North Carolina Residents – Get Assistance from Expert Long-Term Disability Insurance Lawyers

While Capitan Law is not licensed to practice in North Carolina courts, our long-term disability lawyers assist disabled North Carolina citizens with ERISA-governed disability insurance claims. As discussed in more detail below, ERISA is federal law. If you have a claim that is governed by North Carolina law, please contact a local attorney licensed to practice law in your state to assist you with that matter.

Facing a non-work-related injury or illness can threaten your financial stability. Let Capitan Law, your experienced long-term disability insurance lawyers, guide you through the application process of disability insurance via your employer’s ERISA-governed policy. Be aware that this process is complex, with insurance companies often attempting to minimize or deny benefits owed.

Our long-term disability attorneys will defend your rights, collate necessary evidence, and strive for the benefits you deserve. We offer free consultations, so call us at (267) 419-7888 today.

About ERISA and Long-Term Disability Insurance

The Employee Retirement Income Security Act of 1974 (ERISA) typically governs long-term disability insurance plans provided by employers. That means if your employer pays for part or all of your disability coverage, you must follow the rules and procedures set forth by ERISA. The benefits that are provided by your LTD insurance policy will replace a portion of your income for an extended period, which is generally determined by your plan and the nature of your disability. As mentioned above, these claims can get complex. An ERISA benefits claim attorney will provide knowledge and experience to guide you through the process.

Each policy varies slightly in its definition of disability, but in general, to be eligible for benefits, the injured individual must be unable to perform the duties of their own job. After some time, eligibility for benefits may change and may stipulate that the individual cannot complete any work at any job due to their disability.

Differences between LTD Insurance and Workers’ Compensation

The main difference between long-term disability and workers’ compensation is that LTD benefits provide a partial-wage replacement for someone who becomes injured while doing something unrelated to their work, while workers’ comp is for job-related injuries and illnesses. If you are injured at work, you may still be able to apply for disability insurance benefits depending on the specific language contained in your policy. However, if you are eligible for both types of benefits, LTD benefits are usually offset by any benefits received through the workers’ comp claim.

Both insurance policies can come from your employer; however, not all businesses in North Carolina have a legal obligation to provide long-term disability to their employees. If your employer does not offer LTD insurance, you may have purchased your own individual disability plan and paid the monthly premium. It is also possible to have a policy you purchased yourself and one provided through your employment relationship. If you sustain an injury or get sick, you’ll be able to collect benefits based on your policy type. The attorneys at Capitan Law can help you understand the options available to you and are well-equipped to help you navigate these complex issues.

Disabilities Qualifying for LTD Benefits

LTD policies typically cover severe medical conditions that prevent you from maintaining your previous work schedule. These disabling conditions can include autoimmune diseases, back and spine injuries, mental health disorders, and many others.

Filing a Long-Term Disability Insurance Claim

Immediately file a claim when an injury or illness impedes your work. First, file a short-term disability claim; when these benefits end and your disability persists, your LTD benefits can commence. Start the process early to resolve any claim denials or delays promptly. We are happy to assist you in the long-term disability application process.

Common Reasons for Claim Denial

LTD claim filing is complicated, with any errors potentially leading to denials. Common reasons for denial include discrepancies in the definition of disability, missing medical records, procedural errors, inconsistent information, bad faith by insurance, and lack of understanding of rare medical conditions.

Appealing a Denied Claim

You can appeal a denied long-term disability claim. Under ERISA, you must file the appeal within 180 days from the denial notification date. At Capitan Law, we understand the appeals process and will help you through each necessary step.

Long-Term Disability Laws in North Carolina

When it comes to understanding long-term disability in North Carolina, the most pivotal piece of the puzzle is the federal Employee Retirement Income Security Act, or ERISA. Because federal laws take precedence over state laws, all state laws regarding long-term disability insurance must follow ERISA’s lead. If you live in North Carolina and have questions about long-term disability benefits, it’s essential to know that the federal rules set by ERISA are your guiding light.

Who’s Eligible for Long-Term Disability in North Carolina?

In North Carolina, employers and government agencies pick their preferred insurance providers. The insurers set the criteria determining who qualifies for long-term disability benefits. That said, most full-time employees typically qualify for long-term disability insurance if their employer offers it.

But what if your workplace doesn’t provide this coverage? No need for concern. North Carolinians have the option to purchase individual long-term disability policies. This way, you’re not only securing your future but taking proactive steps to protect it.

North Carolina’s Definition of Long-Term Disability

Most insurers consider a disability to be “long term” if it has lasted or is projected to last at least six months. However, don’t be surprised if you come across some insurers with a slightly longer timeframe in mind, requiring the disability to persist for up to a year before granting long-term status and the relevant benefits.

Now, it’s also vital to be aware that not every illness or injury will qualify for long-term disability coverage, even if it lasts more than six months. To give you an idea, here are a few disabilities that insurers often exclude:

Self-inflicted injuries or suicide attempts
Disabilities arising from acts of war or participation in riots
Injuries or illnesses stemming from the commission of a crime or illegal activity
Conditions related to substance abuse, unless they are part of a documented treatment program

This list isn’t exhaustive and can vary from one insurer to the next. But it gives a glimpse into the conditions that might be out of the coverage sphere.

Long-Term Disability Insurance Benefits in North Carolina

As with all matters related to long-term disability insurance in North Carolina, it’s essential to remember that policies vary widely among employers and insurers. However, most long-term disability policies include the following benefits:

Replacement Income: The primary benefit of a long-term disability policy is the provision of a portion of your usual salary or wage. The North Carolina Department of Insurance says most policies will replace 50 to 75 percent of your pre-disability earnings.
Waiver of Premium: If you become disabled and begin receiving benefits, many policies will have a provision that waives your premium payments. This means you won’t have to pay for the policy while you use it.
Cost of Living Adjustments (COLA): Given the rising costs of everyday living, some policies offer COLA. This adjustment increases your disability benefits over time to keep pace with inflation, ensuring the real value of your benefits remains consistent.

Contact our ERISA Benefits Claims Experts

At Capitan Law, we comprehend the urgency of receiving LTD benefits. We work tirelessly to protect your rights and ensure fair treatment during the claims process. If you’re unable to work in North Carolina, call us at (267) 419-7888 for assistance with filing for benefits.