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

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

Private employers in Wisconsin are not required to provide long-term disability (LTD) insurance, although many do, as an additional employee benefit. State employees are usually provided an optional LTD plan through their employer.

If your private employer does not offer a plan, or you don’t like the plan or want additional coverage, you can purchase your own LTD policy through a private insurance company. Any insurance carrier offering LTD in Wisconsin may not offer a plan that conflicts with federal ERISA laws.

Wisconsin Long-Term Disability Eligibility

Each insurance carrier offering LTD in Wisconsin uses its own definition of disability, and specifies any conditions that are excluded from coverage. Each carrier may have multiple LTD plans available, with different terms, conditions, pricing, and exclusions, so carefully read the fine print of each plan to ensure you’re getting the coverage you need.

Qualifying for Long-Term Disability Benefits in Wisconsin

Each insurance company defines “long-term disability” differently, although most consider that to be a condition that prevents the disabled employee from working for a prolonged amount of time. Most LTD policies have a waiting period, which could be as little as ninety days or as many as 180.

However, some medical conditions are excluded, such as:

A pre-existing condition
Nervous disorders
Mental illness
Substance abuse-caused disease

Although each carrier defines LTD-eligible health conditions differently, there are commonalities among each carrier. Many insurance companies consider these illnesses or injuries to be LTD-qualifying conditions:

Cardiovascular complications
Cancer
Debilitating back or spine injury

Own Occupation/Any Occupation Coverage

When you purchase your LTD policy, you may be given the option to purchase “own occupation” or “any occupation” coverage. “Own occupation” coverage pays benefits if you are disabled from performing the duties of your particular job. “Any occupation” coverage pays benefits if you are unable to work in any job in any field. It’s common for a policy to begin with a year or two of “own occupation” coverage and then switch to “any occupation” coverage. Check your policy carefully to make sure there are no surprises.

Wisconsin Long-Term Disability Benefits

The purpose of Wisconsin long-term disability insurance is income replacement when you become unable to work. Your benefit will not be the full amount you were earning before the disability but rather a percentage of your average wages for a time period specified in your policy.

Your policy may provide between 50-70% of your average wages, although some plans may offer as much as 80%. When you purchase your policy, you will have the option to purchase a more expensive plan that pays greater benefits. You will have the option to purchase LTD coverage that lasts for a couple of years or a policy that will pay until you reach retirement age.

Another consideration for long-term benefits is whether you will pay taxes. If your employer paid for the policy and premium, you’ll probably pay state and federal taxes on your LTD benefits. However, if you used post-tax earnings to pay for the plan, then your benefits should be tax-exempt.

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