If you have disability coverage through your employer, you may assume that should you become injured or permanently disabled, your insurance will protect you from financial hardship. If your belief is based on communications with an insurance representative or on the two-page brochure you have stored away in a file, your understanding may be wrong. When it comes to employer-sponsored disability insurance benefits, the terms of the plan are what ultimately matter.
Most often, when people initially obtain disability insurance coverage, they receive a copy of a document entitled the summary plan description or “SPD.” The SPD is summary of the information included in the plan and of how the plan operates. The purpose of the SPD is to provide a clear and simple description of the plan. Because this document is merely a summary, it does not include all the information in the plan itself. It is not legally binding, and if you become injured or disabled, it does not govern whether you will receive disability benefits.
The Plan Document is a much larger document (usually 20 or more pages), which includes definitions of key terms, eligibility requirements, benefit offsets, exclusions, limitations, procedures for appeal, and more. The language of the Plan Document determines your benefit entitlement, and the plan administrator must consistently apply these terms to all plan participants.
Recent case law suggests that even if information in the SPD is ambiguous, or arguably inconsistent with the plan language itself, courts will not enforce the terms of the SPD. The summaries do not modify the plan.
The best method for determining the extent of your disability insurance coverage is to request a complete copy of the Plan Document from the plan administrator or your employer’s human resources department. You have a right to this document within 30 days of your request. If you have any questions about your short or long term disability benefits, please contact an attorney at Hawks Quindel.
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