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Long-Term Disability

Pennsylvania Long Term Disability Attorney
Quatrini Rafferty

The Long Term Disability practice area at QR encompasses the broader area of Disability Insurance Litigation which includes: Short Term Disability Claims Litigation, Long Term Disability Claims Litigation, Contractual Disability Income Policy Litigation and Bad Faith Insurance Litigation.

Although some cases in this area have common themes, litigation is based entirely on the terms of the contract which govern the payment of benefits. Therefore, it is imperative that the client obtain a copy of their policy, so that the specific terms of the policy can be analyzed. If you have an ERISA case, then your employer must provide you with a copy of the policy after receiving a written request, or they will face civil penalties of up to $110 per day that they do not provide you with the policy. If you have another type of case, contact the insurance company or your local agent to obtain a copy of the policy.

In most cases the client is considered disabled for an initial period of they can not return to their prior occupation. In most policies, the definition of disability changes after a 2 year period of time and a client is only considered disabled if they can not engage in any occupation.

Those clients who have obtained disability insurance coverage through an employer, or who, have purchased an employer endorsed policy, whether or not the employer is actually paying for the benefit or not, are subject to the Federal Regulatory scheme called ERISA or the Employee Retirement Income and Security Act of 1974. Those cases that are subject to ERISA have mandatory appeals procedures and regulations that must be followed precisely by the client. Failure to properly follow the ERISA procedures and regulations, including the timely filing of an administrative appeal may result in the client losing the right to file a civil action.

Those of you who have been denied contractual disability benefits which were not endorsed by an employer may have a cause of action against the insurance company for Bad Faith based on their conduct in intentionally and wrongfully denying your benefit. Those of you who have ERISA type policies are limited to suit for the payment of back benefits with interest and the possibility of obtaining an attorney fee award, where your benefit has been wrongfully denied.

Generally, the Statute of Limitations for Disability Insurance cases is 4 years from the initial date of denial of benefits; however, Pennsylvania and Federal Law permits the insurance carrier to shorten this period of time in the actual contract, therefore it is imperative that if you have been denied benefits that you obtain a copy of your contract to determine the precise statute of limitations applicable to your case.

There can be numerous and complex issues in these types of cases, including the interaction with the receipt of Personal Injury awards, Workers Compensation, and Social Security disability to name a few. If you are receiving a settlement or benefits, the carrier may be entitled to some portion of your settlement, or is entitled to reduce or offset your benefit. Again every case and every policy has different terms, so it is in your best interest to obtain a copy of your policy and have it reviewed by QR if you think you have been wrongfully denied benefits.

For more information please visit: A Summary: Long-Term and Short-Term Disability

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