When you navigate the complicated terrain of employer-sponsored Long Term Disability (LTD) benefits, It is crucial to understand how SSA determinations can impact your LTD benefits.
First, your SSDI claim will impact the chance of your LTD claim being approved. Your LTD benefits under such a policy typically hinge on proving that you are unable to work on a full-time basis. Simultaneously, your policy will usually require you to file a claim for SSDI benefits. If the SSA deems you eligible for SSDI benefits, this determination can bolster your claim for LTD benefits. This is because in most situations, the SSDI definition is disability is more stringent than the definition in your LTD policy, and the assessment performed by the SSA is more thorough than that performed by the LTD insurer. While an award of SSDI benefits does not automatically guarantee approval of your ERISA claim, it is a persuasive factor that insurance providers must consider.
Second, an award of SSDI benefits will almost always result in a reduction in the amount of benefits paid to you by the insurer going forward, as well as a balance due to the insurer when you receive past-due benefits from prior months.
Need an LTD lawyer to represent you? Contact us today at 818-886-2525.
What Is Social Security Disability Insurance?
While most employer-sponsored LTD benefit plans fall under the Employee Retirement Income Security Act (ERISA), the payment of SSDI benefits is governed by the Social Security Act, which establishes the criteria for granting such benefits.
Individuals who have worked for a covered employer or have been self-employed for a sufficient duration and earned the required number of credits within the necessary time frame are considered “insured” under the Social Security Act. Consequently, they are eligible to apply for SSDI benefits, which are disbursed to the individual and, if applicable, their dependents.
To qualify for monthly SSDI benefits, a disabled worker must meet several criteria:
- fulfill the “insured” requirement outlined in the Social Security Act,
- meet the disability definition set forth in the Act,
- undergo a five-month waiting period while remaining disabled as per the Act, and
- not have reached the normal Social Security retirement age.
SSDI claim denials are frequent, prompting the Social Security Administration to maintain an internal review process. While individuals can represent themselves or others before the Administration, many applicants opt for assistance from a Social Security attorney to navigate the complex procedures effectively.
Understanding Social Security Determinations
Social Security determinations refer to the process by which the Social Security Administration (SSA) evaluates and decides whether an individual is eligible for disability benefits, either under Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). The determination process involves several steps to assess if an applicant meets the SSA’s criteria for being considered disabled.
SSDI is a federal program that provides financial assistance to individuals who are unable to work due to a long-term or permanent disability. SSDI is managed by the Social Security Administration and is funded through payroll taxes under the Federal Insurance Contributions Act (FICA).To qualify for SSDI benefits, applicants must have worked jobs covered by Social Security and meet the SSA definition of disability.
The SSA uses a rigorous evaluation process to determine eligibility for disability benefits, considering factors such as the severity of the applicant’s condition, their ability to perform work-related tasks, and whether their impairment prevents them from engaging in substantial gainful activity. Substantial gainful activity refers to a level of work activity and earnings used to determine disability. Specifically, it is used to assess whether a person is considered disabled under long-term disability insurance policies or Social Security Disability Insurance. For disability insurance purposes, a claimant must show that they are unable to engage in any substantial gainful activity due to a medical condition. In some cases, earnings thresholds are used to determine if work is substantial. For non-blind individuals, the monthly SGA amount for 2024 is $1550.
ERISA and LTD Benefits
ERISA governs most employer-sponsored LTD insurance plans, establishing standards for administering and enforcing these benefits. Under ERISA, individuals who participate in these plans have certain rights and protections, including the right to appeal benefit denials and the right to file a lawsuit if their claim is wrongly denied.
However, ERISA’s regulations and procedures can be complex and difficult to understand without experienced legal guidance. Insurance companies often have significant discretion in evaluating disability claims, and their decisions may not always align with the best interests of claimants.
SSD Effects on LTD Claims
Here are some key effects SSD can have on LTD claims:
1. Impact on Benefit Eligibility
One of the primary effects of SSD on LTD claims is its impact on benefit eligibility. Many LTD insurance policies require claimants to apply for SSD benefits as a prerequisite for receiving disability benefits under the policy. This means that individuals must undergo a rigorous evaluation process by the Social Security Administration (SSA) to determine their SSD benefits eligibility before pursuing LTD benefits.
2. Offsetting of Benefits
Another significant effect of SSD on LTD claims is offsetting benefits. When a claimant is approved for SSD, the benefits received from SSD may be offset against the benefits payable under the LTD plan. This means that the amount of LTD benefits received may be reduced by the amount of SSD benefits received.
3. Potential of Conflicting Interests
The SSA considers all impairments and does not limit benefits for specific diagnoses. In contrast, LTD policies often contain limitations for disability caused by mental health conditions. A claimant with disabling physical and mental conditions may be served by emphasizing both in their SSDI claim while emphasizing both in the LTD claim could result in an unnecessary limitation of benefits. This is a complex situation that can only be properly avoided by consulting with an experienced ERISA LTD litigator.
How We Can Help with Your Case
We recognize that the complexities of LTD benefits governed by ERISA can be overwhelming. That is why our team is dedicated to providing comprehensive legal assistance to individuals facing challenges with their disability claims. Here is how our experienced team can help you:
1. Thorough Case Evaluation
We begin by evaluating your case to understand the specifics of your situation. Our LTD attorneys will review your LTD policy, medical records, and any communication with the insurance company to assess the strength of your claim.
2. Strategic Advocacy
When it comes to advocating for our clients, we leave no stone unturned. We leverage our ERISA law knowledge and experience handling disability claims to build strong cases for our clients. Whether negotiating with insurance companies or representing you in court, we will strive to achieve the best possible outcome for your case.
3. Appeals Representation
If your LTD claim is denied, we are prepared to represent you in the appeals process. We handle all aspects of the appeal, from gathering additional evidence to representing you in administrative hearings or court proceedings, if necessary.
4. Experienced Negotiation
In many cases, we are able to negotiate favorable settlements with insurance companies without the need for lengthy litigation. Our LTD lawyers are skilled negotiators who will work to achieve your best possible outcome.
5. Litigation (When Necessary)
We are prepared to take your case to court if negotiations fail to yield a satisfactory resolution. With extensive experience in ERISA litigation, we have the knowledge and resources to effectively advocate in the courtroom for your rights.
Contact Our LTD Lawyers for Representation Today
We believe every client deserves to have their voice heard and their rights protected. With our extensive experience and unwavering dedication, we strive to level the playing field and advocate for those in need. Our goal is not just to secure benefits but to provide peace of mind and a sense of security for our clients and their families.
If you face obstacles in pursuing LTD benefits, contact Kantor & Kantor. Let us be your advocates, allies, and champions in the fight for the benefits you deserve. We are people helping people, and we can overcome challenges and pave the way toward a brighter, more secure future.
Contact us at 818-886-2525 and take the first step toward finding relief and resolution.
