Those who need to file a claim under ERISA (Employee Retirement Income Security Act) often find themselves saddled with confusing requirements and demands from the insurance company that furnishes your employer with their policy. Indeed, they make it intentionally difficult because if there are too many claimants drawing on the plan at the same time, then the fund becomes insolvent. Nonetheless, they have a legal and moral duty to act on behalf have the best interests of their policyholders.
If you are concerned that an injury or ailment will prevent you from working for an extended period of time, an ERISA litigation attorney at CJ Henry Law Firm can help you get the evidence you need to cash in on your claim. Below, we discuss what evidence you will need in order to prove that your claim is valid.
Although each policy is different, there are some general rules that apply. The insurance company will require you to prove:
In some cases, it is easy to prove that you have a disability that prevents you from working. Other conditions, like fibromyalgia, are based on subjective reports that the patient gives the doctor. It is conditions like these that may provoke insurance company suspicion. That is because the insurance company requires objective proof to pay out on an ERISA claim and conditions like fibromyalgia may not have the kind of proof that they’re looking for. Nonetheless, these are real documented conditions than greatly inhibit an individual’s ability to sustain employment. In this case, it becomes a matter of getting expert opinions on what you can and cannot do on the job.
In some cases, this is quite easy. You can simply provide the insurance company with a paystub or other information from your employer that will specify when the last day you went to work was. In addition, medical records should show when your condition worsened to the extent that you became unable to work.
In some cases, this is very easy to prove. But remember that the insurance company will make this process as cumbersome as possible to deny your claim. You will need to work with your doctor in order to get that evidence or at least get your doctor to sign off on a specific date.
The insurance company along with ERISA statutes requires that you provide objective medical evidence for both your medical condition and that your medical conditions prevents you from working. If, for instance, you’re paralyzed from the neck down, then it may be quite easy for you to prove your claim. In most cases, however, this will require an extended battle and the insurance company may not accept what you have to offer.
Nonetheless, the insurance company is required by law to pay up under certain circumstances, in this is where having an experienced ERISA litigation attorney advance your cause can be of real benefit.
Acceptable medical evidence can include:
It is important that your ailments are objectively documented. When you tell the doctor that your arm hurts when you hold it a certain way, they take you at your word. The doctor then documents that in your report. This is precisely the kind of evidence that will not prove your ERISA disability claim. You will need objective proof of an injury to your shoulder.
The last part of the equation will be to prove that your disability impairs your ability to do your job. In some policies, it will explicitly state that your disability must prevent you from doing your current job. Other policies will state that your disability must prevent you from doing any job. The majority of policies meet somewhere in the middle. If your disability prevents you from doing your current job, you will be able to collect ERISA benefits for a period of time. Then the standard will change to any job.
We can help our clients get the evidence they need to appeal an ERISA denial. If the insurance company has denied your claim, schedule an appointment with CJ Henry Law Firm today.