Many companies provide disability insurance benefits for their employees. Disability insurance policies are supposed to pay benefits to disabled workers. However, both ERISA insurance policies and ERISA law are complicated. It is easy for disabled workers to make mistakes that may cost them some or all of their benefits. If you are applying for disability insurance benefits, follow the advice of our experienced ERISA long-term disability lawyers to avoid these common mistakes:
Mistake #1: You Don’t Understand the Terms and Conditions of Your Policy.
Before you apply for disability insurance benefits, you should request a copy of your Summary Plan Description (SPD) in writing. The SPD contains a lot of important information, including your plan’s:
- Definition of disability
- Specific filing deadlines
- What benefits you are entitled to
- How these benefits are calculated, and
- How long you can receive disability insurance benefits.
It is important to review the SPD before you file a claim. An early understanding of the policy’s terms and conditions will help you provide the right evidence and information to the insurance company. If it is clear that you do not qualify for benefits under your policy, you may want to delay your application.
Mistake #2: You Fail To Provide All Your Information to the Disability Insurance Company.
You probably won’t win your ERISA claim by simply filing out a couple of forms. To win a disability insurance claim, you must prove that you are unable to work. A successful disability claim typically contains a great deal of supporting evidence. Your evidence may include:
- Medical records that contain diagnoses and objective (or fact-based) findings;
- Functional assessments or detailed restrictions from your treating doctors; and
- Descriptions of your work history, education and skills.
While the insurance company will get some of your information and records, don’t expect it to get everything. You (or your ERISA long-term disability lawyer) should follow up with the insurance adjuster and help them get all of your supporting evidence.
Additionally, your doctor may be asked to complete forms, which may contain basic check boxes and ask for very general information. Sometimes, the insurance company discounts doctors’ opinions because they seem contradictory or vague. Don’t rely on these basic forms. Instead, sit down with your treating doctors and explain the requirements of your disability plan. If your doctors support your claim, ask them to write detailed letters that explain your diagnosis, restrictions and prognosis. It is better if your doctors provide detailed restrictions, rather than a vague statement that you are disabled.
Mistake #3: You Ignore Your Doctors’ Restrictions and Advice
Insurance companies are for-profit businesses and tend to be skeptical of most disability insurance claimants. The insurance company is looking for reasons to deny your benefits.
When you ignore your doctors’ restrictions and advice, you risk losing your disability insurance benefits. If your medical records (or surveillance footage) show that you are physically active, the insurance company may assume that you can work. You also may be labeled a malingerer or scammer. Additionally, if you refuse medical treatment (including physical therapy, medications and surgery), the insurance company may deny your benefits claim for non-compliance.
Remember, your doctors have assigned restrictions for a reason. If you ignore your work or activity restrictions, it may take you longer to heal or you may reinjure yourself. It is best to respect your body and your doctors’ advice.
Mistake #4: You Blindly Follow Your Employer or Insurance Adjuster’s Advice.
Your employer may support your claim for benefits, but it does not make the decision to approve or deny your claim. (That is the insurance company’s responsibility.) The support of your employer is not enough to win a disability insurance claim. Moreover, while your human resources representatives may be well intentioned, they are not ERISA experts. If you rely on the advice of an HR representative, you may get inaccurate advice.
Similarly, do not rely solely on the advice of your insurance adjuster or plan administrator. Your insurance adjuster works for the insurance company and is not necessarily on your side.
Mistake #5: You Overstate (or Understate) Your Functional Abilities.
The insurance company will send you forms and may schedule medical examinations during the disability claims process. These forms and examination reports will become an important part of the evidentiary record.
It is important that you provide accurate and up-to-date information when completing forms or when speaking with a medical professional. Disability insurance adjusters are skeptical of claimants. If your information is not consistent, your claim may be denied.
If you minimize your functional limitations, the insurance company will assume that you can work. Many disabled workers overstate their abilities on insurance forms and report activities and hobbies that they no longer can do. If you need breaks or lie down frequently, report this on your disability forms. On the other hand, if you exaggerate your symptoms, the insurance company will think that you are malingering. The best practice is to be honest and forthright.
Mistake #6: You Ignore Deadlines and Appointments.
Disability insurance claims typically have very strict time deadlines. These deadlines can vary from policy to policy. If you fail to complete a form or file an appeal, or if you skip a medical exam, your case may be denied. Check your SPD and insurance company correspondence for filing deadlines.
It is particularly important to file evidence (like medical records) on time. In ERISA claims, you need to file all of your evidence during the claims process and insurance company appeal. It is almost impossible to submit additional evidence once your case gets to the federal courts.
Mistake #7: You Wait Too Long to Hire an Experienced ERISA Long-Term Disability Attorney.
ERISA disability insurance claims are complicated. These claims typically require a detailed medical, vocational and legal analysis, and a small mountain of paperwork. They also involve strict filing and evidentiary deadlines. If you fail to meet all of these requirements, your claim will be denied. Your best course of action is reach out to an experienced ERISA long-term disability lawyer early in the application process to help you avoid common mistakes that lead to a denial of your claim or a delay in benefits. Call or email us today for a free consultation.
Title: Common Mistakes to Avoid When Applying for Disability Benefits Under an ERISA LTD Policy
Meta description: ERISA insurance policies and the benefits application process are complicated. ERISA long-term disability lawyer, David M. Hicks, can help you avoid seven common mistakes that may cost you some or all of your benefits.