Can You Receive Both Social Security Disability and ERISA Benefits?

If you are disabled, if you are unable to work, and if you need to receive disability benefits, start by having a discussion with a California disability benefits attorney. The right attorney will know what disability benefits you are eligible to receive and will help you obtain those benefits.

What help may be available to someone who suffers a disabling injury and is no longer able to work? What steps do you have to take to be approved for disability benefits? And what are your options if the benefits that you believe you are eligible for are denied to you? Do ERISA long-term disability plans reduce their benefit payments to insureds if they receive other types of disability benefits?

If you continue reading this brief discussion of disability benefits, these questions will be answered, and you will also learn where to find the help you may need if you are disabled and you are seeking to obtain long-term disability benefits.

What Programs Provide Disability Benefits?

When people say that they are “on disability,” it usually means that they are receiving any of the following benefits or some combination of these benefits:

1. Veterans’ disability compensation
2. State disability income
3. Social Security disability insurance
4. Private individual disability insurance
5. Group long-term disability insurance
6. Worker’s Compensation disability

These are different programs that provide financial assistance to disabled persons who cannot work at all or who cannot work full-time at their occupation or at any occupation. If you are disabled, it is important to know which benefits you are eligible for and how the programs work alone or in combination. It is more complicated than you may think at first.

What is Social Security Disability Insurance (SSDI)?

If you become disabled, you may apply for Social Security Disability Insurance (SSDI). You will need to have enough work credits, and you will have to satisfy the stringent disability standards set by the Social Security Administration (SSA).

The number of work credits you must have in order to receive SSDI benefits depends on your age when you become disabled. Most workers will need forty credits, but in some cases, younger disabled workers with fewer credits may also be eligible for SSDI benefits.

You also must demonstrate to the SSA that you have a severe medical impairment by providing test results, imaging, and other medical records as evidence of the diagnosis and symptoms that define your disability.

What is ERISA and How Does it Apply to Long-Term Disability Claims?

If you have purchased long-term disability insurance through your employer, you may also file a claim for those disability benefits. Employee benefits are governed by the Employee Retirement Income Security Act of 1974 (ERISA).

ERISA is the federal law that sets the standards for most retirement, health, and disability plans offered by private employers. A California disability benefits lawyer who handles ERISA claims can help you with an ERISA disability claim or help you file an appeal if your claim is denied. It is too long of a discussion to outline all of the ways ERISA may impact your long-term disability claim. There are numerous ERISA rules and regulations that impact your claim and you should consult an ERISA disability claims attorney to help you navigate these rules and regulations.

If Your ERISA Disability Insurance Claim Is Denied, Then What?

ERISA disability insurance claims are denied more often than they are paid. That means your claim will likely be denied by insurers who put profit first in evaluating whether to pay claims. If your long-term disability claims is denied, ERISA rules require you to appeal a denial of long-term disability benefits directly with the insurance company, in accord with the wording of your policy, before you may sue the company over a denial of your benefit claim.

ERISA plans give you 180 days to appeal a denial of disability benefits. Some plans require two appeals before you may file a lawsuit. In any of these situations, you should have a disability benefits lawyer handle the appeal on your behalf.

It is faster (and sometimes easier) to receive disability insurance benefits from an insurer than it is to receive SSDI benefits. However, some disability insurance policies require you to apply for SSDI before a specific deadline, and if you are approved for SSDI, your insurance payout will be reduced.

How and Why Can Someone’s ERISA Disability Benefits Be Reduced?

ERISA plans almost always provide for offsets or deductions from the standard disability benefit owed under an LTD policy for certain types of disability benefits. This means that an insurance company may reduce the payout amounts in order to “offset” and recover any overpayments.

That is how insurance companies can shift their disability payout obligation to Social Security. In addition, LTD policies will often provide for offsets for benefits received from state disability income, other group long-term disability insurance, and worker’s compensation disability.

How Can You Know You Are Receiving the Right Benefits?

If this sounds complicated, it is. To make sure that you are receiving the benefits that you are legally entitled to receive – and to stay compliant with ERISA and Social Security rules – you may need the advice and services of a California disability benefits attorney. Your attorney can:

1. determine which benefits you qualify to receive and when to apply for those benefits
2. guide you step-by-step through the application process for disability benefits
3. ensure that your application forms and additional paperwork are accurate and complete
4. take legal action on your behalf to obtain the disability benefits that are rightfully yours
5. advise you as to what offsets are proper and in what amounts

Why Might Your ERISA Disability Benefits Be Denied or Terminated?

Even if the SSA has approved your application for SSDI benefits, you may still be denied ERISA long-term disability insurance benefits under your long-term disability policy.

It is the insurance policy’s definition of a disability that will determine if you qualify for long-term disability benefits. You should read – and you should be certain that you understand – how your ERISA long-term disability insurance policy works.

For example, in many long-term disability policies, the definition of a “disability” changes after the first 24 months that you are disabled. Your plan might pay disability benefits for the first 24 months because you can no longer work at your “own occupation.”

But after 24 months, the policy may change the definition of disability if you can work at “any occupation” – a more restrictive definition. Disabled persons may be surprised to learn their disability benefits may end after two years because of the changed definition of “disability.”

How Do California Courts Handle Denials of ERISA Claims?

ERISA rules and regulations often tend to favor insurance companies. In some states, a court will only order an insurance company to pay a denied claim for ERISA disability benefits if the court determines that the denial was “arbitrary and capricious.” In other states, a “de novo” standard of review will apply, which is much more favorable to insureds/employees.

California courts in most situations apply a the “de novo” standard of review, in which the judge simply determines if the insurance company was wrong or right when it denied a claim without giving deference to the insurer’s decision. ERISA rules and regulations are complicated and the courts will apply these ERISA rules and regulations to decide the outcome of your disability claim. That’s why, if the long-term disability benefits that you believe you are entitled to under ERISA are delayed or denied, you should obtain the advice and services of a California disability benefits lawyer as quickly as possible. Whether you receive disability benefits is often dependent on hiring an experienced ERISA disability claims attorney like McKennon Law Group PC.