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How Does SSD Affect Long Term Disability Claims Under ERISA?

UPDATED: August 5, 2019

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How does Social Security disability (SSD) affect a long term disability claim under ERISA (the Employee Retirement Income Security Act)? In many positive ways, according to Ron Dean, a California attorney who has been engaged in employee benefits litigation primarily on behalf of participants for over 30 years. Here’s what Dean told us in a recent interview:

If people can get Social Security disability, I encourage them to do it for a number of reasons – the most compelling of which is that, even though your long term disability benefits will be reduced by the social security award, if you need a lawyer to get those long term disability benefits and the lawyer is working on a contingency fee, that lawyer’s fee will be reduced. So, you get the entire social security award instead of only a percentage of it. That’s very valuable too.

Insurance benefits easier to receive if SSD already approved

Dean says that the insurance company is also more likely to agree that you’re disabled if the Social Security Administration agrees that you’re disabled. He provided the following four reasons for why that may be true:

  1. Because [it’s] an objective standard;
  2. Because if they approve your claim, they won’t have to pay you as much money as if you didn’t have a social security award;
  3. The taxability issues get involved and if your long term disability benefits are taxable, the tax on the social security benefits is usually less than they would be on the long term disability benefits; and
  4. If you’ve been on social security disability for two years, you’re entitled to be on Medicare. Medicare is great medical insurance and isn’t something you get if you’re on long term disability.

There’s also a smattering of other benefits, Dean says, which sometimes apply and have a minor affect, but can still be very beneficial.

Information your doctor should give to your insurer

In order to get long term disability benefits in general, it’s important to know what kind of information a doctor should give, and not give, to an insurance company concerning a long term disability claim. Dean told us, “In these cases, the doctor should be giving just about everything. If the doctor isn’t on board, then you’ve got nothing but trouble. It should be someone who understands your condition because if your doctor won’t certify your disability, then your case is lost. The doctor should provide all the records, x-rays and every piece of evidence that he or she can think of to support your claim.”

If you’ve been denied valid long term care benefits, consult with an experienced ERISA attorney to discuss your situation and evaluate your options. Consultations are free, without obligation and strictly confidential.

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