Short Term/ Long term FAQ's

STD & LTD FAQ's

How important is it to develop the "claim file" in my LTD case?

The most important thing in an ERISA disability claim, whether STD or LTD is the development of the claim file. If it becomes necessary to file an appeal of an insurer's denial in federal court, in many cases it is then not possible to add any medical evidence for consideration. Therefore, the addition of supportive medical evidence during the claim process is crucial.

If we have to sue on my LTD claim, can we get punitive damages?

No. The federal courts have determined that ERISA does not allow for punitive damages. The most an insurer must pay if a federal court overturns its denial is benefits to the point of the decision, with accumulated interest, and possibly attorneys' fees (if the judge is so inclined). The claimant would then be put back "on claim," to collect benefits as long as s/he remained "disabled," in accordance with the plan.

My current lawyer has sent the insurer a Chapter 93A demand letter; is that standard procedure in an LTD case?

The answer is: it probably shouldn't be. If the claim is governed by ERISA, then any claim under the Massachusetts Consumer Protection statute, Chapter 93A, will be pre-empted. That's a fancy way of saying that it just won't work--you won't get 93A's triple damages. If a lawsuit is filed in state court, the insurer will have it removed to federal court, and any state law claims will likely then be dismissed. If the LTD insurer's denial letters have cited "ERISA" then make sure your lawyer can explain why, and describe what steps must be taken to preserve your rights under ERISA.

I'd been receiving LTD benefits for months, and when my Social Security Disability benefits came through, the insurer said that I am now "overpaid," and is asking for my retroactive SSD money. Is this right?

If the specific written plan allows for the "offset" of SSDI benefits, your benefits may be reduced after you receive an award (including minor childrens' benefits), and the insurer may be entitled to repayment of a portion of benefits it provided prior to your award. We recommend consulting with an attorney on this issue, however, as in some circumstances you may receive a credit for attorneys' fees related to the SSD case, and in others, you may not have a legal obligation to make the repayment demanded by the insurer.

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				STD & LTD FAQ's How important is it to develop the "claim file" in my LTD case? The most important thing in an ERISA disability claim, whether STD or LTD is the development of the claim file. If it becomes necessary to file an appeal of an insurer's denial in federal court, in many cases it is then not possible to add any medical evidence for consideration. Therefore, the addition of supportive medical evidence during the claim process is crucial. If we have to sue on my LTD claim, can we get punitive damages? No. The federal courts have determined that ERISA does not allow for punitive damages. The most an insurer must pay if a federal court overturns its denial is benefits to the point of the decision, with accumulated interest, and possibly attorneys' fees (if the judge is so inclined). The claimant would then be put back "on claim," to collect benefits as long as s/he remained "disabled," in accordance with the plan. My current lawyer has sent the insurer a Chapter 93A demand letter; is that standard procedure in an LTD case? The answer is: it probably shouldn't be. If the claim is governed by ERISA, then any claim under the Massachusetts Consumer Protection statute, Chapter 93A, will be pre-empted. That's a fancy way of saying that it just won't work--you won't get 93A's triple damages. If a lawsuit is filed in state court, the insurer will have it removed to federal court, and any state law claims will likely then be dismissed. If the LTD insurer's denial letters have cited "ERISA" then make sure your lawyer can explain why, and describe what steps must be taken to preserve your rights under ERISA. I'd been receiving LTD benefits for months, and when my Social Security Disability benefits came through, the insurer said that I am now "overpaid," and is asking for my retroactive SSD money. Is this right? If the specific written plan allows for the "offset" of SSDI benefits, your benefits may be reduced after you receive an award (including minor childrens' benefits), and the insurer may be entitled to repayment of a portion of benefits it provided prior to your award. We recommend consulting with an attorney on this issue, however, as in some circumstances you may receive a credit for attorneys' fees related to the SSD case, and in others, you may not have a legal obligation to make the repayment demanded by the insurer. BACK