To start the ERISA filing process, you must file a claim through the ERISA-governed long-term disability program that your employer provides. ERISA establishes specific rules for insurance companies regarding when they must make decisions concerning employee claims and what rights employees have to appeal any denial.
As a rule, long-term disability plans require you to endure a waiting period before filing a claim for benefits. As such, it may be essential for you to understand when to file an ERISA long-term disability claim in Louisiana to give yourself the best possible chance for success.
Long-term disability insurance plans are designed to provide people with emergency income when they can no longer work because of a disabling injury or illness. This condition can be either physical or mental in nature. Under these plans, a person does not need to be totally disabled, but rather must no longer be able to perform the job that provided the plan.
In order to receive benefits, it is essential for injured workers to seek out immediate medical care for their condition from a licensed medical professional. A large portion of the application process for ERISA benefits is medical verification of the supposed disabling condition. Furthermore, benefit recipients should continue to visit their doctor for the length of their disability, as the insurance provider has the right to request a recertification of the condition at any time.
A long-term disability plan is exactly that: a plan providing income for a long-term disability. For this reason, all plans incorporate an exclusion period following the onset of a condition. A potential applicant must wait out this period before filing a claim.
For instance, a worker may suffer a stroke while at home that leaves them unable to perform their job duties as a roofer. Even though the injury is a clear example of a debilitating condition, there is a chance that they could make a recovery. Therefore, this person must wait out their plan’s exclusion period before filing a claim.
This exclusion period typically differs on a plan-by-plan basis. However, in general this period lasts between three and six months. It is important for each individual claimant to read through their plan’s statement of benefits and terms to understand when their eligibility for benefits begins.
Long-term disability benefit programs are run by insurance companies, who to a large extent make their profits by denying claims whenever possible. One way that they do this is by using lengthy exclusion periods that you must wait through before claiming benefits.
In addition, you must have a condition that remains constant through this waiting period with no substantial improvement. While this condition can be either physical or mental, you should maintain constant contact with your doctors to verify the disability.
An experienced lawyer could help you understand the language in your company’s insurance plan. Contact an attorney today to discuss this and other aspects of when to file an ERISA long-term disability claim in Louisiana.
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