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Ensuring your ERISA LTD application makes the grade

| Aug 12, 2020 | Long Term Disability Claim Denial

Today’s blog post headline might reasonably strike some readers as objectionable in the sense that it arguably implies a test of sorts and hurdle to clear for an applicant filing for ERISA long-term disability benefits.

After all, an applicant is not a supplicant seeking favor from an insurer having a 100% unilateral – and final – say concerning an application’s fate. A disabled individual calling upon an insurer to contractually act in response to a claim needn’t have Hemingway’s chops or convey a disability narrative in mesmerizing detail.

Rather, his or her duty is to present the facts as best as possible to an entity obliged to evaluate and act upon them in good faith. Insurers do not command unfettered discretion when deciding LTD claims. They must duly consider submitted evidence and render a decision fairly based upon it. Their decisions can be challenged and appealed when they stray from that standard.

Still, it bears noting that some LTD applications sail and that others flatly flounder. An individual need not present a claim in best-seller fashion, but there is certainly much that he or she can do to promote its likely success.

Like be comprehensive and error-free, for starters. An in-depth online overview of what a claimant should reasonably know concerning an ERISA LTD application underscores that “making a mistake in the process could jeopardize your ability to obtain benefits.”

Common errors ERISA LTD claimants make in applications

The above primer spotlights a number of factors that commonly render LTD applications deficient and result in claimants being deemed ineligible to receive benefits. Here are a few prominent inclusions:

  • Assuming you’re a slam-dunk certainty to qualify for benefits in the stated view of your employer (management’s opinion might seem important, but it has no weight in ascertaining eligibility based on policy terms and conditions)
  • Being too skeletal in providing supportive medical information (e.g., submitting an application that is missing key data and could stand an infusion of materially detailed information from one or more medical providers)
  • Documented evidence showing participation in activities that reasonably undermine a disability claim (the above overview notes that “the insurance company will be watching your activities”)
  • Securing help from legal counsel who lacks specialized knowledge and training in ERISA matters ranging from processes and deadlines to denials and appeals

That last bullet point merits special mention. The article cited herein duly stresses that ERISA “is a complicated law” that requires close and timely – and often sustained – input from an attorney team with a demonstrated record of advocacy in LTD matters.

The bottom line with an LTD application: Take pains to get it right in all relevant particulars. An experienced ERISA attorney can help ensure that you do.