Many companies provide long-term disability insurance as a perk to incentivize people to work there. However, not every employee will qualify for these programs, as qualifying recipients must meet specific criteria to collect benefits after suffering an injury or illness that keeps them out of work.
Qualifying for ERISA long term disability insurance can often be complex. Fortunately, a skilled disability insurance attorney could help you understand the language in your policy and determine if your specific situation qualifies for coverage.
ERISA, also known as the Employee Retirement Income Security Act of 1974, is a federal law that governs the way employer-provided benefit plans must be administered. As a simple rule, ERISA applies to any employer-provided benefit plan. Naturally, this includes any long-term disability plan.
In the same vein, ERISA places certain restrictions upon when a person can qualify for benefits under these plans. A basic understanding of ERISA, when combined with a close reading of an individual insurance policy, could help potential claimants determine whether they qualify for long-term disability insurance benefits.
Most individually controlled long-term disability plans can provide coverage for any sort of disability for any given period of time. However, ERISA-controlled plans place strict limits on disabilities for mental conditions. In many cases, plan holders can only claim benefits for a maximum of two years if they cannot work due to an emotional disability.
Perhaps the most important difference between these two types of plans is how holders can contest denials of claims. Individually controlled plans are simple contracts that allow people to file claims in court to demand enforcement. ERISA plans, on the other hand, require people to exhaust all their insurance company’s internal appeals processes before taking a case to court.
In general, a person seeking to claim disability benefits must suffer an injury or illness that prevents them from doing their job. This can be either a physical injury such as a broken back, or a mental condition such as severe depression. In any event, this person must obtain legitimate medical records from accredited doctors that verify these conditions and continue to visit these doctors throughout the term of disability.
Many plans also require disabled workers to seek SSI or SSDI benefits during their term of disability. These payments can help offset the financial burden on the insurance company, and the application process also serves to verify the extent of the worker’s disability.
Finally, most plans employ an exclusion period during which a worker must wait to collect benefits. These periods can range from three to six months in length and are intended to give people with a temporary condition time to make a recovery without placing any burden on the insurance provider.
Whether or not you qualify for a long-term disability program governed by ERISA is determined by both the extent of your injuries and how long you are expected to be out of work. In short, you must have a condition that prevents you from doing your old job that has lasted at least one month. In some cases, this exclusion period may be as many as 180 days.
An attorney could help you interpret the language in your employer-provided long-term disability plan and determine if what aspects of that policy apply to your situation. In cases where you and the insurance company disagree as to whether benefits should be issued, a dedicated lawyer could help you file the appropriate appeals. To find out more about qualifying for ERISA long-term disability insurance, schedule a consultation today.
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