The policies determining your long-term disability (LTD) benefits from your employer are regulated by federal ERISA (Employee Retirement Income Security Act) laws. Under this system, your applications for disability are assessed by your company’s insurance company. This setup can create, in some cases, a conflict of interest that can lead to a claim denial, despite ample evidence to the contrary.
How LTDs are approved
An LTD is supposed to protect employees from income loss following a medical event, injury or accident. A medical condition that calls for long-term disability could take years to resolve if that is a possibility at all. Here are three forms of documentation that can support a disability claim or appeal under ERISA:
- Your medical diagnosis: A physician’s recorded statements recording your condition are of paramount importance in a long-term disability claim. Often these statements are not recorded by insurers in an attempt to deny your claim. You must request a report by the physician(s) who diagnosed your condition, as well as those practices where you continue to receive treatment. The opinion of multiple doctors may be necessary in some cases.
- Medical records: You need a record of your regular appointments for medical treatment for the condition that is the cause of your disability claim. The insurer will look for visits to medical providers and specialists that recur at higher frequencies. These visits should include some evidence of your medical condition in the form of blood tests, CT scans, EKGs, MRIs, etc. For psychiatric treatment, you need to document your regular visits to mental health providers such as psychologists and psychiatrists.
- Insurer oversight: You need to ask your insurance for the kinds of information they collected regarding your case so you can inform them if their data is incomplete or inaccurate. This oversight can be a tiresome process, but it is a necessary function.
Dealing with a claim’s rejection
A severe injury or medical condition can be financially devastating to the disabled person. Sadly, refusals are all too common for LTD benefits claims. Though ERISA laws are federally regulated, a Louisiana attorney will have a better understanding of the trends in how local employers and insurers handle these cases. Whether you’re ready to make your long-term disability claim or appeal a denial of coverage, an attorney with experience in how ERISA laws apply to disability claims can guide you through this challenging process and fight for the coverage you deserve.