Disability and Insurance Law Information

General Information- Short Term Disability

There are several disability income benefits that may be available to you. In New Jersey, most employers must either contribute to state mandatory TDB benefits coverage or have their own short term disability coverage for up to six months of disability. The Division of Temporary Disability and Family Leave Insurance, located at https://myleavebenefits.nj.gov/help/faq provides useful information about temporary disability insurance benefits in New Jersey.

Alternatively, many employers offer “salary continuation benefits” for the first three or six months of disability. This may coincide with leave under the FMLA. Salary continuation benefits are taxed in the same format as regular income, and may be paid based on a percentage of your salary depending on your years of service for your employer.

Our vast experience in short term disability claims teaches us that the administrators of these claims are focused solely on blunting the duration of the short term disability. Expect to submit biweekly updates that the administrator, as they stress a return to work and try to focus the claim on when you will return to work. So too, the short term disability forms that are provided to your doctors are designed to funnel the case into a short claim life.

General Information- Long Term Disability- ERISA

People can obtain group long term disability income benefits by opting in to a group plan provided by the employer. These will be regulated by “ERISA”, or the Employee Retirement Income Security Act of 1974. ERISA was enacted to provide certain protections for people with private health and pension plans, as well as employer-provided long-term and short-term disability insurance coverage. It regulates employer disability plans, outlining provisions for how claims should be processed, the timeline for processing them, and an individual’s rights when a disability claim is denied. Note that employees have the right to receive a Summary Plan Description from their employer, outlining the available long term disability (LTD) coverage and the rules regarding establishing a claim. The administrator of the plan or policy requires you to submit proof of your disability. Typically, long term disability coverage requires you to be disabled for a set period of time, “the elimination period” before payment will begin.

The disability income benefits are based on a percentage of your income. The benefits vary based on what insurance policy is issued to cover the benefits. It is important to find out what benefits are available, and usually the Human Resources department of the company can provide this information upon request. While on medical leave for a disability the employee may be eligible for continued benefits that active employees have such as medical, dental, or vision coverage. There are certain reductions in the amount of long term disability benefits you may receive, considered “offsets”. It is important to read your policy carefully and understand what other income benefits will reduce what the disability insurance carrier will pay to you. This often includes pensions, severance payments, social security disability, settlements of third party actions such as automobile accidents and workers’ compensation benefits.

General Information- Other Benefits

Many employers provide benefits to its employees, such as health coverage, pension contributions, life insurance, while you are an active employee. If you become disabled, what happens to these benefits of employment?

When you are filing your claim, you should contact your employer to find out in writing, what other ancillary benefits may be available to you. Your employer must, under ERISA law, make a Summary Plan Description available to you. In fact, ERISA regulations require that your employer provide to you, within 30 days of asking for it, a complete copy of the plan in effect. Understanding how your other ancillary benefits are impacted by your filing for disability is crucial to a smooth transition during this important time.

While disabled, you may be eligible for continued life insurance with a waiver of premium and continued medical, dental or vision coverage for a period of time. While disabled, your company may provide for health insurance at the same rate as if you were working, or such coverage may end, requiring you to seek continued coverage under COBRA.

Look into

* whether your 401(k) matching contributions change,
* whether your employer will continue pension contributions.