Long-Term Disability

Anyone can suffer an incapacitating injury or illness at any time. For the majority of us, an injury or illness that prevents us from working is a huge problem, and the disruption of income just when it is needed the most is challenging. Long-term disability benefits may be available pursuant to individually purchased policies or as a benefit through one’s employment, much like health insurance, dental coverage, 401K, etc.  At Feldheim & Wilenkin, our Detroit disability benefits lawyers have 60 years of experience fighting for injured people and their right to receive the financial assistance that they need and deserve.

The purpose of purchasing long-term disability insurance is to provide a financial safety net by paying you a percentage of pre-disability earnings in the event that you become disabled and unable to perform your occupation. . However, quite often, it is not unusual for the insurance company to deny your claim, despite compelling and substantial medical evidence supporting your entitlement to long-term disability benefits.

Long-term disability insurance policies offered by employers are governed by the Employment Retirement Income Security Act of 1974 (ERISA). ERISA sets forth standards for plan administration, but the actual policy language and terms determine under which conditions you may be eligible for benefits. Sometimes an applicant's initial application for benefits is used against him or her, so it can be helpful to retain an attorney even before you submit this application.

Under ERISA, the insurer is required to give you reasons for its denial in writing. You then must have a reasonable opportunity to have the decision reviewed. The plan administrator is not permitted to make arbitrary or capricious decisions. In some cases, the plan administrator determines eligibility for benefits and also pays the benefits. When there is a dual role like this, the court is supposed to consider it as a factor in determining whether the denial of benefits is correct or whether there may be a conflict of interest.

Only after your administrative remedies are exhausted are you allowed to file suit. This means that you must try to convince the administrator or insurer to reverse a denial. Under ERISA, if you have exhausted your remedies, you can sue in one of the two Federal District Courts in Michigan. If you purchased an individual plan, you may need to file in Michigan Circuit Court, depending on the location of the insurer.

You should be aware that in ERISA cases, unlike Social Security disability cases, the court is not required to give deference to your treating physician's opinions. The plan administrators cannot arbitrarily reject your treating doctor's opinion, but they do not need to give him or her special deference. In fact, your treating physician's opinion will not be given great weight by the court if it is unsupported by medical records. The administrator may hire an independent expert. The court will have to take into consideration whether the administrator's independent doctor physically examined you, but this is just one factor to investigate.

Although a treating physician is not given special deference, his or her informed opinion, supported by medical records, can be powerful evidence in your case. It is important that we get involved as soon as possible so that we can help guide you through each step of the process. If you need to file a long-term or short-term disability claim, you should consult the Detroit disability benefits attorneys at Feldheim & Wilenkin. Our injury lawyers are dedicated advocates who represent individuals in many areas of Michigan, including in Wayne, Oakland, and Macomb Counties. Call us at 248.737.0700 or contact us via our online form to set up a free consultation.