Understanding Long Term Disability Insurance
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Your ability to earn an income is often your most valuable asset. What would happen if an unexpected illness or injury prevented you from working? Disability insurance is designed to protect you when the unexpected occurs, providing crucial income replacement if an injury or illness prevents you from being able to work.
At Dorian Law, we understand the importance of disability insurance and are dedicated to helping individuals secure the disability benefits they are rightfully entitled to. Whether you are exploring disability insurance options or facing challenges with a disability claim, this overview will provide you with an understanding of disability insurance and how Dorian Law might be able to help.
“Brent Brehm handled my case very professionally. He carefully reviewed all the details of case and followed up very closely. He always replied my questions and concerns in timely manner. Eventually my case was nicely settled. Thank you Brent!”
At Dorian Law, we focus our disability insurance practice on representing individuals in claims and disputes related to:
Group Disability Insurance (ERISA and Non-ERISA)
Individual Disability Insurance (State Law Governed)
We have a Proven Track Record of success in helping clients secure the disability benefits they are entitled to under both group and individual policies. Our Deep Industry Knowledge of disability insurance law, policy interpretation, ERISA regulations, and state insurance laws allows us to effectively advocate for our clients at every stage of the claim process – from initial application to appeals and litigation. And our Client-Focused Approach ensures you receive compassionate, personalized support and guidance throughout your disability claim journey.
What is Disability Insurance and Why is it Important?
Disability insurance is a contract between you and an insurance company. In exchange for regular premium payments, the insurer promises to pay you a portion of your income if you become disabled and are unable to work due to illness or injury. This income replacement helps you maintain your financial stability, cover living expenses, and support your family when you can no longer earn a paycheck.
Disability insurance is vital because:
Disability is more common than you might think: A significant portion of the workforce will experience a disability that keeps them out of work for an extended period at some point in their careers.
It replaces lost income: Disability benefits provide a financial safety net to cover essential expenses like mortgage/rent, utilities, food, healthcare, and other living costs when your income stops due to disability.
It protects your financial future: Disability can derail your financial plans and savings. Disability insurance helps maintain your financial stability and protect your long-term financial goals.
It provides peace of mind: Knowing you have disability insurance coverage provides peace of mind and financial security, knowing you are protected if the unexpected happens.
Types of Disability Insurance
Disability insurance comes in various forms, designed to meet different needs and circumstances. While Dorian Law focuses on Group and Individual Disability Insurance, understanding the broader landscape is helpful. Here's an overview of common types:
Types of Disability Insurance Dorian Law Does Handle:
Group Disability Insurance: Typically offered by employers as a benefit to their employees. Group disability policies can be:
Short-Term Disability (STD): Provides benefits for a short period (e.g., weeks or months), usually covering the initial weeks or months after a disability begins. STD often replaces a higher percentage of your income than long-term disability.
Long-Term Disability (LTD): Provides benefits for a longer duration, potentially years or even until retirement age, if you remain disabled. LTD benefits usually replace a lower percentage of your income than STD, but for a much longer period.
ERISA-Governed Group Disability: Most employer-sponsored group disability policies are governed by ERISA (Employee Retirement Income Security Act), a federal law that sets specific rules for claims, appeals, and lawsuits. Dorian Law has extensive experience in ERISA disability claims and litigation.
Non-ERISA Group Disability (Less Common): In some rarer cases, group disability policies (e.g., for church employees or government entities in certain circumstances) may not be governed by ERISA and are instead subject to state law.
Individual Disability Insurance: Purchased directly by individuals from an insurance company, independent of employment. Individual disability policies offer greater customization and portability:
Individual Short-Term Disability (Rare): Less common as individual policies tend to focus on longer-term protection.
Individual Long-Term Disability: The primary type of individual disability insurance. Offers long-term income replacement tailored to individual needs.
This distinction is one of the most important terms in your policy.
- An ‘own occupation’ definition pays benefits if you can’t perform the duties of your specific job or profession.
- An ‘any occupation’ definition is stricter — you must be unable to perform any job for which you are reasonably suited by education, training, or experience.
Some policies start with ‘own occ’ for a set period and then shift to ‘any occ.’ Understanding your policy’s definition is essential, especially if your claim is denied for medical or vocational reasons.State Law Governed: Individual disability insurance policies are governed by state insurance laws, offering different legal frameworks for claims and disputes compared to ERISA.
Types of Disability Insurance Dorian Law Does Not Handle:
Workers' Compensation Insurance (Worker's Comp): This is a state-mandated insurance system provided by employers to cover employees who are injured or become ill on the job. Worker's Comp covers medical expenses and lost wages specifically related to work-related injuries or illnesses. Dorian Law does not handle Worker's Compensation claims.
State Disability Insurance (SDI) / Unemployment Compensation Disability (UCD): Offered by some states (like California, New York, New Jersey, Rhode Island, Hawaii, and Puerto Rico), these are short-term disability programs that provide temporary benefits to eligible workers who are unable to work due to non-work-related illness or injury. Benefits are typically a percentage of your wages for a limited duration (e.g., weeks or months). Dorian Law does not handle State Disability Insurance claims.
Social Security Disability Insurance (SSDI): A federal program administered by the Social Security Administration (SSA). SSDI provides benefits to individuals who have a severe, long-term disability that prevents them from performing any substantial gainful activity. SSDI has strict eligibility requirements and a lengthy application process. Dorian Law does not handle Social Security Disability Insurance claims.
Veteran's Affairs (VA) Disability Benefits: While we deeply respect and support our veterans, Dorian Law does not handle claims for Veteran's Affairs (VA) disability benefits. This is a specialized system with its own rules, regulations, and appeals processes that fall outside of our firm's expertise in ERISA and private disability insurance. If you are a veteran seeking assistance with VA disability benefits, we recommend contacting organizations that specialize in veterans' law and can provide you with the dedicated support you need.
Choosing the Right Disability Insurance and Understanding Your Coverage
Whether you are considering purchasing disability insurance or already have a policy, it's essential to:
Understand the type of policy you have (Group or Individual).
Know if your Group policy is ERISA-governed.
Carefully review your policy's definition of "disability," benefit amounts, elimination periods, benefit durations, exclusions, and limitations. Many policies change their definition over time — for example, starting with an ‘own occupation’ period and later shifting to ‘any occupation.’ These transitions are where insurers often look for ways to terminate benefits.
Determine whether your disability benefit will be taxed or not.
Consider consulting with an insurance professional or financial advisor to determine the right type and amount of disability coverage for your individual needs.
Common Disability Insurance Claim Denials
Common Disability Insurance Claim Denials
Insurance companies often deny claims using tactics like:
- Arguing your condition doesn’t meet the definition of “disability”
- Invoking pre-existing condition exclusions
- Capping benefits due to mental health or self-reported symptom limitations
- Claiming you can still work in “any occupation,” regardless of realism
If your claim was denied, it’s important to understand why — and whether the insurer’s reasoning holds up under legal scrutiny.
Denied a Disability Claim?
Don’t assume the insurer is right. Many denials are overturned on appeal — especially under ERISA. We can review your claim, help you understand the denial, and fight to restore your benefits. Contact us, we’re happy to help.
Frequently Asked Questions (FAQ) About Disability Insurance
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A: These terms define when you qualify for disability benefits and are explained earlier on this page. But knowing how your specific policy applies them is just as important. Some policies start with an “own occupation” definition but shift to “any occupation” after a year or two — which can be used as a trigger for denial. If you’re unsure how your insurer interprets your policy, or you’re facing a denial based on these definitions, we can help.
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A: Insurers frequently deny valid claims using these tactics — especially when your policy shifts to an “any occupation” definition after 24 months, or when your condition doesn’t show up on objective tests. They may also invoke exclusions buried deep in your policy. These denials can often be appealed or overturned. At Dorian Law, we focus on fighting back against these common — and often unfair — denial strategies. If you’ve received a letter citing one of these reasons, we can help.
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A: Yes. Many professionals carry individual disability policies in addition to their employer-sponsored group coverage. Individual policies offer greater customization, aren’t tied to your job, and often contain more claimant-friendly terms. Group policies, on the other hand, are often governed by ERISA and may be more restrictive. If you have both, it’s important to understand how they interact — some contain offset or coordination of benefit clauses that can affect your payout. We can help you evaluate how your coverage layers together.
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A: A common guideline is to aim for benefits that replace 50–70% of your gross income. But the impact depends on whether those benefits are taxed — which hinges on how premiums were paid. If your benefit is taxable, your “real” income replacement may fall short. This kind of gap often surprises people after a claim is filed. If you’re reviewing your coverage or facing a shortfall, we can help you understand what your policy actually provides.
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A: Many long-term disability policies contain hidden limitations that insurers use to restrict benefits. Common examples include:
Mental/nervous condition limits (often capped at 24 months)
Self-reported symptom limitations, often applied to fibromyalgia, ME/CFS, or Long COVID
Musculoskeletal condition limits (like for back pain or arthritis)
These limitations are often buried in dense policy language and misapplied by insurers. If your claim involves one of these conditions, it’s important to understand whether the limitation actually applies.
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A: If your disability coverage is provided through a private-sector employer, it’s probably governed by ERISA, a federal law that sets strict rules for how claims and appeals must be handled. But ERISA doesn’t apply to all group plans — church and government plans are often exempt. Why it matters: ERISA limits discovery, imposes short deadlines, and affects your ability to sue for bad faith. If you’re not sure what rules apply to your policy, we can help you figure it out.
If you have questions about your disability insurance coverage, are considering filing a disability claim, or are facing challenges with a disability claim denial, Dorian Law is here to help. Contact us for a free consultation. Let us put The Dorian Law Advantage to work for you.