An employer-sponsored ERISA (Employee Retirement Income Security Act) plan allows you to apply for long-term benefits in the event that you become disabled and are unable to work. However, applying for benefits under ERISA can be a challenging process where a mistake could lead to longer approval times or even a denial. Here are 5 mistakes that you should steer clear of when making your ERISA disability claim.
Assuming That Your Employer's Opinion Is Enough to Justify a Claim
Your employer's opinion regarding your ability to work is just that - an opinion. When it comes to determining whether or not you meet all of the necessary requirements to qualify for ERISA benefits, it'll be your employer's insurance company, not the employer, who'll make that determination.
Keep in mind that the legal criterion for disability often varies among insurance companies. It's always a good idea to check the insurance company's policy for its definition of disability, as well as other requirements for benefit eligibility.
Also, you should avoid the temptation of listening to your company's human resources department when it comes to advice on your ERISA disability claim. Most HR departments are simply not trained in insurance matters, plus any advice offered may jeopardize your disability claim.
Performing Activities Prohibited by Your Doctor
If your doctor tells you to refrain from performing certain strenuous activities, such as kayaking, biking or lifting heavy objects, then you shouldn't do those things. Although your doctor might not keep close tabs on your activities, you can definitely be certain that the insurance company will.
As personal injury attorney Pete James explains, insurance companies may hire a private detective to monitor your activities, especially if the claim involves a specific disability. Insurers often do this to ensure that there's no ongoing fraud.
Documenting Your Disability Claim Using Only the Insurance Company's Forms
Although the insurance company will provide forms you can use to document your disability claim, this may not be enough to offer a substantial and concrete claim that'll be approved with little hassle and few delays. In most cases, you'll need more information than what can be provided on the insurance company's forms in order to explain and solidify your claim.
In addition to filling out the forms provided by the insurance company, you should also have your doctor make a report that provides a complete and thorough explanation of how your condition or illness prevents you from performing your work duties. Some doctors may do this free of charge, while others may request a reasonable fee. Either way, it's important to have this crucial documentation on hand if you want your disability claim to go forward.
Working With an Attorney Who's Not Well-Versed in ERISA Law
When it comes to your ERISA claim, you want an attorney who understands all of the intricacies of the process, from the evidence that's needed to push your claim forward to the deadlines for submitting evidence and other information. Working with an attorney who is relatively inexperienced when it comes to this complex process is definitely a big mistake that should be avoided at all costs.
Allowing the Insurance Company's Attorneys to Help You Apply for Social Security Benefits
Under most circumstances, you are required to file for Social Security benefits after receiving long-term disability benefits under ERISA. This is so that the amount you receive from Social Security is offset against your monthly long-term disability payment. The attorneys representing the insurance company may offer to assist you in filing for Social Security benefits. However, that helping hand could prove harmful in the long run.
It's not uncommon for those attorneys to make selections and even introduce mistakes in the application process that make it more difficult for you to prove your long-term disability claim. In short, you're better off using your own attorney to assist you with the application process.
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