Applying for Clarksburg ERISA Disability Insurance Benefits

If you have become disabled and unable to work, you may be eligible to receive benefits to make up for your lost income. Short-term disability benefits can provide some relief for a few months, and if the disability lasts longer, then long-term benefits could kick in.

Many people in Clarksburg have disability insurance provided by their employers, and if so, the federal law ERISA establishes some requirements for that insurance. Applying for Clarksburg ERISA disability insurance benefits can involve several steps. Because thorough documentation can be critical to the success of a case, workers often find it helpful to work with an experienced ERISA lawyer when filing a claim or appealing a denial.

Pay Attention to the Terms in the Policy

Although ERISA establishes guidelines for disability insurance offered by employers, the most critical provisions regarding applications for disability benefits are those contained in the insurance policy itself. It is a good idea to obtain a full copy of the policy and review the terms before filing an application for benefits.

The policy may specify the procedures for applying, including documentation requirements. A disability policy may also describe the definition of a qualifying disability. This definition is key. Applicants will need to demonstrate that they meet the standards before they can receive benefits to make up for lost income.

The Definition of Disability

Even the federal government uses several different standards for determining if an individual is considered “disabled.” Under the Americans with Disability Act, for example, an individual may qualify as disabled if they have “a physical or mental impairment that substantially limits one or more major life activities.” This definition is fairly vague and could apply to a number of conditions. By contrast, the definition used by the Social Security Administration (SSA) to determine eligibility for Social Security Disability Insurance (SSDI) is much more stringent. To qualify under the SSA definition, an applicant must suffer from a condition that prevents them from performing any type of gainful employment, and that condition must be expected to last at least a year or to result in death.

The terms within a particular disability policy will determine whether an applicant is eligible to receive benefits. Some policies may pay benefits when an applicant becomes unable to perform their current job, for example, without considering whether they can perform other work. An ERISA attorney could review the terms of a policy to help determine a Clarksburg applicant’s eligibility for disability insurance benefits.

When an Application is Denied

ERISA requires disability policies offered through an employer to provide a means to appeal a decision if the provider denies benefits. The appeals process will vary according to the terms of the policy.

Some policies provide two levels of reconsideration of a claim within the insurance company, while others may only provide one. ERISA requires an applicant to appeal a denial through administrative channels first. If this produces an unsatisfactory outcome, the applicant may file a lawsuit in federal court.

Seek Help with Your ERISA Disability Application from a Clarksburg Attorney

Sometimes, applying for Clarksburg ERISA disability insurance benefits can seem like a simple process. A claimant may be asked to fill out a few forms and submit paperwork from a doctor. However, what an insurer may not explain is that the answers and documentation provided will be closely scrutinized for certain information. If that information is lacking, the insurer will deny the claim.

Working with an experienced disability insurance attorney can help ensure that a claim contains the information necessary to document a disability adequately. If a claim is denied, it is important to obtain and submit proper documentation to receive a favorable outcome on appeal.