South Carolina Residents – Get Assistance from Expert Long-Term Disability Insurance Lawyers

While Capitan Law is not licensed to practice in South Carolina courts, our long-term disability lawyers assist disabled South Carolina citizens with ERISA-governed disability insurance claims. As discussed in more detail below, ERISA is federal law. If you have a claim that is governed by South Carolina law, please contact a local attorney licensed to practice law in your state to assist you with that matter.

Facing a non-work-related injury or illness can threaten your financial stability. Let Capitan Law, your experienced long-term disability insurance lawyers, guide you through the application process of disability insurance via your employer’s ERISA-governed policy. Be aware that this process is complex, with insurance companies often attempting to minimize or deny benefits owed.

Our long-term disability attorneys will defend your rights, collate necessary evidence, and strive for the benefits you deserve. We offer free consultations, so call us at (267) 419-7888 today.

About ERISA and Long-Term Disability Insurance

The Employee Retirement Income Security Act of 1974 (ERISA) typically governs long-term disability insurance plans provided by employers. That means if your employer pays for part or all of your disability coverage, you must follow the rules and procedures set forth by ERISA. The benefits that are provided by your LTD insurance policy will replace a portion of your income for an extended period, which is generally determined by your plan and the nature of your disability. As mentioned above, these claims can get complex. An ERISA benefits claim attorney will provide knowledge and experience to guide you through the process.

Each policy varies slightly in its definition of disability, but in general, to be eligible for benefits, the injured individual must be unable to perform the duties of their own job. After some time, eligibility for benefits may change and may stipulate that the individual cannot complete any work at any job due to their disability.

Differences between LTD Insurance and Workers’ Compensation

The main difference between long-term disability and workers’ compensation is that LTD benefits provide a partial-wage replacement for someone who becomes injured while doing something unrelated to their work, while workers’ comp is for job-related injuries and illnesses. If you are injured at work, you may still be able to apply for disability insurance benefits depending on the specific language contained in your policy. However, if you are eligible for both types of benefits, LTD benefits are usually offset by any benefits received through the workers’ comp claim.

Both insurance policies can come from your employer; however, not all businesses in South Carolina have a legal obligation to provide long-term disability to their employees. If your employer does not offer LTD insurance, you may have purchased your own individual disability plan and paid the monthly premium. It is also possible to have a policy you purchased yourself and one provided through your employment relationship. If you sustain an injury or get sick, you’ll be able to collect benefits based on your policy type. The attorneys at Capitan Law can help you understand the options available to you and are well-equipped to help you navigate these complex issues.

Disabilities Qualifying for LTD Benefits

LTD policies typically cover severe medical conditions that prevent you from maintaining your previous work schedule. These disabling conditions can include autoimmune diseases, back and spine injuries, mental health disorders, and many others.

Filing a Long-Term Disability Insurance Claim

Immediately file a claim when an injury or illness impedes your work. First, file a short-term disability claim; when these benefits end and your disability persists, your LTD benefits can commence. Start the process early to resolve any claim denials or delays promptly. We are happy to assist you in the long-term disability application process.

Common Reasons for Claim Denial

LTD claim filing is complicated, with any errors potentially leading to denials. Common reasons for denial include discrepancies in the definition of disability, missing medical records, procedural errors, inconsistent information, bad faith by insurance, and lack of understanding of rare medical conditions.

Appealing a Denied Claim

You can appeal a denied long-term disability claim. Under ERISA, you must file the appeal within 180 days from the denial notification date. At Capitan Law, we understand the appeals process and will help you through each necessary step.

Long-Term Disability Laws in South Carolina

For those in South Carolina dealing with long-term disability, it’s pivotal to understand the influence of a critical federal law: the Employee Retirement Income Security Act, or ERISA. ERISA sets nationwide standards for pension and insurance plans in the private sector. One of its pivotal features is its power to override state laws on long-term disability benefits. In legal terms, this is called “pre-emption.” Simply put, when state disability regulations conflict with ERISA, federal law takes precedence. This means that all long-term disability regulations in South Carolina and across the U.S. must align with national guidelines.

Who Qualifies for Long-Term Disability in South Carolina?

In South Carolina, the question of who qualifies for long-term disability isn’t a one-size-fits-all answer. Here’s why: The insurance companies determine the eligibility requirements, not the state. When employers or government agencies in South Carolina offer long-term disability benefits, they choose an insurance company to provide those benefits. These insurance companies, in turn, have the authority to set eligibility requirements for disability benefits.

Though requirements can differ from one insurer to another, there’s a silver lining. Most full-time workers in South Carolina are eligible to purchase long-term disability policies if their employer offers them.

South Carolina’s Definition of Long-Term Disability

Generally speaking, a long-term disability is an injury or illness that completely prevents someone from working for an extended stretch, often at least six months. For instance, South Carolina’s long-term disability plan for public employees says they must be disabled for 90 or 180 days to qualify for benefits. However, it’s essential to note that some insurance companies set the bar higher, requiring the disability to last a year or even longer before they provide benefits.

Of course, there are exceptions to every rule. Some disabilities, even if they might not last for extended periods, are so severe that they’re considered fatal. Certain insurers recognize the gravity of such situations and may provide benefits even if the disability’s duration isn’t as long as is typically required.

It’s equally crucial to understand what long-term disability policies typically exclude. While each policy may have specific exclusions, some conditions generally aren’t covered, such as:

Self-inflicted injuries
Disabilities arising from the commission of a crime
Conditions related to substance abuse
Injuries sustained during acts of war

South Carolina’s Long-Term Disability Benefits

Navigating the landscape of long-term disability benefits in South Carolina can feel like deciphering a complex puzzle, mainly because the benefits often differ based on the employer and the chosen insurer. However, most long-term disability policies include the following coverage:

Replacement Income: The cornerstone of a long-term disability policy, this benefit provides a portion of your salary, typically between 50 percent to 70 percent, when you can’t work due to a qualifying disability.
Cost-of-Living Adjustments (COLA): To counter the effects of inflation, some policies will adjust the benefit amount annually based on the rise in the cost of living.
Waiver of Premium: This provision ensures that policyholders don’t need to pay their insurance premiums while receiving long-term disability benefits.

Contact our ERISA Benefits Claims Experts

At Capitan Law, we comprehend the urgency of receiving LTD benefits. We work tirelessly to protect your rights and ensure fair treatment during the claims process. If you’re unable to work in South Carolina, call us at (267) 419-7888 for assistance with filing for benefits.