The Employee Retirement Income Security Act (ERISA) is designed to protect the rights of employees who have pension plans. While it primarily focuses on retirement, it also has provisions that affect disability plans offered to employees.
Unfortunately, many employees find out only after they end up with a disabling condition that the "perk" their employer offered in the form of a pension and disability plan was more of a polite fiction than a reality. If you're about to file for disability benefits through your employer's long-term disability (LTD) plan, here are some important things to know.
1.) You need to read your plan's definition of disability very carefully.
A lot rides on exactly how your employer's LTD plan defines the term "disability." For example, it may use the same definition that Social Security does, which means that you have to be unable from doing any substantial gainful activity in any occupation. That could come as a big shock if you were expecting it to kick in if you were unable to do just your own job or something fairly similar.
2.) You need to look at term limits on your disability benefits.
If your LTD plan does allow the "own occupation" definition of disability, it's likely to do so only for a certain period of time. You may be given a year or two, at most, before the broader definition kicks in. The logic is that (assuming you're capable of some sort of work) you should use the time under the "own occupation" standard to find another occupation or go through training somewhere so that you can get back to work. if you're not expecting to be cut off, or not expecting to have to suddenly prove the severity of your disability, that time limit could come as a disastrous shock down the road.
3.) You need to find out if you are required to file for other programs.
Many LTD benefits will require you to file for Supplemental Security Income, a needs-based disability program administered by Social Security, as well as Social Security disability benefits. If you don't meet the qualifications, you may be required to file an appeal. It's important to know, in advance, what rules you'll be asked to comply with so that you can do what you need to do and not have your benefits denied or terminated over a technicality.
4.) You can't count on your employer or human resource department's advice.
Neither your employer nor your human resource department makes the decisions about your LTD benefits—that's solely up to the insurance company. Your employer may have clearly conveyed that he or she knows you can't continue working and human resources may have been totally understanding and great to work with, but they don't approve or deny your claim. On the other hand, having your employer's support may come in handy if you need to get documentation that your job is beyond your current physical capabilities to perform.
5.) You need your doctor to understand what the insurance company is wanting in order to approve you.
People often feel very awkward talking to their doctor about disability claims. Sometimes they feel like the doctor may judge them for being weak or secretly think that they're capable of working if they really want to work. However, if you have a real disability, you shouldn't feel awkward discussing the situation with your doctor. Explain what you do and why your disability is stopping you from doing it. Your doctor may be surprisingly able to understand the importance of filling out the insurance forms or sending a letter with the right language to help you get approved. And, your doctor is likely to be supportive—most professionals like doctors and lawyers have LTD plans of their own, just in case they become disabled, so they may have more sympathy for you than you realize.
If you do have problems (or even suspect that you're about to) with your LTD plan, talk to an attorney who handles ERISA claims. ERISA is a complex set of rules and an attorney who is familiar with the pitfalls can keep you from missing important deadlines or missing a chance to provide evidence that's essential to your case, but it may end up keeping you from being denied the LTD benefits you deserve. Continue reading more.