ERISA Attorney

ERISA Attorney who will fight for you.Pursue the benefits you are entitled to under your employer’s insurance plan.  Tracy Collins, an experienced ERISA attorney, can help you with this process from the inception of your claim, through your administrative appeal, and through litigation, if litigation becomes necessary.

Ms. Collins is an ERISA specialist with years of experience in Federal court.  She has successfully helped hundreds of claimants obtain disability and life insurance benefits from employers and insurers, including, Unum, Provident, MetLife, The Standard, Reliance Standard, Hartford, CIGNA, Aetna, Prudential, SCE, Boeing, A T & T, Eaton, and many more.

Contact Tracy for a Free Consultation!  818-889-2441  or Email

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The Relationship Between the ERISA Disability Claim and Social Security Disability

ERISA Disability Claim and Social Security DisabilitySubject to a few, limited exceptions, claimants who are applying for disability benefits under their employer’s group disability plan should also apply for social security disability benefits.  In fact, most, if not all,  group disability plans require the claimant to do so.

The requirement stems from the fact that near all group plans allow the plan administrator or insurance company to offset any sum the claimant (and usually also his or her dependents), is receiving in social security disability benefits from the group plan benefit payable to the claimant.

To illustrate: If the claimant is entitled to group long term disability benefits of $2,000.00 a month and is also entitled to $500.00 per month in social security benefits, the plan will offset the $500.00 per month payable by the SSA thereby reducing the claimant’s long term disability benefit to $1,500 per month.  The claimant thus receives $500.00 from the SSA and $1,500.00 in group long term disability benefits for a total of $2,000.00 per month.

Why is this fair?  It isn’t really.  However, it is what the insurance policy or plan typically provide in order to reduce the plan administrator’s liability to the claimant and there is nothing illegal about it.   Further, social security is not the only type of offset most plans allow.  Typically, the plan administrator may also offset worker’s compensation benefits, state disability benefits and even sometimes, employer paid retirement benefits.   Claimants should review their specific plan document to determine offsets allowed under their plan.

The news is not all bad, however.  There are benefits to applying for and receiving social security disability benefits even if the result will be a reduction in the claimant’s group long term disability benefits.  First, because the standard  applied by the SSA for determining entitlement to social security disability is generally more stringent than the definition of disability contained in most group disability plans, an award of social security disability can serve to strengthen the group disability claim and make it more difficult for the plan administrator to terminate long term disability benefits.  Although the courts in most jurisdictions hold that a plan administrator does not have to approve long term disability benefits just because the SSA has awarded disability benefits, the SSA award is still compelling evidence of disability benefits.  In addition, many courts have held that it is inconsistent for the plan administrator to require the claimant to apply for social security disability benefits and thereafter disavow that disability exists by terminating long term disability benefits.  Another benefit to rechecking social security disability benefits is that the claimant qualifies for Medicare after a specified waiting period.  This is helpful to many disabled claimants who have lost their group health insurance after leaving work on disability.   Lastly, probably the most important benefit of receiving social security income is that it is another source of income and is less vulnerable to a termination of benefits.  Unlike an ERISA plan administrator, the Social Security Administration is not motivated to find a way to terminate disability benefits.

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Is your group disability benefit taxable?

Q. Are disability benefits payable under a group policy of disability insurance sponsored by an employer taxable?

A. It depends.  As of this posting in January 2013,the Internal Revenue Service provides these benefits will be taxed in the following manner:

Group disability benefits are fully taxable if:

  1. The employer pays the full cost of the premium for the disability insurance; or
  2. The employee pays for the full cost of the premium with pre-tax dollars; or
  3. The employer and the employee share the cost of the premium and the employee pays his or her share with pre-tax dollars.

Group disability benefits are not taxable if the employee pays the full cost of the premium with post-tax dollars.

Group disability benefits are partially taxable if the employer and employee share the cost of the premium and the employee pays his or her share with post-tax dollars.  In this case, the potion paid by the employer is taxable but the portion paid by the employee is not.

Note:  This information is not intended to constitute tax advice and is provided, rather, as a general guideline for understanding group disability benefits.  Each individual’s situation may vary.  To determine whether your disability benefit is taxable, consultation with a certified public accountant is recommended.    Different rules, which are not addressed here, may apply to disability benefits which are not obtained under an employer-sponsored group disability plan.

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Unfair Insurance Claims Practice

California Department of Insurance Investigation Reveals CIGNA’s Continuing Unfair Insurance Claims Practices   

A recent follow-up investigation by the California Department of Insurance (“CDI”) into the claims practices of CIGNA subsidiary, Life Insurance Company of North America (“LINA”), revealed that LINA continues to engage in the same unfair insurance claims practices for which LINA was previously reprimanded and fined by the CDI in 2009.

Those familiar with the investigation may recall that on June 30, 2006, the CDI issued a Market Conduct Examination report (“the 2006 MCE”) which described numerous unfair claims practices in which LINA was engaging in its administration of disability claims, including but not limited to, failing to consult with the claimant’s treating physicians to determine the claimant’s medical and disability status, failure to consult with an appropriate medical specialist when assessing a claimant’s medical and disability status, misrepresenting relevant facts and misinterpreting its own policy provisions in communications to claimants, failing to timely respond or to respond at all to relevant inquiries by claimants, failing to pay legitimate claims and forcing claimants to litigation to obtain their benefits, failing to obtain functional capacity evaluations and independent medical examinations to properly assess claimants’ disability and medical status, among many other actions deemed unfair claims practices under the California Insurance Code.

LINA responded to the CDI’s 2006 MCE by attributing the improprieties in its claims practices to under staffing and insufficient training of  claims personnel in LINA’s Glendale, California office and promised to direct more resources to cure the deficiencies.  A copy of the 2006 MCE may be found here: http://www20.insurance.ca.gov/epubacc/REPORT/174772.htm The parties thereafter in August 2009 entered into a Stipulation and Waiver pursuant to which LINA agreed to cease its unfair claims practices and pay a fine in the sum of $600,000.00.

In August 2012, the CDI issued a second Order to Show Cause against LINA after a follow-up investigation the conducted between January 1, 2009 through December 31, 2010 (“the 2010 MCE”), revealed that LINA had not, in fact,  ceased its unfair claims practices as promised in the 2009 Stipulation and Waiver and instead, continued to effect many of the same claims violations which had been previously revealed by the 2006 MCE.  A copy of the 2010 MCE may be found here: http://www20.insurance.ca.gov/epubacc/REPORT/174772.htm  Further information as to this matter will be provided as it becomes available.

Do you need an attorney who will represent your interests?  Contact Tracy Collins at 818- 889-2441.

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