Skilled ERISA Attorneys Serving Clients In NY

The most recent statistics from the CDC indicate that around 3.7 million adult residents of the state of New York are living with a disability of some kind.

Many New Yorkers of working age who have a disabling illness or injury have ERISA group disability insurance coverage as a benefit of their employment. However, be aware that this kind of coverage doesn’t always guarantee financial safety or security. Insurers do whatever they can to delay or wrongfully deny claims, and, regrettably, they often succeed.

Hiring a seasoned New York State ERISA lawyer is the most important step you can take to minimize the risk of this happening to you.

How Does ERISA Work?

The Employee Retirement Income Security Act of 1974 (or ERISA for short) is a body of legislation that establishes rules and minimum standards for, among other things, group disability insurance plans employers provide for their employees. Sounds good, right?

Unfortunately, ERISA fails miserably to protect claimants more than it helps them. The rules in relation to insurance claims and appeals under ERISA are less favorable than those under individually purchased policies from an agent or broker. The strict mandatory appeals process the legislation sets out in relation to ERISA group disability insurance claims is particularly problematic.

Following an initial denial of an ERISA group disability claim, you must generally submit an administrative appeal within a strict set timeframe, usually 180 days. ERISA law states you are not entitled to sue your group insurance provider in federal court without first completing this mandatory appeals process. Part of the process involves the compilation of an administrative record alongside the insurance carrier. As a claimant, you’re responsible for including every piece of medical, financial, occupational, and vocational evidence in the record that supports the case you’re trying to make, and the appropriate law from where you live.

Crucially, you cannot introduce any item of evidence in a federal ERISA disability lawsuit unless it appears in either your administrative record or your underlying claim. So, unless you can put together a truly comprehensive appeal in the allotted timeframe following a claim denial, you risk missing a vital piece of evidence that could sink your whole claim.

This is part of the reason why an experienced New York State ERISA lawyer offers such an invaluable service to their clients. Without a competent lawyer on your side, you’re running a much greater risk of missing out on the monthly benefits to which you’re entitled.

Does Your Condition Qualify for ERISA Group Disability Benefits?

Employer-sponsored disability insurance policies cover sicknesses and injuries that qualify for compensation as long as you meet the waiting period and are disabled.

In order for you to collect on an employer-sponsored group disability insurance claim, your physician must confirm that you’ve suffered an illness or injury that has left you unable to carry out the required duties of any occupation for which you are trained, educated, or suited. Some group employer-sponsored plans pay disability benefits for 24 months. If you can’t do your occupation this “any occupation” language is crucial, as it is the way most employer-sponsored group disability insurance policies define disability. Individually purchased long-term disability insurance policies sometimes use more generous “own occupation” definitions, treating claimants as disabled once their condition
prevents them from working in the full- or part-time job they had directly prior to the onset of their claim.

Additionally, your physician must administer the most appropriate treatment for your disabling condition, and the elimination or waiting period on your policy must have elapsed before you can start collecting monthly benefits.

The Role of Your Employer in New York ERISA Claims

Employers pay for ERISA policies, so you might think they would involve themselves closely in your mandatory ERISA appeals process when things don’t go your way. However, this isn’t the case.

Remember, human resources managers are not generally equipped to deal with the nuances and strict claim requirements of an ERISA group policy. These operatives are highly skilled and have a singular focus, keeping as much money in the coffers of their employers as they can.

Another point to note is the fact that your employer has no incentive to push for your claim to succeed. When employees collect on group disability insurance claims, their employers face a higher premium the next time they renew their employee disability insurance. Technically, therefore, your employer would actually benefit financially from the failure of your claim.

If you want someone on your side who is sufficiently competent and motivated to secure a great result in your ERISA disability dispute, you need to hire an experienced and dedicated New York State ERISA lawyer.

Are New York State ERISA Disability Benefits Taxable?

One of the key differences between individually purchased and employer-sponsored group disability insurance comes in the form of tax implications.

When you purchase long-term disability insurance yourself using post-tax money, without any assistance from your employer, you generally don’t have to pay tax on any monthly benefits you receive. This is because, in the eyes of the law, you have already paid the tax you owe in relation to the policy as part of the cost of your premiums.

However, you do not incur any tax liability when you receive group disability insurance coverage that your employer pays for fully. Therefore, after you collect on a claim, you may have to pay tax on the monthly benefits arising from it.

Tax law is highly complex, and the rules around the taxation of long-term disability insurance benefits are no exception. To find out for sure what the tax implications of your benefit entitlements are, you’ll need to carefully examine your policy and consult with your New York City ERISA attorney.

Getting the Help You Need By Using A New York State ERISA Lawyer

At DarrasLaw, we’ve helped many frustrated New York state ERISA claimants secure the group insurance disability benefits they’re entitled to. If your interactions with your insurance carrier have left you fearing the worst, the time to act is now. Contact us today to schedule a free initial policy or claim analysis or assistance. Remember, if your insurer has already rejected your initial employer-sponsored group disability claim, it’s imperative that you begin the process of filing a timely, comprehensive appeal as quickly as you can.