Qualifying for Long-Term Disability Insurance in Clarksburg
People in Clarksburg who suffer from a condition that renders them unable to work may be able to receive income benefits to make up for lost wages through long term disability insurance. Some people purchase long term disability policies, while others obtain coverage through an employer-sponsored plan covered by federal ERISA laws.
Regardless of the source of long-term disability benefits, insurance companies are often reluctant to pay claims. Qualifying for long term disability insurance in Clarksburg requires showing that you meet the eligibility standards set forth in the policy. If you qualify but still receive a denial, an experienced ERISA attorney could assist in seeking remedies under contract law or ERISA.
Types of Conditions Eligible for Coverage
The qualifications for long term disability insurance in Clarksburg vary depending on the situation. Some policies adhere to a standard similar to Social Security Disability Insurance, meaning an individual must demonstrate they are unable to perform any type of gainful employment to receive benefits.
In other policies, the standard for disability may be broader and pay benefits if a worker becomes unable to “substantially” perform their previous occupation. It is not unusual to have a standard change. A worker could receive benefits for a while because they have demonstrated an inability to work at a particular job. Then, the standard might change so that the worker must prove they are unable to perform any paid occupation to continue to receive benefits. Eligibility standards are set by the terms of the insurance policy.
Demonstrating Qualifications for Long-Term Disability Benefits
Individuals in Clarksburg may find their claims for long term disability benefits denied even if they meet the eligibility standards in the policy. Not only must they suffer from a qualifying disability, but they must also document that disability in no uncertain terms. Failure to provide adequate evidence to support a claim may lead to a denial.
To qualify for long term disability insurance in Clarksburg, individuals should be prepared to submit objective medical evidence such as medical records and the opinion of a physician explaining how a disabling condition makes it difficult to perform work-related tasks. Opinions of vocational experts could be helpful as well.
How ERISA Affects Long Term Disability Claims
ERISA, or the Employee Retirement Income Security Act, is a federal law that establishes standards for certain benefits provided by employers. While ERISA does not require employers to offer long term disability insurance, it governs the provision of that insurance when an employer elects to provide coverage.
Among the many standards set for long-term disability plans by ERISA are requirements for:
- An appeal process for claim denials
- Providing copies of records and documents relevant to the claim
- A timely decision on appeals
- The right to file a lawsuit for benefits once administrative remedies are exhausted
An ERISA attorney could assist with asserting a claimant’s rights under ERISA if an insurer denies a claim for long term disability insurance.
Learn More About Qualifying for Long Term Disability Insurance in Clarksburg
Long-term disability insurance policies may be governed by many areas of law. ERISA applies when a policy comes through an employer, but all policies may also be subject to insurance laws and general contract laws. If you need assistance filing or appealing a long-term disability claim, it is wise to work with an attorney who understands how the different areas of law work together.
Qualifying for long term disability insurance in Clarksburg can be a challenging and frustrating experience. Claimants must work to demonstrate their eligibility at the earliest possible stages because later, additional evidence may not be allowed.