If you have long term disability insurance through your employer or union, it is subject to the Employee Retirement Income Security Act or ERISA. This does not apply to those employed by the government or a religious institution. There is no easy, quick explanation of ERISA, but our years of commitment to employee benefits can guide you through the ERISA long term disability claims process.
Working to Secure Benefits for Our Clients Under ERISA
ERISA is a federal law governing employee benefits provided by private sector employers. This law is complicated and often contested. If your long-term disability policy is under ERISA, you should retain an ERISA long term disability lawyer.
Jonathan M. Feigenbaum, an ERISA long term disability lawyer, has spent his legal career helping people file for disability benefits. He knows how to decode the complex language of insurance policies in order to secure the benefits you need. He can assist you in your pursuit of benefits under Section 502 of ERISA, 29 U.S.C. §1132.
An ERISA Long Term Disability Lawyer in RI Expands on the Legal Meaning of Disability
Legal disability is an elusive concept. Policy makers often define disability as the inability to perform work due to an impairment arising from a medical condition. Similarly, the United States government characterizes disability as the inability to perform work, or the reduction in capacity to work.
The medical condition causing the impairment may be temporary, permanent, or chronic. The person is disabled when the medical condition and resulting impairment prevents the individual from working. Above all, determining disability requires combining a medical as well as vocational analysis with a legal definition.
Definition of Disability in Insurance Policies
Disability insurance policies are generally classified as:
- “Own occupation.” To be disabled under these policies, the policyholder has to show he or she can’t do the material duties of his or her own or regular occupation. Some of these policies define own occupation very narrowly, e.g., a medical doctor within a particular specialty or sub-specialty.
- “Any occupation.” To be disabled under these policies, the policyholder has to prove he or she cannot do any occupation. In general, these policies include language stating that any occupation means any occupation to which the individual is suited by education, training or experience.
- “Any gainful employment.” To be disabled under these policies, the policyholder has to show he or she cannot engage in any gainful employment. Gainful may be defined as employment that pays the policyholder at least a certain percentage of the salary he or she was earning before becoming disabled.
The blended versions of “own occupation” and “any occupation” policies focus on “loss of earned income”. These policies provide benefits if an insured suffers a loss of earned income due to disability.
Restrictions and Limitations
In ERISA long-term disability cases, a claim is often approved or denied based on the insurer’s perception of your 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 with the same frequency, intensity, or duration that you could before suffering an injury or sickness.
Medical doctors do not use these terms in their daily practices. Educating your doctor about the importance of expressing his or her opinion regarding your medical condition in terms of “limitations” and “restrictions” may be necessary. 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. An experienced ERISA long term disability lawyer in RI can help you with all of the legal details that can potentially result in the awarding of benefits.
The legal complexity of disability arises from linking a medical condition to impairment. For example, a person could suffer the loss of a lung as a result of disease. That loss is measurable as well as observable. A person with little medical or impairment training can readily understand the disabilities associated with having only one lung. Missing a lung would not, however, automatically equate with disability. For example, having one lung limits a person from working as a salvage diver. Yet a person with that same limitation could probably work as an insurance agent or broker.
The salvage diver’s entitlement to disability benefits depends on how his or her policy defines disability. Whether the policy is subject to ERISA also comes into play. ERISA and individual policies share one thing in common – the lack of a uniform, consistent and unwavering standard of disability.
Contact Boston Massachusetts ERISA Lawsuit Lawyer, Jonathan M. Feigenbaum, Esquire
We offer free initial consultations. For assistance with your claim, contact ERISA lawyer Jonathan M. Feigenbaum, Esquire. Reach us by phone at 617-357-9700 or 866-396-9722 (toll-free), or through our How Can We Help form.