Long term disability (LTD) coverage is a common benefit offered by many employers and sometimes purchased individually. The purpose of such an insurance policy is to ensure you can continue to receive most of your salary if you become physically unable to work.
While this may give you peace of mind and seem straightforward, qualifying for Texas ERISA long term disability insurance can actually be a long and difficult process without a qualified ERISA attorney’s help. The most important qualifying factor is to prove via sufficient medical evidence that you meet the definition of disability as provided in your policy contract. You must also adhere to waiting periods and other requirements.
Anyone who believes they qualify for a disability insurance claim should first consult the summary plan description in the policy. The exact way that disability is defined typically dictate whether or not an applicant has a chance at being approved. In general, most insurance companies state that an employee is totally disabled if they are unable to perform the duties of their own occupation due to an illness or injury.
However, insurance companies are bound to the provisions of the federal Employee Retirement Income Security Act (ERISA) of 1974. This act provides disability applicants with certain rights and outlines the process of applying and appealing a claim.
Some plans may have provisions for a partial disability claim if the applicant cannot work full-time in their own occupation anymore, even if the applicant is capable of working full-time or part-time at another job. Additionally, many insurance carriers require that the applicant no longer be on their employer’s payroll in order to apply for benefits.
When it comes to qualifying for long term disability benefits, the most important factor is the opinion of the treating doctor. As a part of the application process, the physician must complete a form or write a statement about their opinion of a disability applicant’s medical condition. While the opinion of this physician is vital to the claim, the claims administrator may also want hard proof of the disability, such as medical records that include all test reports, clinic notes, and surgical reports.
Another key factor to qualifying for Texas ERISA long term disability insurance benefits is the ongoing nature of the disability. It is important that the applicant continues to receive treatment and oversight from their physician during the application and approval process.
Even after an applicant is approved for benefits, they may want to continue any treatments or medical appointments recommended by the treating doctor. Not complying in medical treatment can be grounds for the insurance carrier to stop the benefits.
Qualifying for Texas ERISA long term disability insurance is often not easy. The process can be frustrating and time-consuming, which is why many applicants choose to have an attorney represent them in their claim.
Our attorneys have experience in dealing with ERISA insurance carriers and may be able to help you qualify for the benefits you have paid for. Your dedicated Texas ERISA attorney could discuss your situation and craft a plan to move forward with your claim. If you need help qualifying for these benefits, call an experienced legal advocate that could help.
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