Important Things to Know When Filing an LTD ERISA Claim

If you have filed a disability insurance claim, a claims adjuster will investigate and look for reasons to limit or deny your benefits. Because of this investigation, your long-term disability (LTD) application must include more than your completed forms. Your claim must include detailed evidence that documents your medical conditions, identifies your limitations, and demonstrates that you meet your policy’s definition of disability. Also, you must show that you have one of the conditions that qualify for LTD in the United States. Assembling evidence of your disability can be challenging but you have more peace of mind if you have an LTD attorney on your side. 

How Disability is Defined by ERISA Plans

Disability is defined differently in long-term and short-term disability insurance plans. Your medical condition or injury should prevent you from performing your current job. Also, you can’t do any work within the national economy because of your health problems. Some plans describe it as an illness, injury, or chronic condition that limits your ability to do your job. Your attorney can review your LTD policy before you apply for disability insurance benefits. They can interpret the terms and conditions of your plan to ensure the validity of your claim. 

Kinds of Evidence You Must Present

If you apply for an LTD claim, you will fill out a form that lets you provide your medical condition, the contact information of your doctors and providers, and information on why you can’t work. But, this is just the start of your LTD claim. You can expect the insurance provider to ask you to sign medical releases and fill out even more forms. They will try to settle your case before they can have all the records from your treating doctors. This is the reason you should hire a lawyer as soon as possible to collect evidence for you such as medical records, diagnostic studies, detailed statements from your medical providers regarding your condition, a resume that outlines your education, training, and work experience, functional capacity evaluations, and others. 

When to Submit Evidence 

ERISA (Employee Retirement Income Security Act of 1974) is a federal law that controls a lot of employer-funded benefit plans, including LTD benefits. This law is not easy to navigate and an ERISA disability claim involves different stages. You need to provide evidence during the application and administrative appeal stage. Often, the federal court won’t consider additional evidence. Thus, you must work with an attorney early on in the LTD claim. 

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