Hello, I'm Karla Mitchell. Going through a legal case can be very expensive and challenging. I won't go into details, but I recently underwent my own legal battle that lasted several years. It is finally over and I successfully received a settlement, but I had to spend so much time studying law in order to play my role in my own court case. While I found a great attorney at one point, I felt completely lost initially and I don't want anyone else to experience the same thing. So I decided to create this blog for those who would like to know more about law.
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If you have an employer-provided disability plan and you are suddenly unable to work, you may need to apply for ERISA benefits (Employee Retirement Income Security Act). Also known as long-term disability (LTD), these benefits can provide for you and your family should you become disabled. But knowing what to expect can keep you from being totally blindsided, or worse, denied altogether. Here are six things you should know before filing for ERISA disability.
Your Policy's Definition of "Disability"
Have a look at your policy, and make sure you know how it defines the term "disability." Some LTD policies have a rather broad definition, saying that you meet the criteria if you are unable to perform the job duties of any occupation. Other policies will only cover you if you are considered unable to perform your current job duties.
Alternatively, some might have a stipulation that if you receive disability benefits for a certain length of time, then the definition of "disability" will change from being unable to perform your current job to being unable to perform any job. Depending on your condition, this could result in a termination of benefits after this length of time.
Waiting Period
Most plans have a waiting period between the time that you are considered disabled and when you can start receiving benefits. This is called the "elimination period," and it varies from policy to policy. Most employees are given a choice of 30-, 60-, or 90-day elimination periods, with most people opting for the 90-day option since it's the cheapest. Rest assured that, in most cases, you should be eligible to receive short-term disability. And this elimination period is typically over once your short-term disability expires.
If you have sick time, you generally have to use all that up, as well as your short-term disability benefits, before you can file for ERISA.
ERISA Benefits and SSDI
If you are approved for long-term disability, you will more than likely be required by the insurance company to file for Social Security Disability Insurance (SSDI). Once you're approved for SSDI income, your long-term disability payments will be offset by whatever the amount is. Some insurance companies are so proactive in making sure you get approved for SSDI that they will provide you with an attorney to help with your case. Obviously, they benefit financially because the more you make in SSDI, the less they have to pay.
ERISA Benefits Approval
Whether you are approved for LTD will depend on the insurance company, not a government entity. As a result, a lot of people are initially denied. Fortunately, every policy is required to provide the employee with an appeals process. If your appeal is also denied, then you can take your case to federal court. Once in court, a non-biased judge will make a final ruling.
It's important to note that once your case goes to court, you cannot bring forth any new evidence of your existing disability. That's why it's so important to have an attorney knowledgeable on ERISA laws. That way, if any new medical conditions do arise with your disability, your attorney can help you file an appeal in federal court.
Special Rule for Mental Illness
If you become disabled due to depression, anxiety, bipolar disorder, alcoholism, or drug addiction, your LTD will be limited to 24 months. These are conditions that are diagnosed based on patient-reported symptoms and cannot be medically confirmed with x-rays and other scanning devices, blood work, or through clinical observation. It's important to talk with an attorney about what kinds of medical evaluations and paperwork you'll need to have in order to prove your case.
Undercover Investigators
It might seem like something out of Hollywood, but some insurance companies do hire investigators to monitor your activities. If your condition forbids you from lifting more than 10 pounds, then don't try to be a hero carrying ten bags of groceries at once into your home, even if you think you can handle it. If you've been advised not to drive, then take the bus or call a cab. It's just not worth getting caught, even if you're feeling your best.
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