Long-term disability insurance pays a monthly disability benefit if you become sick or injured and cannot work. The majority of people who have disability insurance get their long term disability policy from work. A federal statute known as ERISA, the Employee Retirement Income Security Act, is the law that applies to the majority of long-term disability claims.
When you have a claim for long term disability benefits, the disability insurance company will want your medical records and ask that you complete disability forms or provide other information. Your doctors will also be asked to complete a form known as an Attending Physician Statement (APS). You may also be sent for a medical examination by the disability insurance company’s doctor and surveillance might be done to check your activity levels.
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What Is Long Term Disability?
It is important to understand the terms of your disability insurance policy if you have a disability claim. The typical long-term disability policy defines disability to mean you are unable to work in your “own occupation” for the first 24 months. After 24 months, you have to prove you are disabled from working in “any occupation.” The majority of disability benefits that are terminated by disability insurance companies occur around this time.
Many disability policies also limit payment of disability benefits due to a mental health condition to 24 months. This is called a mental health limitation. Depression, anxiety, bipolar disorder, and PTSD are some of the mental health conditions that have this limited payment period. Insurance companies sometimes ignore that there is also a physical condition that causes the person not to be able to work in order to limit the time during which someone can receive disability benefits.
What Does Total Disability Mean?
Under ERISA law, the ability to work in Any Occupation requires sitting at least 6 hours in total out of an 8-hour workday. That includes breaks as needed. The remaining 2 hours require the ability to walk or stand. There are other requirements under ERISA, but sitting for 6 hours is the most important when dealing with an Any Occupation disability claim review.
Any occupation does not mean any job whatsoever. The insurance company must take into consideration your past training, education, and experience when evaluating whether there is another occupation in which you can actually work.
The insurance company will conduct a review of your medical records or examinations by their doctors. Then based on that review, they may do a vocational review or transferable skills assessment to identify other potential jobs they believe you could perform.
Disability benefits claims are reviewed periodically and disability benefits can be terminated at any time. However, most long term disability benefits are terminated because of the “Any Occupation review.”
For this reason, it is important to speak with your doctors ahead of time so they are aware the standard for disability has changed. You will want to make sure your doctors understand that you are now required to be disabled from any occupation.
Denied Disability Benefits: What's Next?
If you have been denied disability benefits, it's crucial to take the appropriate steps to protect your rights and pursue the benefits you deserve. Here's a guide on what to do next:
Filing an Appeal
The first course of action in an ERISA disability benefits claim is to file an appeal. Typically, after receiving a denial or termination, you have 180 days to submit your appeal. This is a critical opportunity to present additional evidence in support of your claim.
During the appeal process, you need to address and challenge the reasons provided by the disability insurance company for their denial or termination. It's essential to include all relevant medical records and any supportive information from your doctors that strengthen your case.
Working with an experienced Miami long-term disability insurance attorney can greatly assist in determining the most compelling evidence to include in your appeal. They can also identify any potential violations or irregularities in the disability insurance company's handling of your claim.
If Your Appeal is Denied
In the event that your appeal is denied, you may have the option to pursue a second appeal. However, it is more likely that your next step will involve filing a lawsuit in federal court. It is highly recommended to engage the services of an attorney during this stage, as federal ERISA litigation involves intricate rules that must be strictly followed. Even a minor mistake could jeopardize your claim.
Having an attorney by your side provides several advantages. They will have a comprehensive understanding of the complex federal ERISA laws, ensuring that your case is properly presented and argued. They will work diligently to protect your rights, gather additional evidence if necessary, and navigate the legal procedures skillfully.
By enlisting the support of a knowledgeable ERISA attorney in Miami, you enhance your chances of securing the disability benefits you rightfully deserve.
Get Help Identifying Your Options
ERISA gives certain rights to people who have disability claims. ERISA also gives many advantages to disability insurance companies. The long-term disability lawyers in our firm are experienced with disability insurance claims and ERISA.
Our lawyers can help with the initial disability claim, appeal a denied disability claim, and file a lawsuit for disability benefits. Dabdoub Law Firm is proud to help people nationwide.