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Friday, October 17, 2014

Social Security Found I was Disabled. How can the Disability Insurer Disagree?

More than twenty years ago, when I started my practice as an ERISA disability lawyer in Connecticut, I would tell my clients that it was generally easier to get group long term disability benefits under their employers plan than it was to get Social Security Disability Income.  Now, the situation is reversed; so long as you do several levels of appeal, Social Security disability benefits are generally easier to qualify for than ERISA group disability insurance.   All the clients I represent in ERISA disability appeals are receiving Social Security.  

It is a strange result.  On paper, Social Security has a stricter definition of disability: the disability standard for Social Security is that you can’t do any job; for most long-term disability plans, you are disabled for the first 24 or 36 months of coverage if you can’t do your specific job.  Social Security has a number of doctrines and practices, though, that really help claimants.  If your disability fits into a certain category and your treating physician supports your claim, Social Security is obligated to pay benefits.  In the ERISA disability claim area, the doctrines that courts apply, such as applying a deferential standard of review to the plan’s decisions, have the effect of making it harder for claimants to prevail.  

So, based just on the different standards for disability, you may get complacent about pursuing an appeal vigorously, thinking “How can Unum deny my claim if Social Security found I was disabled?”  Believe me, the insurers do this all the time.  If you are denied disability benefits, make sure you pursue any appeal as hard as you can even if you have prevailed with Social Security.

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