ERISA (Employee Retirement Income Security Act) disability benefits are available to those of us who are too sick to work. This need not be a work-related injury. Your employer purchases the policy as a group plan. And so long as you are covered by that plan, you can file a claim with their insurance company.
On the other hand, ERISA benefits are notoriously difficult to secure. Insurance companies will look for any loophole in the contract to deny your claim. At CJ Henry Law Firm, we help employees appeal insurance claim denials and recover benefits that they are entitled to under the Employee Retirement Income Security Act.
If you are applying for long-term disability benefits and are unfamiliar with the process, then try to avoid these common mistakes.
Your employer’s opinion concerning your condition is neither here nor there when it comes to determining whether or not you will receive ERISA disability benefits. Your employer is not a doctor and they are not the ones who will be paying out the benefits. The folks you need to convince are the insurance company and, failing that, you need enough evidence that an arbitrator will rule in your favor under the law.
The HR department may very well have your best interests at heart. The insurance company that will be paying out your ERISA disability claim does not. It’s important to understand that you are asking them to pay on a long-term policy. Gird yourself for a fight. Getting those benefits will require both patience and persistence. And while HR departments no doubt staff skilled individuals, they are not skilled in legal matters nor in interpreting the terms of an insurance policy.
This is one of the reasons why claimants on policies have a tough time going it alone. The insurance company makes the process overly cumbersome and confusing, even for the doctors who will be filling out the forms. One thing to remember is: The insurance company will interpret any vagueness in the documents against you. The majority of claims are denied due to insufficient information. This is the insurance company’s way of making you jump through each and every hoop.
On the one hand, this makes some degree of sense. If they approved everyone who applied for ERISA disability benefits, they would quickly go out of business and then no one would get any benefits.
On the other hand, if you or your employer has paid into the policy and you need those benefits, then you’re entitled to them.
Simply returning the form an insurance company gives to your doctor will probably not be enough. You may have to go to a doctor of their choosing. Or you may have to contact other experts, specialists, and more before your claim is approved. This is where a lawyer who is skilled in managing these claims can be of benefit to you.
If you think the stakes are high for you, you should also remember that the stakes are high for the insurance company. It isn’t uncommon for them to send representatives to your home or hire private investigators to watch you. If you claim that you have trouble going up and down the stairs, but the insurance company has video of you carrying your new TV out of the store, you’re in for some trouble. Not only will your claim be denied but you may be charged with insurance fraud.
If your doctor tells you that you can’t go bowling, then don’t go bowling.
You should under no circumstances interact with the insurance company’s lawyers. Their job is to protect the interests of the insurance company and the insurance company’s goals are contrary to yours. In some cases, an insurance company will require a claimant to apply for social security or state disability benefits. If the insurance company’s lawyers offer to help, kindly reject their assistance. There have been instances in which insurance company lawyers have guided ERISA claimants to select disabilities on their applications that can make it more difficult to file an ERISA claim later.
At CJ Henry Law Firm, we understand how the application process for ERISA long-term disability claims works. We can help you make your case under the law. Call us today.