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5 mistakes that jeopardize ERISA disability claims

On Behalf of | Aug 15, 2022 | Erisa

Long-term illnesses and injuries create tremendous physical and mental anguish for millions of American workers. Financial harm can also result when a person cannot work due to a health condition beyond their control.

Many rely on long-term disability to relieve some of the economic burdens when an employer-sponsored Employee Retirement Income Security (ERISA) plan covers their injury or illness. But too often, receiving benefits is challenging and frustrating.

Avoid these common ERISA errors

When most people start a new job, they don’t look at the fine print for employer-sponsored disability benefits. It’s only when an accident or illness occurs that they look into whether their condition is included under their employer’s plan. Many rely on the advice of their employer when filing for benefits. But it’s crucial to understand that insurance companies, not employers, administer plans and look for any reason to deny benefits. So, what can you do to protect yourself? Here are a few common mistakes:

Not complying with deadlines

Dates are crucial when applying for long-term disability. You have a certain amount of time to notify your employer and respond to insurer requests to supply evidence of your injury or illness. Missing any deadline can put your claim at risk.

Not supplying adequate medical evidence

You must provide detailed medical information describing your condition and how it impacts your ability to do your job. Just filling out the insurer’s claim form with symptoms and a general diagnosis will not be sufficient. Detailed treatment records, test results and comprehensive explanations from doctors on the provider’s letterhead are necessary.

Ignoring your doctor’s advice

Insurance companies don’t make massive profits by taking people at their word. They will watch you. If they find you are doing something your doctor says you shouldn’t or can’t do, they’ll likely take quick action. If you receive a letter asking you to log your activities, you can bet they are suspicious. That’s why it is vital to your claim to follow your doctor’s orders to the letter.

Social media red flags

Facebook, Instagram and TikTok are convenient resources for insurers, and employers, to monitor your actions. Posting anything that contradicts your injuries or conflicts with your treatment plan can be used as evidence against you to deny benefits.

Not seeking legal advice from ERISA attorneys

In some cases, attorneys working for the insurer will offer to help you fill out your application. Resist this offer as they may try to steer you toward choosing disabilities that are harder to prove. Also, it’s advisable to avoid working with lawyers without experience in ERISA claims. The rules, deadlines and appeals processes are complicated. Experienced ERISA attorneys understand this complex system and the requirements for submitting successful claims.