Applying for ERISA Group Disability Benefits
If you're applying for long-term group disability benefits under ERISA or another plan, follow these steps.
If you are disabled and can't work, you may qualify for long-term disability benefits if your employer has an Employment Retirement Income Security Act (ERISA) plan or another type of long-term disability policy. But getting long-term disability benefits under your employer's insurance policy is not always easy. The process can be long and grueling, and applicants don't always get the results they want.
Before you apply for disability benefits under ERISA or another employer-sponsored plan, learn about the law and important steps to take in the application process. This will improve your chances of qualifying under the disability policy. Read on to learn more. For tips on common mistakes to avoid in the ERISA disability benefits application process, check out Nolo's article ERISA Disability Benefits Applications: 6 Common Mistakes. (For more general information on health care and employee health benefits, visit Nolo's Health Care and Your Health & Safety in the Workplace topics.)
Employee Retirement Income Security Act (ERISA)
The majority of disability insurance plans offered to employees are governed by a federal law called ERISA. This law, which was enacted in 1974, regulates just about every aspect of any employee welfare benefit. If you apply for long-term disability benefits and the insurance company denies your claim, ERISA gives you the right to pursue a lawsuit in federal court.
Why Is Your Initial Disability Claim So Important?
It's tough to overturn a denial of ERISA disability benefits in court. This is because the insurance company only needs to show a small amount of evidence to support its decision to deny benefits. The judge will review your claim and the accompanying documents. If you made errors during the application process or didn't provide enough support for your claim, your chances of winning will be slim.
This means that your initial claim should be as strong as possible to reduce the odds of denial in the first place.
Long-Term Disability Claims: A Step-by-Step Approach
Below are some steps that will guide you through the complicated process of applying for long-term disability benefits.
Read the policy. Before you file your claim, become familiar with your policy and what is and is not covered. Get a copy of the Summary Plan Description, as well as the insurance policy itself. Under ERISA, you have the right to receive copies of these documents after you send a written request to the plan administrator.
Identify the date of disability. This step is crucial since all other relevant dates such as when you are required to file a proof of claim, and when payments start will be based on the date of disability. Review the policy to determine how a disability is defined. That will help you identify the actual date that you would be considered disabled under the insurance plan.
Choose your last day of work carefully. The last day you worked, also known as LDW, is an important date. Gather as many documents as possible that support your disability, before you stop working. In one case a man quit his job and applied for benefits, even though the doctor's medical records didn't show he was disabled. He ultimately lost his job and health insurance; plus, he was denied disability benefits.
Know your deadlines. There will be numerous deadlines that you will have to meet. Your policy will outline many of these deadlines, and it's very important that you familiarize yourself with them including your time frame to file an appeal because failure to meet deadlines can mean you won't get disability benefits.
Get copies of your medical records. You need to know what your medical records say about your condition, because this is the same information the insurance company will use to approve or deny your claim. Your medical records must contain objective proof of disability. (Learn more in Nolo's article Getting Your Medical Records: Information on Rights, Procedures, and Denials.)
Talk to a lawyer. Qualifying for long-term disability benefits is not a simple process. It's often wise to enlist the help of an experienced disability attorney.
by: Ben Glass, a disability attorney with BenGlassLaw. Mr. Glass practices law in Virginia.