exists. But this is what many ERISA plans require. Or they say you can get benefits if you can’t do your own job for 24 months—but after 24 months, they raise the standard so you must show you can’t do any job.

With individual policies, you can arrange “own job” and “any job” coverage however you like.

Detroit ERISA lawyers: Employer and individual long-term disability plans can have different processes for appealing a denial.

Employer and individual long-term disability plans can have different processes for appealing a denial.

4. Your Avenues of Appeal

When your long-term disability benefits are denied or terminated, you can—and often should—appeal the decision.

With ERISA plans, you have to go all the way through your insurer’s appeals process before you can file a lawsuit to get your benefits. If you have an individual policy, you don’t necessarily have to go through every step of appeals within the insurance company before you can sue.

Detroit ERISA lawyers: If you need to sue to get your long-term disability benefits, your plan type makes a difference in where you file your lawsuit.

If you need to sue to get your long-term disability benefits, your plan type makes a difference in where you file your lawsuit.

5. Which Court Hears Your Case

Sometimes when other appeals don’t work, you have to go to court. Your type of policy determines which court you use.

If you have a group, ERISA policy, you have to sue in federal court. Individual policies allow you to sue in state court over issues such as insurance bad faith and breach of contract.

Detroit ERISA lawyers: Different courts have different approaches to lawsuits over long-term disability benefits.

Different courts have different approaches to lawsuits over long-term disability benefits.

6. How Courts View Your Claim

When you go to court under ERISA with your employer’s LTD policy, you have to prove that by denying your claim, the insurance company lacked any evidence and was flat-out wrong.

When an insurer denies or stops your benefits in an individual policy, state courts will consider whether the insurer violated the contract it had with you.

Detroit ERISA lawyers: If you have an individual long-term disability plan, it's not tied to your job.

If you have an individual long-term disability plan, it’s not tied to your job.

7. Taking Your Coverage with You

When you leave a job, your coverage under a group plan ends. You can keep your individual LTD coverage when you change jobs or have periods of unemployment.

Detroit ERISA lawyers: The way you pay taxes on your long-term disability benefits varies between individual and ERISA plans.

The way you pay taxes on your long-term disability benefits varies between individual and ERISA plans.

8. The Taxes You Pay

Under group plans, your long-term disability insurance premiums are usually paid, either by you or your employer, before taxes are deducted. But when you receive benefits, you have to pay income taxes on those benefits.

Under individual plans, you usually pay for your coverage with after-tax money. But when the policy is paying you benefits, you don’t have to pay taxes on those payments.

How to Fight Your LTD Denial

When you’re denied long-term disability benefits, you should appeal to protect the life you’ve built.

But LTD is a complicated area of law.

Don’t miss any deadlines during your appeal. That could jeopardize your case.

Sometimes insurance companies conduct surveillance on you looking for reasons to turn you down. Sometimes they tell you just to write a letter protesting your denial, but that’s not good enough.

Your exact strategy for your appeal will be driven by the kind of policy you have and your particular circumstances.

Get experienced Detroit ERISA lawyers to maximize your benefits.

Get an experienced long-term disability lawyer to maximize your benefits.

Bring In Someone to Back You Up

It’s best to talk to a lawyer.

At Levine Benjamin, we’ll evaluate your case for free. And we don’t charge a fee until you win.

Levine Benjamin Law Firm has experienced long-term disability lawyers who can fight to get you the maximum possible disability income.