If you have a condition that impairs your ability to perform your duties or work, then you may qualify for long-term disability (LTD) benefits under your employer-sponsored ERISA insurance (Employment Retirement Income Security Act) or other group insurance plan. When you are applying for LTD benefits, every seasoned ERISA attorney knows how crucial the application process is to obtain benefits. A mistake or lack of information could mean the difference between success and denial of benefits.
Some common avoidable mistakes made on LTD benefits applications include:
1. Assuming you qualify for disability benefits when your employer tells you that you are too sick to work.
Every LTD policy under ERISA insurance provides a definition for disability that you must meet to qualify you for LTD benefits. Thus, the insurer’s opinion as to whether you are disabled is important, not your employer’s opinion. LTD policies usually have one of two definitions for disability:
- Medically unable to carry out duties of your “own occupation.” This focuses on your particular career.
- Medically unable to perform duties of “any occupation.” This includes job opportunities outside your specific career.
Your LTD policy may change the definition for disability from “own occupation” to “any occupation” after a period of time, usually 24 months. Additionally, your LTD policy may have exclusions, such as pre-existing conditions or medical impairments related to substance abuse.
2. Relying solely on your employer’s human resource department.
Human resource personnel are available to provide you with information. They are not trained, do not have expertise, and cannot apply on your behalf for LTD benefits. You are the one who needs to be proactive to obtain LTD benefits.
3. Documenting your disability claim using only the form provided by your disability insurance company.
Forms provided by your insurance company only request for basic information. It is necessary to expound on that information. Do not leave your doctor with only filling out the forms because the forms will not elicit enough information regarding your condition. A knowledgeable ERISA attorney would request your doctor to prepare a report detailing your condition, symptoms, limitations and restrictions that prevent you from performing the substantial and material duties of your occupation or any occupation.
4. Participating in activities your doctor told you not to.
Insurance companies have been known to retain investigators to investigate your claim, including reviewing your social media or even photographing or videotaping your activities. If you are doing something that your doctor cautioned you against, such as carrying 40 pounds when your doctor said not to carry more than 20 pounds, your insurance company can deny your claim.
5. Using your disability insurance’s lawyer to file a Social Security Disability Insurance (SSDI) claim.
When you receive LTD benefits, you may be required to apply for SSDI benefits. Your insurance company’s attorneys or affiliated law firm may offer to assist you in the application process. The lawyer’s loyalty is to the insurance company. They have sometimes been known to steer claimants towards choosing disabilities on the SSDI application that later make it harder for the applicants to prove their LTD claim.
6. Working with an inexperienced ERISA attorney.
ERISA is complex with many rules governing the application process. It is important you retain a tenacious ERISA attorney who understands the strict deadlines, what evidence should be gathered and submitted, how your ERISA insurance application should be packaged to be persuasive and the rules governing appeals.
Contact an ERISA Attorney
If you are thinking of or are applying for LTD benefits, consult an experienced ERISA attorney with Jonathan M. Feigenbaum, Esquire at 617-357-9700.