Employer Sponsored Disability Benefits – What You Should Know Before Filing a Claim
When you are hired, your employer may offer a group disability plan for short term and/or long term disability benefits. These plans provide income replacement benefits if you are injured or sick and unable to work. The plans are governed by ERISA which is the Employment Retirement Income Security Act, a Federal Act. Under ERISA there are complex rules and regulations that apply to both the Plan Administrator and the Claimant. For these reasons it is imperative to have an attorney to help you navigate the numerous and complex regulations.
Definitions
To seek benefits under a disability plan you must meet the definition of disability stated in the plan. In most instances the plan will state that you must have an injury or a sickness which precludes you from performing the material duties of your regular occupation. Also, for the purposes of long term disability benefits, there will be an elimination period during which you may be eligible for continued salary or short term disability benefits until you meet this condition. The elimination period is usually 90 or 180 days during which you must be continuously disabled.
Furthermore, the term regular occupation in the plan may be defined either as the occupation you are performing for your employer, or your occupation as it is generally performed in the national economy. This could make a difference in determining if you qualify for benefits. The plan may also call for a definition change after 24 months from regular occupation to any occupation. Such group plans generally include a limited period of benefits for disabilities caused by mental health conditions or certain specified conditions such as musculoskeletal disorders or chronic fatigue.
Proof of Claim
To seek disability benefits you must follow the claims procedures in the plan. It is your responsibility to provide the insurance carrier with proof of your disability. The insurance carrier will not obtain this evidence for you. It is necessary for you to secure copies of all your relevant medical records. Further, your physician must complete a statement documenting your functional restrictions and limitations which preclude you from working. It is not satisfactory for the physician to merely comment that you are disabled and unable to work. Rather, it is imperative that your physician document any functional physical or mental health conditions that restrict you from performing the material duties of your own job and/or any job.
The claims procedures also provide time limitations for the insurance carrier to review your claim and issue a decision. During its review, the insurance carrier may seek an independent medical review of your records or refer you to a physician for an independent medical evaluation.
Legal Assistance
The disability claims process is complex and may be overwhelming. In addition to the challenges that you are facing with your medical condition and financial constraints, you may experience stress and the emotional toll of trying to gather the necessary paperwork for the insurance claim. For these reasons it is critical that you seek legal assistance to help you with the disability claims process. An experienced attorney, such as the attorneys with Steinhardt, Siskind and Lieberman, can assist you with preparing the pertinent documentation to support your claim for disability benefits. It is also critical to provide all necessary information to the insurance carrier to support your claim either during the initial application process, or the appeals process. Once the insurance carrier issues a final decision on your claim, then your record is closed, and you may be precluded from introducing any new evidence if your case goes to court.
Attorney’s Fees/Representation
In most instances the Law Firm of Steinhardt, Siskind and Lieberman will accept a disability benefits case on a contingency basis. This means that you will not have to pay any fees in advance and our firm will only get paid if you obtain a recovery from the insurance carrier either through the approval of your benefits or a settlement. Our firm offers free initial consultations. We can be reached by phone at 410-766-7630 or through our website at www.steinhardtlawfirm.com. We look forward to hearing from you to discuss your disability benefits claim.