QuatriniRafferty is one of the few law offices that handle Long-Term Disability claims. We handle cases in the area of Disability Insurance Litigation which include:
- Short-term disability claim litigation
- Long-term disability claim litigation
- Contractual disability income policy litigation
- Bad faith insurance litigation
Although some cases in this area have common themes, litigation is based entirely on the terms of the contract which governs the payment of benefits. It is a must that the client obtains a copy of his or her policy because the specific terms are important and need to be analyzed.
If you have obtained disability insurance coverage through an employer (or you have purchased an employer-endorsed policy), whether the employer is actually paying for the benefit or not, claims are subject to the federal law known as ERISA or the Employee Retirement Income Security Act of 1974. Those cases that are subject to ERISA have mandatory appeal procedures and regulations that must be followed precisely. Failure to properly follow the ERISA procedures and regulations, including the timely filing of an administrative appeal, may result in the loss of the right to file a civil action.
Most disability policies are governed by ERISA. If you have an ERISA case, your employer must provide you with a copy of the policy after receiving a written request. If they don’t, the ERISA law provides that they will face civil penalties of up to $110 per day until they do 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, you are considered disabled for an initial period if you cannot return to your prior occupation. In most policies, the definition of disability changes after a two-year period, and you are considered disabled only if you cannot engage in any occupation.
If you have been denied contractual disability benefits which were not endorsed by an employer, you may have a cause of action against the insurance company for bad faith based on their conduct in intentionally and wrongfully denying your benefit. However, ERISA-type policies are limited to suit for the payment of back benefits, with interest. It is possible to obtain an attorney-fee award where benefits have been wrongly denied.
Generally, the statute of limitations for disability insurance cases is four years from the initial date of denial of benefits; however, Pennsylvania and federal law permit the insurance carrier to shorten this period of time in the contract. Once again, it is important 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 benefits, 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 entitled to reduce or offset your benefit. Again, every case and every policy have different terms, so it is in your best interest to obtain a copy of your policy and have it reviewed by QuatriniRafferty if you think you have been wrongfully denied benefits. To schedule a consultation with our lawyers at our Greensburg, Pittsburgh, Latrobe, or Altoona office locations, call 888-534-6016 or complete our online form.
For more information, please visit: A Summary: Long-Term And Short-Term Disability.