Disability Insurance Benefits And ERISA Attorneys
Doing What’s Right For Greater Colorado
Helping You Get The Disability Insurance Coverage You Need And Deserve
Shawn McDermott and the staff of McDermott Law, LLC, have extensive experience in handling denied short-term disability claims and long-term disability claims, including assistance in submitting the applications for those benefits, internal appeals and litigation, if it becomes necessary. We have handled thousands of these claims. Few attorneys, if any, in Colorado have handled as many disability insurance claims as we have. Such claims may arise from the purchase of an individual disability policy or, as is more often the case, the short-term disability and long-term disability coverage is provided as an employee benefit from your employer. Our attorneys represent clients in matters of individual disability claims, ERISA disability claims and Colorado PERA short-term disability and disability retirement claims.
This overview of disability insurance is designed to give you an introduction to eligibility and other aspects of disability coverage in Colorado. If you believe you have a case related to short-term disability (STD) or long-term disability (LTD) insurance, nothing can replace the personalized advice of an experienced lawyer
If you have questions about your disability claim and live in the Rocky Mountain area, contact McDermott Law by completing our contact form, or call 303-964-1800. We can answer your disability law questions in a free, no-commitment consultation.
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 disability insurance is a benefit of great value to employees and often can be provided at little cost to the employer. Employer-provided disability 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.
Short-Term Disability Insurance Benefits
Group short-term disability (STD) plans are typically designed to provide income replacement benefits after you have missed work for at least seven days, but your plan may be designed differently. STD benefits are usually paid when the employee is unable to perform the material duties of his or her own occupation or even own job, and are payable at a rate of 60% to 100% of the person’s pre-disability earnings. Oftentimes the STD benefit is self-insured, meaning that your employer is ultimately responsible for the payment of the benefit even though, more often than not, a third-party administrator (often an insurance company) actually processes and administers the claim.
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% to 67% 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 or your Social Security Normal Retirement Age (SSNRA); 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.
“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 initially 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 or SSNRA.
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.
If your disability insurance claim has been denied, or you believe that it will be, please contact the insurance lawyers at McDermott Law by completing our contact form, or call 303-964-1800 for a free, no-obligation consultation. We advise and represent clients throughout Colorado and the Rocky Mountain region.