If you are unable to work, you may qualify for long-term disability (LTD) benefits under your employer’s Employment Retirement Income Security Act (ERISA) plan. An ERISA LTD plan can provide you with financial security while you are unable to work due to a serious medical condition. Your employer and/or insurance company should provide you with an application and all necessary information to apply for LTD benefits.
An ERISA LTD application can be complex and may require significant details regarding your medical conditions. Although your employer does not have a legal right to details regarding your medical condition, the insurance company that may be providing you with LTD benefits can request certification of your conditions. It is your responsibility to complete all application materials and to provide medical proof of your condition. However, in doing so, there are many issues that can raise red flags that will cause your insurance company to investigate further or request additional information.
When completing the application, avoid these common mistakes:
- Missing deadlines. Your employer and the insurance company will have deadlines by which you must notify them of your medical condition and submit your application and supporting information. Do not miss those deadlines. Make sure your medical provider knows that you need supporting medical information by a specific date. If you cannot meet a deadline, contact your employer or insurance company and make sure they know the information is on its way.
- Failing to keep copies of documents and medical records. You will submit multiple documents related to your LTD application and supporting medical information. You will also have to obtain medical records and provide copies to your insurance company. You may also have to submit to a disability evaluation by your medical provider or an independent provider. You should keep copies of everything you give to the insurance company and all correspondence you receive from them.
- Choosing the wrong last date worked (LDW). Your insurance company will need to know the last day you worked in order to begin processing your LTD claim. You must have evidence from your employer and your medical provider regarding your LDW. Your employer should provide information about when you became unable to perform the essential duties of your job, and your medical provider should offer information about when your condition became so serious that you were unable to work. Those dates should coincide. If they do not, your insurance company may inquire further and may even deny your claim.
- Only providing documentation on forms provided by the insurance company. Although your insurance company will provide you with forms to document your disability, you should also provide medical records, test results, and any other medical documentation that proves you have a serious medical condition and are unable to work. The insurance company forms don’t provide much space for you to describe your condition. You’ll need to attach additional sheets to provide an adequate description. The more information you provide, the more likely you are to be approved for benefits.
- Relying on advice from your human resources department. Although your human resources department can help you when applying for LTD benefits, you should know your rights and responsibilities according to the insurance company. Human resources personnel are not experts on the law or on insurance policies. Legally, your insurance company must tell you your rights and responsibilities. Make sure you review what you need to do in order to meet those responsibilities.
- Participating in activities that your doctor prohibited. If your doctor gives you restrictions for physical or mental activities, you must abide by those restrictions both at work and in your personal life. If you take part in recreational activities that appear inconsistent with your work impairments, you may be denied benefits. Insurers look for evidence of such activities on social media or through surveillance. .
- Failing to seek legal help quickly. If you apply for LTD benefits and are denied, you should immediately seek the assistance of a disability attorney to represent you in an administrative appeal. Don’t wait until your next step is federal court. Better yet, get an attorney involved before you apply. Your chances of success dramatically improve if you submit a thorough, timely, and professionally prepared application. Making an ERISA LTD application may seem straightforward, but it’s easy to make errors that can result in denial of a deserving claim. The application can be complex and the medical information needed to prove that you are disabled may be confusing. Our experienced ERISA disability attorneys can help you at every step of the process. We will help you complete an application and answer any questions you have about your rights and responsibilities.
Our Georgia insurance firm has an impressive 95 percent success rate in recovering benefits on individual and ERISA disability claims, and we have recovered in excess of 50 million dollars in claims for our clients after an initial denial by their insurer. Call us today for a free case evaluation and to learn how we can help.