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

While Capitan Law is not licensed to practice in Texas courts, our long-term disability lawyers assist disabled Texas 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 Texas 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 Texas 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 Texas

When diving into Texas disability laws, it’s vital to recognize ERISA’s role. The Employee Retirement Income Security Act, or ERISA, is a pivotal federal law that sets the standards for employer-sponsored benefit plans. ERISA preempts state laws, meaning it supersedes them. So, even though each state may have its own laws, they must bow to ERISA’s mandates if there are discrepancies. This ensures a unified standard, guaranteeing everyone receives the same core protections.

Texas Eligibility Requirements for Long-Term Disability

Determining who qualifies for long-term disability in Texas largely rests with the insurance companies. Why? Because it’s the employers and government agencies that select their preferred insurance providers. These insurers then lay down the rules for eligibility.

While each insurance company might have its own criteria, most full-time workers are eligible to purchase long-term disability insurance if their employer provides it. However, it’s essential to delve into the specifics of your policy or consult with professionals like those at Capitan Law to ensure you know the requirements for the benefits you’re purchasing.

Texas’s Definition of Long-Term Disability

When trying to grasp the definition of long-term disability in Texas, the timeframe of the disability becomes a vital component. Here’s what you should know:

Duration Matters: In most instances, for an injury or illness to fall under the umbrella of long-term disability, it must have a lasting impact. Typically, it should persist or be expected to linger for at least six months. However, it’s worth noting that certain insurers might stretch this timeframe, requiring the disability to last a full year before benefits kick in.
Fatal Conditions: There might be a compassionate aspect to some of these policies. Insurers might make exceptions for terminal or severe health conditions. Even if such conditions may not necessarily last for six months or a year, the urgent and grave nature of these ailments might warrant an exception.
Exceptions to the Rule: Not all conditions are covered under long-term disability policies. For instance, conditions stemming from drug or alcohol abuse, self-inflicted injuries, or certain pre-existing conditions might not be covered by your policy. Some policies also do not cover mental health disorders.

Long-Term Disability Benefits in Texas

Depending on their employer and their employer’s choice of insurer, Texas residents might find a diverse array of long-term disability benefits. However, even amidst this diversity, there are several commonly included benefits in long-term disability policies:

Income Replacement: The most critical aspect of any disability policy is the promise to replace a portion of your income if you cannot work. The amount usually ranges from 50 to 70 percent of your original salary, depending on the policy. For example, public employees in Texas can receive up to 60 percent of their pre-disability salary, up to a predetermined cap.
Cost of Living Adjustments (COLA): Some policies adjust the benefit amount over time to keep up with inflation and the rising cost of living.
Waiver of Premium: In some instances, once a policyholder starts receiving benefits, they’re no longer required to pay policy premiums.

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 Texas, call us at (267) 419-7888 for assistance with filing for benefits.