What is the difference between group and individual long-term disability insurance?

The distinction between group and individual disability insurance is not just technical — it fundamentally changes your rights and your litigation strategy. If your LTD policy was obtained through an employer as part of a benefits package, it is almost certainly an ERISA plan. ERISA pre-empts state insurance law, which means your only remedy for a wrongful denial is to sue in federal court for the benefits owed, plus attorney fees at the court’s discretion, under 29 U.S.C. §1132(a)(1)(B).

Individual disability insurance — policies you purchased privately, often from a broker as supplemental coverage — is a contract between you and the insurer, governed by state law. In New York, the insurer’s duty of good faith and fair dealing is enforceable. Unreasonable claim denials can support a bad-faith cause of action with potential for consequential damages beyond the policy benefit. The evidentiary rules are also different: you can conduct discovery, depose witnesses, and introduce new evidence at trial.

Many professionals carry both: a group ERISA plan through their employer and a supplemental individual policy purchased privately. The claims are handled separately under different legal frameworks, though the factual record — your medical documentation — is largely shared. Coordinating both claims simultaneously requires careful strategy to avoid inconsistencies that either insurer could exploit.

Knowing which framework applies is step one. We review your policy before advising on strategy. We handle both ERISA and individual LTD cases on contingency. No fee unless we win.