ERISA (Employee Retirement Income Security Act) disability benefits can be a much-needed source of financial support if you become too disabled to work. Unfortunately, these benefits are so strictly regulated that it can be immensely challenging getting your claim approved. Here are just a few things you should know about ERISA disability claims to help you make the best decisions in your case.
There is a Waiting Period
If you want to submit a claim for long-term disability benefits under ERISA, you will typically have to wait out what is called an elimination period. This time period will last anywhere from 3 to 6 months based on whether you have short-term disability and what it says in your policy. Additionally, your provider will typically require you to use up all of your sick days and similar time-off benefits before you can file for long-term disability.
There are a couple of reasons benefit providers enact this waiting period. First, they want policyholders to use up other available resources before they have to pay out. Second, they want to make sure your disability is—in fact—a long-term condition. If your health issue clears up during the waiting period, you become ineligible for payment.
Your Legal Options are Limited
Like any other disability benefit, there is a chance your claim will be denied for any number of reasons, including failing to submit the right paperwork. The trouble is the appeals process is not very friendly to claimants. You must file the appeal by the deadline specified by ERISA and the insurance company gets to say whether or not your appeal is approved. Unfortunately, if your appeal is denied, you don't get any more chances. You must file a lawsuit with the court if you want to continue pursuing benefits.
However, even your court case will be challenging to litigate. This is because ERISA rules limit what judges can see. In particular, the judge will only consider the information contained in your insurance file. This is why you must submit as much data about your condition and other relevant issues to the insurance company as possible. If you don't, the judge may consult with the insurance company to fill in the blanks, which can hurt your case to say the least.
You May Be Put Under Surveillance
Perhaps a more unsettling issue with ERISA disability benefits is the insurance company may put you under surveillance. The company may claim this is to help fight fraud. However, an additional motive is to find reason to deny your claim. You're more likely to be the subject of undercover surveillance if you suffer from conditions that don't manifest in a physically obvious way (e.g. fibromyalgia) or you are suffering from a psychological disability.
Typically the surveillance will be conducted by a private investigator who will take pictures and video of you while you go about your day. However, the investigator may also interact actually with you if he or she believes that may uncover additional information the company can use against you.
This is why it's critical you follow your doctor's instructions and avoid participating in prohibited activities. Additionally, be wary of odd interactions with people you don't know and talk to you family about discussing your private information with strangers who may approach them.
Winning an ERISA disability claim can be challenging. Your best option for success is to hire an attorney who has experience handling these types of disability claims. He or she can help you navigate the process to obtain the outcome you want. For more information about these and other ERISA issues, contact services like Iler and Iler.
