If my long term disability benefits are governed by ERISA and I win at trial, does the insurance company have to pay me for the remainder of the policy life, or a lump sum amount?

Should your case go to trial under an ERISA governed disability plan and you win the insured is only entitled to an award of disability benefits that have not been paid by the insurance company. This is further contingent on whether the insurance company denied your claim under the “own occupation” or “any occupation” definition of disability. Many courts throughout the country have held that if the claim was denied under an “own occupation” definition of disability and then became subject to litigation in which the insured won at trial, the insured is entitled only to the remainder of benefits for the “own occupation” period. The Courts then often “remand” (send back) the claim to the insurance company to do a review for entitlement to benefits under the “any occupation” definition of disability.

As disability benefits are never a guaranteed benefit, meaning the insurance company can and will conduct reviews on a month to month basis, courts do not award future benefits. This position was recently reiterated in a recent Florida case against Aetna. The insured, after prevailing at trial, moved for an award of future benefits. On this issue the Court stated, “There is no question that the Court may not award payment for disability benefits beyond the period of final judgment.” The judge presiding over the matter found that an award of future benefits would deprive Aetna of the right to potentially terminate the insured’s benefits in the future for failure to comply with provisions of the policy; based upon new information gathered; or even the insured’s return to work.

It is important to remember that if you win an appeal of a denial of benefits, or even win at trial, there is no guarantee that benefits will continue for the maximum period of disability (under most policies, age 65). As such, Courts do not award “future benefits” only benefits that have not been paid by the insurance company, with a potential limitation to even that based upon an “own occupation” or “any occupation.” It is important to never let your guard down and always do everything possible to protect your long term disability insurance benefits.

Leave a comment or ask us a question

There are 2 comments

  • Dana,

    If you filed a lawsuit I would assume you have an attorney. As such, I would refer you to your attorney to discuss your questions and concerns.

    Stephen JessupJan 5, 2014  #2

  • I was denied LTD from my employer so we filed a lawsuit, now they want to settle and what should I expect from them and how much is approximate that they have to pay me if I was only making 12 dollars per hour? I did receive CPP disability after I was denied from my employer insurance company and now I am confused if I have to pay CPP money. Thanks.

    DanaJan 4, 2014  #1

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

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