Group vs. Individual Disability Insurance: What's the Difference?

Posted on November 14, 2018 by cjblog

Often, insurance companies will not tell you everything about how their policies differ from others. What are the pros and cons of group vs. individual disability insurance? When selecting disability insurance, it's important to be able to make an informed decision.

Whether you have group vs. individual disability insurance can impact both your claim and your changes of receiving an approval. To learn more about your options regarding disability insurance, contact CJ Henry Law Firm, PLLC today.

Group Disability Insurance Policies

Most group disability insurance is provided through an employer. Employer plans can be easier to obtain because they may have fewer requirements. However, they may also have more restrictions when making a claim.

Employer-sponsored plans must comply with a federal law called the Employee Retirement Income Securities Act (ERISA). ERISA controls most health and welfare benefits plans offered by employers, even if they are voluntarily provided by your employer. Some disability plans offered by trade organizations may not be covered by ERISA. Private companies, however, generally must offer benefits plans including disability insurance that complies with ERISA.

Individual Disability Insurance Policies

Many individual disability insurance policies are purchased independently of an employer. However, if you have a plan through your trade organization, it might also be considered an individual plan. This means that your plan is not covered by ERISA. ERISA provides a legal structure for disability insurance plans and also protects the rights of beneficiaries.

If you have an individual disability insurance policy, then you should understand what your policy provides and make sure they offer you appropriate notifications when they say they will. Your policy is like a contract, so your insurance company must comply with that contract. If you feel your group vs. individual disability insurance company is not comply with your contract, you should consult with an attorney right away.

Appealing a Claim Denial

When considering group vs. individual disability insurance, you should also know the differences in claim denials and appeals processes. With an individual disability insurance plan, you may be able to immediately file a lawsuit if your claim is denied. This allows you to begin gathering evidence right away. A lawsuit will let your disability insurance company know that you mean business. They often ignore people until you file a lawsuit.

With a group disability insurance plan, it’s likely that you will have to submit an appeal if your claim is denied. You have to do this within a specified period of time, usually 180 days from the date of your denial. You would file the appeal directly with the disability insurance company, instead of filing a lawsuit in court. This allows your insurance company to re-review your claim and make another determination. This tactic can allow group disability insurance companies to waste time and prevent you from obtaining evidence quickly.

If you need to appeal a denial, you will benefit from the help of a skilled disability attorney. An ERISA attorney will be familiar with the appeals process and can help you avoid mistakes. An attorney will also protect your rights and make sure the insurance company does not take advantage of you.

Filing a Lawsuit

If you appeal your insurance claim through a lawsuit, then the process may be a bit different depending on the type of insurance you have, group vs. individual disability. For example, a judge must resolve an ERISA disability lawsuit. You do not have a right to a jury if you file a lawsuit based on a group disability insurance plan covered by ERISA. With individual plans that ERISA does not cover, though, you have a right to a jury.

Another difference when it comes to group vs. individual disability insurance lawsuits is that you may not be able to receive an award for attorney fees in an ERISA insurance plan case. If you have an individual disability plan that ERISA does not cover, then you may be able to obtain attorney fees, if you win your case. This can help you obtain the best legal representation to help you in a group vs. individual disability insurance lawsuit.

Contact a Disability Insurance Lawyer to Learn More About Group vs. Individual Disability Insurance

When you're shopping for a disability policy or considering filing a claim, it's important to understand the differences of group vs. individual disability insurance. Discuss your situation with a disability insurance attorney at CJ Henry Law Firm, PLLC today.

This entry was posted in Blog by cjblog.