If you have a pension plan or a private plan to protect you in the event of disability, there are laws in place to protect you. ERISA is one such legislation that can help you in the event you’re injured and cannot work.
How to File for ERISA Disability Benefits
The Employee Retirement Income Security Act (ERISA) is a federal law that regulates many of the important specifics of employer-sponsored healthcare plans. One of the things covered by ERISA is the procedure for submitting a long term disability claim.
If you have suffered an illness or injury that has prevented you from returning to work in the same capacity as before, ERISA regulations play a large role in determining how you get benefits. Becoming familiar with the act is an essential first step in submitting a successful claim that allows you to focus on your health without stressing about work.
ERISA Disability Claims Procedures
One of the biggest benefits of ERISA is that it gives employees who have had their long or short term disability claims denied the ability to file a claim against the insurer — in the hopes of having their benefits reinstated. Pursuing an ERISA disability lawsuit can be difficult, however. The burden is on the employee to produce evidence that they have been unfairly denied coverage for a legitimate condition.
To avoid having to file a lawsuit, familiarize yourself with ERISA regulations and with the requirements of your health plan ahead of time. Insurers often deny long term disability claims based on a lack of supporting evidence or other administrative issues.
Who Is Eligible for ERISA Disability?
ERISA disability eligibility depends on many factors. While policies vary, you’ll generally need to be:
- Employed by the provider of your disability benefits on the last day you worked (LDW). This is important if you resign or are terminated shortly after your injury. You must be able to establish and prove you were employed at the time of the disability and application, before you stopped working. You also generally need to be employed as a full-time employee to qualify for benefits, although every employer will have slightly different terms.
- Able to meet deadlines for applications and appeals. These vary by policy, but failure to meet them will mean your petition for benefits will be denied.
- Able to offer hard, objective evidence of your disability. You will not qualify for disability unless you have solid medical proof. This may mean x-rays, MRIs, the opinions of specialists and additional evidence. Gather as much documentation as you can and keep copies of your medical records to ensure you can show disability. You may also wish to speak to a disability attorney to ensure you can establish disability and can make your case as strong as possible.
- Disabled enough that your condition prevents you from doing essential work tasks. Your ability to perform work duties must be severely hampered by your condition, and you’ll need a doctor’s report or other medical evidence of that fact.
- Injured enough for Social Security Disability Insurance (SSDI). Many ERISA disability benefits policies require you to apply for SSDI as well.
- Injured consistently. It’s not unusual for insurance companies to send activity logs to injured applicants or even to hire private investigators to follow workers. If you feel better one day and worse the next, it may affect your activity levels. If you’re shown to be participating in more physical activities you may be accused of trying to falsify or exaggerate your condition.
If you’re not certain you qualify for ERISA disability benefits or if you have been denied but believe you qualify, contact the law office of Lisa M. Ritacco for a consultation with a disability attorney.
One thing to expect from a successful application is that it may not be successful right away. Sometimes, employees expect their benefits to arrive with no problem because their employer or someone in human resources assured them they qualify for benefits. However, ERISA group disability benefit programs are administered by insurance companies, not by anyone at your organization. If you’ve been denied, your benefits are delayed or you encounter any problems, contact a disability attorney for assistance.
If you’ve applied for ERISA disability benefits and have been accepted, you can expect to have a waiting period. Many policies have a short-term disability policy, which will cover you for the first 90 to 180 days of your injury, and then a long-term disability benefit program thereafter. You may be asked to use up all your short-term disability and sick time before you can apply for long-term disability. Read your policy information carefully to understand what is covered and when. This can ensure you don’t miss a long-term disability benefits application deadline.
Once you’re on long-term disability benefits, the insurer may continue to be in touch. They may ask you to complete an activity log to gauge what kind of activity you can do. They may also ask that you apply for SSDI benefits and offer their own attorneys for you to do so. In both cases, you should speak to your own disability attorney, since either of these choices can affect your qualification for long-term disability.
Once you start receiving your benefits, you should receive them monthly. If your policy was paid with pre-tax money, tax withholdings will be applied to your monthly benefit payments. This is more common, although some plans do not require any tax withdrawals because they were paid for with after-tax dollars.
ERISA and Disability Law: What You Need to Know
- Your insurer makes the final decision regarding your disability claim — not your employer and not a government representative. Just because your hiring manager has agreed that your disability is preventing you from working doesn’t mean your insurance company will.
- Your insurer has the right to request additional medical information about your condition. They may also investigate your activities to make sure you are following your doctor’s orders. Incomplete documentation or participation in activities you’ve been warned against can result in a denial of your claim.
- Details are incredibly important. Misidentifying the date your disability began is enough to merit a denial of your claim. Make sure all medical records are properly dated and agree with the timeline you’ve described in your paperwork.
How an ERISA Lawyer Can Help
With the complexities of ERISA legislation and the importance of ensuring all paperwork is completed correctly, a qualified ERISA lawyer is an invaluable ally when filing a disability claim. If you are unable to continue at your current job, the law office of Lisa M. Ritacco may be able to help you secure the disability benefits you need to focus on your health.
Whether it’s helping you navigate your insurer’s bureaucracy, or representing you in an ERISA disability appeal, Lisa M. Ritacco has over ten years of experience to work towards getting you the benefits you deserve.
If you have any questions or concerns about ERISA benefits, contact the law office of Lisa M. Ritacco for a consultation. Our law office focuses on disability and employee benefit programs only, meaning we’re poised to answer your queries about these matters.
Call our office or contact us online today to schedule your free consultation.