ERISA Long-term Disability

New England Attorney Handling ERISA Claims

There is no easy, quick explanation for the Employee Retirement Income Security Act (ERISA), but our years of commitment to this area of employee benefits law can help us guide you through the ERISA long-term disability claims process. Attorney Jonathan M. Feigenbaum, Esquire, understands ERISA, and he can help you get the benefits you need and deserve.

The Employee Retirement Income Security Act (ERISA) is a federal law governing employee benefits provided by private sector employers. This law is complicated and often contested, and may be best explained by an attorney experienced in ERISA claims.

Mr. Feigenbaum has spent the majority of his legal career helping people file for ERISA long-term disability benefits. His experience has taught him to effectively read difficult insurance policies, decode the complex language of the policy and the law, and help you secure the benefits you need. He can assist you in your pursuit of benefits under Section 502 of ERISA, 29 U.S.C. section 1132.

Working to Secure Benefits for Our Clients under ERISA

Legal disability is an elusive concept. In general, Western industrialized countries policy makers often define disability as the inability to perform work due to an impairment arising from a medical condition. From the perspective of the United States government, disability is characterized as the inability to perform work, or the reduction in capacity to work relative to the comparable fully-able worker. The medical condition causing the impairment may be temporary, permanent, chronic or having reached a medical end result but still leaving an individual impaired, either mentally or physically or both. The person is only considered disabled when the medical condition and resulting impairment prevents the individual from working, or prevents the individual from working in a capacity that the person would normally be able to engage in. Ultimately determining legal disability is more akin to an art rather than a hard science. It requires combining a medical and vocational analysis with a legal definition.

Disability insurance policies are usually classified as: (1) “own occupation,” some with very specific specialty recognition, i.e., medical doctors within narrow disciplines; (2) “any occupation” (either defined by common law) or by specific language stating that any occupation really means any occupation by education, training or experience; and (3) inability to engage in any gainful employment. There exist blended versions of the “own occupation” or “any occupation” policies that focus on "loss of earned income" providing benefits if an insured suffers a loss of earned income due to disability either with, or sometimes without, a specific relationship to the insured's occupation.

In ERISA long-term disability cases, a claim is often approved or denied based on your perceived functional impairment, using insurance-medical terms called “restrictions” and “limitations.” “Restrictions” mean activities that you cannot do whereas “limitations” mean activities that you are able to do but not at the same level of frequency, intensity or time that you could prior to suffering an injury or sickness. These are terms that most medical doctors do not use in their daily practices. We may need to educate your doctor as to the importance in expressing his/her opinion regarding your medical condition in terms of “limitations” and “restrictions.” Simply saying, “My patient Jane Doe is disabled and cannot return to work at this time,” will almost always result in the insurer denying your claim.

The legal complexity of disability arises from linking a medical condition to impairment and concluding a person is disabled. For example, a person could suffer the loss of a lung as a result of disease. That loss indicates an underlying medical condition that can be readily measured, understood, tested, quantified, observed, and the attendant disabilities reasonably understood by a person with little medical or impairment training. Legal disability would not, however, automatically equate with missing a lung. A person with only one lung would probably be limited from working as a salvage diver. Yet a person with that same limitation could probably work as an insurance agent or broker.

Now assuming that the salvage diver had an individual disability policy, whether the salvage diver is entitled to benefits would turn on specific policy definitions. Individual disability insurance policies and ERISA governed disability insurance policies are treated under very different laws, however both types of insurance policies share in common – the lack of uniformity, consistency and unwavering standard of disability.

Contact Our Boston Lawyer, Jonathan M. Feigenbaum, Esquire

We offer free initial consultations. For assistance with your ERISA long-term disability claim, contact Jonathan M. Feigenbaum, Esquire, in Boston, Massachusetts. We can be reached by phone at 617-367-8787 or through the intake form on our Contact Us page.