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Qualifying for ERISA

The Next Steps Are Critical. As A Former Insurance Company Attorney/insider, I’ll Personally Guide You Through Those Steps And Around Common Pitfalls

Before You Hire Any Attorney, Let Me At Least Do This For You (Free Of Charge):

  • 1 Review Your Denial Letter;
  • 2 Discuss the denial and insurance company tactics in your case with you by phone; and
  • 3 Give you a written step-by-step plan to fight your denial.

Call me or fill out the contact form to get started today.

You can use the plan continue your fight alone, or share it with any other attorney you wish.

Or if you decide you want me to fight for you, no office visit is needed, and you pay nothing – no fee, no costs -- unless we recover.

Listen About Long Term Disability

Qualifying for ERISA

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 Law and Employee Benefit Plans?

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.

ERISA Restrictions on Claiming Long Term Disability 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.

Claiming Long Term Disability Benefits for Injuries or Illnesses

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.

Talk to a Long Term Disability Insurance Attorney About ERISA Benefits Today

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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10455 Jefferson Hwy,
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Baton Rouge, LA 70809
Phone: (225) 201-8311
Fax: (225) 201-8313
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Metairie, LA 70002
Phone: (504) 458-8455
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363 N Sam Houston Pkwy E
Ste 1100 PMB, #114
Houston, TX 77060
Phone: (713) 439-0339
Fax: (225) 201-8313
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