Disability" (LTD) claims are situations where a disabled person has a claim
against a trust fund or insurance policy for a monthly benefit starting on the
31st, 91st, or 366th, day (rarely) or more commonly on the 181st day of
disability. Generally the claimant has to have first fulfilled an
"elimination period" of disability that was continuous during which he or she
could not perform his or her occupation. LTD Plans and Policies can be
either totally private (individuals purchased and paid for coverage directly) or
more commonly through an employee benefit plan. Employee benefits plan LTD
is subject to ERISA (a Federal Law) and therefore if the claimant loses on
administrative level and the claims administrator has discretionary authority to
decide eligibility, it is very difficult to overturn since the Plaintiff
(claimant) has burden of showing the decision by the Plan (employer, insurance
company, or claims administrator) was arbitrary and capricious.
Lawsuit must be brought in US District Court. Plans that are self
paid and not purchased at work are resolved in State Court if lawsuit is
necessary and the standard is usually preponderance of
LTD is not like
Workers' Compensation, SSD or SSI where all rules and plans are the same.
Each varies. This means the claimant should always request a copy of
the "Summary Plan Description" and the actual Plan whenever making a
important single issue to most claimants is how the Plan defines "total
disability" and whether all his/her treating doctors say the claimant meets that
Most LTD Plans
are subject to an offset for any SSD or Workers' Compensation benefits
Anyone who is
denied on an LTD claim should see a lawyer as soon as possible.
Mr. Heller is
one of the few claimants' attorneys in Upstate, Western, and Central New York
with extensive experience. He does not charge for an initial interview.