Disability Claims

Disability ClaimsShawn McDermott and his staff have significant experiences in handling long-term disability claim denials, internal appeals, and litigation, if it becomes necessary. We have handled hundreds and hundreds of these claims.  Few attorneys have handled as many LTD claims as this firm.  Such claims may arise from the purchase of an individual disability policy or, as is more often the case, the long-term disability coverage is obtained as an employee benefit from your employer.  This firm has extensive experience in handling individual disability claims, ERISA disability claims and Colorado PERA disability retirement claims.

This overview of disability insurance is designed to give you an introduction to coverage, eligibility, and other aspects of disability coverage in Colorado. However, if you may have a case related to long-term disability insurance, nothing can replace the personalized advice of an experienced lawyer.

What Is Disability Insurance?

Disability insurance coverage is income replacement coverage that comes in both short- and long-term forms. Disability insurance is either purchased by individuals through private insurance policies or provided by employers for the benefit of qualified employees. Group long-term disability (LTD) insurance is a benefit of great value to employees and often can be provided at little cost to the employer. Employer-provided LTD benefits are specifically included in the “welfare benefits” plan definition and are therefore covered by ERISA.

Are Employers Required to Provide Disability Insurance in Colorado?

In most states, including Colorado, employers are not legally required to provide disability insurance.

Long-Term Disability Insurance Benefits

Long-term disability (LTD) insurance programs typically begin after short-term benefits have been exhausted — usually three to six months after the onset of the disabling illness or an injury has occurred. LTD benefits usually cover 50 percent to 67 percent of an employee’s salary and are almost always subject to a monthly maximum, usually $10,000. Some insurance plans categorize the employee participants in relation to these “welfare benefits,” with executives being entitled to higher benefit limits.

If the employee is also receiving other benefits, such as Social Security disability benefits, the long-term disability insurance benefits may be reduced proportionately, as designated by the policy language. Benefits generally end at age 65; sometimes they terminate within as little as five years after the disability begins. The age at which the participant becomes disabled also may determine the length of available disability coverage. It is extremely rare to find a group policy providing benefits for life.

If you have a question related to your long-term disability insurance benefits, Contact our Long-Term Disability Insurance Attorney in Colorado, a lawyer in Denver, Colorado who has helped many Colorado residents navigate their insurance policies and recover the benefits to which they are entitled.

“Own Occupation” and “Any Occupation” Eligibility

Most group long-term disability insurance plans define disability in two ways for purposes of benefits eligibility. These definitions are often referred to as “own occupation” and “any occupation.”

Disability is usually defined as an inability to perform the material and substantial duties of a person’s “own occupation.” An individual must be disabled from his or her own job or regular occupation for a specified period to begin receiving long-term disability insurance benefits.

If approved for “own occupation” benefits, a transformation of the definition of disability occurs at a certain point in time in the future, usually 24 months after the “own occupation” period begins. The participant’s eligibility is then based on his or her inability to perform “any occupation.” This new definition requires that the person prove both an inability to do the former job and an inability to perform any job for which he or she is capable or qualified, based on past work experience, education, and ability to retrain. If deemed disabled under the “any occupation” definition, the claimant may be entitled to benefits for only an additional three years or, more typically, until age 65.

To determine the eligibility of a plan participant, the claimant and his or her attorney must read the plan documents and the insurance policy. These provide information regarding the exact definitions used, the long-term disability insurance benefits available, and the duration of those benefits. Each group policy insurer uses different language, and even the same insurer may use slightly altered language from one group policy to the next. The claimant should also compare the language used in the plan documents with that contained in the group policy, because the language sometimes differs.

Contact our Long-Term Disability Insurance Attorney in Colorado

If you may have a case related to your disability coverage, please contact the Denver long-term disability insurance lawyers at McDermott Law. These experienced attorneys serve Denver, Colorado and surrounding areas.  We can help you navigate the complicated laws and diligently fight for you in court.

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