ERISA Experience You Can Rely On.

Testing can help provide evidence for an ERISA appeal

On Behalf of | Feb 20, 2024 | Erisa

Someone who has filed a claim for long-term disability insurance likely expects a simple claims process. However, sometimes people who cannot work because of medical issues have a hard time getting the benefits they need.

Even when someone has disability coverage provided through an employer, they may not receive approval when they initially claim benefits. Thankfully, disability insurance coverage provided as part of an employment package is subject to rules established in the Employee Retirement Income Security Act of 19874 (ERISA).

One of the most important ERISA protections for those denied disability benefits is the right to appeal that decision. Undergoing specialized medical testing could help someone gather evidence for their appeal.

An applicant needs proof of their disability

Simply having a diagnosis with a specific medical condition does not automatically entitle someone to long-term disability insurance benefits. The same condition can have significantly different consequences for two patients in different situations. Therefore, an applicant needs more than just diagnostic records.

They typically also need thorough medical records establishing how their condition affects their daily life and ability to work. Adults in California may want to undergo a functional capacity evaluation or similar in-depth medical examination as they prepare to appeal a denied ERISA long-term disability benefits claim.

Such evaluations involved three to four hours of clinical testing during which a specially-trained medical professional evaluates the extent of someone’s injury. The professional performs tests and documents how someone’s condition could limit their independent living ability or the work that they could perform for an employer.

The results of such testing can help convince insurance providers of the severity of someone’s condition. Gathering the right evidence is an important component of a successful appeal for denied long-term disability benefits. Seeking legal guidance from a law firm that has experience in these kinds of cases is a good way to get started in informed, supported ways.