Compelling evidence and thorough documentation are critical to the success of a long-term disability (LTD) claim, especially during an appeal. Insurers and plan administrators evaluate claims primarily through the medical and supporting records submitted. Objective evidence—including diagnostic imaging, lab results, specialist reports, and functional capacity evaluations—carries substantial weight in this process.Beyond clinical data, detailed statements from treating physicians are essential. … [Read more...]
Employment Law Articles
Wisconsin Employment Law Articles Covering Employee Issues - Including Long Term Disability Benefits, Employment contracts, Employment discrimination, Employment benefits and wages, Wrongful termination & Retaliation and Employee rights.
Wisconsin Restrictive Covenant Agreements
Wisconsin restrictive covenant agreements commonly include non-compete, non-solicitation (of customers, clients, and employees), and non-disclosure or confidentiality (NDA) provisions. These are legally classified as restraints on competition and are enforceable provided they are reasonably necessary to protect the employer's legitimate business interests. Standard Provisions in Restrictive Covenant Agreements Non-compete agreements prohibit former employees from working for competitors, … [Read more...]
Discretionary Clauses in ERISA Long-Term Disability Policies
Discretionary clauses in long-term disability (LTD) benefits are provisions commonly found in insurance policies or employer-sponsored plan documents that grant the insurer or plan administrator broad authority to interpret the policy’s terms, determine eligibility for benefits, resolve factual questions, and decide the amount or duration of payments. In practice, these clauses give the administrator significant leeway in evaluating claims, including how to apply definitions of … [Read more...]
Impact of Arrest and Conviction Records on Employment
Title VII of the 1964 Civil Rights Act, applicants and employees are protected from employment discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or transgender status), national origin, age (40 or older), disability and genetic information (including family medical history). While employment discrimination laws offer broad protections, they do not extend protected class status to individuals with criminal records. Title VII does not recognize … [Read more...]
Higher Education Employment Law Disputes
Wisconsin higher education faculty, academic staff, and administrators frequently encounter employment law disputes arising from tenure systems, peer review processes, research expectations, and institutional policies. Public institutions within the University of Wisconsin (UW) System are governed by the Board of Regents and its specific policies regarding appointments, grievances, and due process. Private institutions, however, follow their own individual contracts and handbooks while … [Read more...]
How to Fight a Non-Compete Lawsuit
Non-compete agreements (also called restrictive covenants) protects employers by restricting a previous employee from working for a competing business or starting a similar company within a specified geographic area for a defined period of time. Non-compete agreements are enforceable in Wisconsin and are fairly common in roles with access to customer relationships, trade secrets, confidential information, or specialized skills. Common industries and job types include: Understanding … [Read more...]
Challenging Long-Term Disability Pre-Existing Condition Denials
Employer sponsored long-term disability (LTD) policies, governed by the Employee Retirement Income Security Act (ERISA) commonly include pre-existing condition exclusions, where a policy holder is ineligible for disability benefits for a preexisting condition they had symptoms of, treatment for, or a diagnosis during a look back period of typically 3-12 months before coverage began (typically hire date). Insurers review medical records for symptoms, treatments, or consultations during the look … [Read more...]
Common Issues Regarding Long-Term Disability
There are a number of common issues pertaining to long-term disability benefits (LTD) that claimants’ wish they had known to avoid financial hardship. Policyholder experiences, attorney insights, and anecdotes around denied or terminated claims can help avoid common pitfalls. Issues that Can Result in Denial of LTD Benefits LTD claims may be denied for lack of “objective proof" linking symptoms to inability to work. Self-reported symptoms, gaps in treatment, or relying only … [Read more...]
Long Term Disability and Social Security Disability Benefits
Long term disability (LTD) is private insurance offered through an employer (governed by ERISA law) or purchased by individuals to replace a percentage of income when they are unable to work, lasting for a period specified by the policy. Social security disability (SSDI) is a federal government program based on work history/credits, where benefits are paid as long as the individual remains disabled, converting to retirement benefits at full retirement age. It is important to note that … [Read more...]
Differences Between Short Term and Long Term Disability Versus FMLA
There are two common options available to employees when navigating a medical issue or family emergency requiring time off from work: Short-term disability (STD)/Long Term Disability (LTD) and the Family and Medical Leave Act (FMLA). While STD/LTD and FMLA both cover time away from work for health related reasons and may be used together, they serve different purposes and have different eligibility rules. FMLA at a Glance The family and Medical Leave Act (FMLA) is a federal law that … [Read more...]
