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Key Differences Between Individual Disability Insurance & ERISA Claims

Tucker Law Group
April 7, 2020

When you suffer a disability, you need money to help you move forward in life. Fortunately, many individuals have a long term disability insurance policy through their employer. The Employee Retirement Income Security Act (ERISA) is a federal law that governs these employer group plans. Federal statutes and regulations from the U.S. Department of Labor govern ERISA claims or appeals, and claimants must follow very specific guidelines. However, some people own an individual disability insurance plan. If you own an individual plan, state insurance law governs those.

When filing, appealing or litigating your disability insurance claim, you will find there are many differences between ERISA and individual long-term disability. Understanding those differences is key to getting the benefits you deserve. If you need help handling an ERISA claim, an experienced disability attorney at our firm can help.

The ERISA and Individual Long Term Disability Claims Process

There are many differences between ERISA and individual long term disability insurance claims. Understanding the differences between these two claim processes can help you determine how to best handle your claim.

Understanding the Differences

There are many differences between ERISA claims and individuals claims. Here are a few significant differences to keep in mind when you are handling a long term disability insurance claim.

ERISA Claim Individual Claim
Filing the Initial Claim ● Claimants will follow ERISA group claim procedure stated in the employer’s plan ● Follow individual insurance company’s claim procedures
Appealing a Denied Claim ● Must exhaust internal appeals process before filing an ERISA lawsuit

● Must appeal within 180 days

● Appeals move slower, but are governed by specific time deadlines

● Insurer must decide appeals within 45 days, but can get a 45 day extension to 90 days

● Can typically file a lawsuit at any time after a claim is denied

● Some policies require an  appeal within 60 days

● May use Bad Faith laws before suit to present an appeal

Litigating ● No jury trial. Judge makes the final decision.

● Must file in federal court

● Jury trial

● May file a claim in state court

Awarding Damages ● Individuals can only collect money for back benefits and interest

● No punitive damages

● Court may award attorney fees and costs

● Individuals can seek compensatory damages – usually back benefits and interest

● May be able to use bad faith law to collect  punitive damages

● Many states have laws that require insurers to pay  attorney fees and costs

Filing ERISA Claims and Appeals

If a disabling illness or injury means that you can no longer work, you may need to file an ERISA claim. Your ERISA long term disability lawyer can help you file your claim and improve your chances of getting an approval. All ERISA plans have a claim-filing procedure that you need to follow. If you do not know what this procedure is, you can ask your insurance company or employer’s HR department to send you a written procedure free-of-charge.

Once you receive this procedure, you can begin to file your ERISA claim. When filing your disability insurance claim, it is important that you provide the right supporting information to have the best chance of having your claim approved. If you have questions about filing your initial ERISA claim, contact our office to speak to an ERISA long term disability lawyer.

Unfortunately, many disabled individuals receive ERISA claim denials. If you receive an ERISA claim denial, you only have a certain amount of time to appeal the claim (usually 180 days from the date of your denial letter). Some employer plans deny as many claims as possible. As such, it is important to act quickly when you receive a denial.

Contact an ERISA Long Term Disability Lawyer Today

If you have questions about collecting long term disability insurance benefits, we can help. At the Tucker Law Group, we can help answer your questions about long term disability and ERISA. We have handled thousands of ERISA claims and know how important these benefits are to your life and future.  We want to help you. An ERISA long term disability attorney at our firm can fight for you throughout the claim or litigation process to ensure that you have the best chance of receiving the benefits you deserve.

Contact us today at (866) 233-5044 or fill out our confidential contact form. Our attorneys are licensed in Florida and many federal courts around the country, and we provide counsel in all 50 states. Call us today!