Fairmont ERISA Lawyer

Many people have access to group disability benefit plans through their employers. These benefits provide partial income replacement to employees when they become disabled and unable to work.

Supporting yourself and your family when you are suffering from debilitating injury or illness can be challenging, especially when your medical condition may result in permanent impairments. Fortunately, if you receive a denial when you file a claim for disability benefits, a personal injury attorney may be able to help. A Fairmont ERISA lawyer can help you understand your rights and pursue any benefits to which you are entitled.

ERISA Disability Benefits Plans

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that governs most short and long-term disability plans that employers offer. 29 U.S.C. Ch. 18 places various time limits, restrictions, and procedural requirements on how insurance companies must administer these disability plans. These rules tend to be very stringent and can make applying for disability benefits under an ERISA plan very challenging.

For instance, employees are subject to strict time limits for filing claims and appeals. Likewise, plan administrators must either approve or deny claims for benefits within specific timeframes. Plan administrators are also responsible for giving members relevant information if they reject their applications, including the reasons for the denial.

Employees do have the right to appeal the denial of their disability claims if they adhere to the required timelines for doing so. They also must exhaust their administrative remedies before seeking review of the denial of benefits in federal court. As an ERISA attorney in Fairmont may note, this means that applicants may have to go through one or more stages of an administrative review before they can file suit.

Defining Disability Under ERISA in Fairmont

Different insurance policies define “disability” differently. Some policies consider applicants to be disabled if they can no longer perform the essential functions of their regular jobs. Other policies base eligibility on whether applicants can complete any work.

Furthermore, ERISA-governed disability insurance policies often change their definition of disability over time. For example, a plan may initially define disability as the inability of individuals to perform their usual job. After individuals receive benefits for 12 months, however, that definition may change to the ability to perform “any occupation” as opposed to their “own occupation.”

In many cases, this abrupt switch in the definition of disability can disqualify someone from further benefits. As a result, individuals who qualify initially need to be aware of the changes that can affect their eligibility in the future. Consulting a Fairmont ERISA attorney can be crucial to a clear understanding of the terms of a specific disability insurance policy.

Limits on Disability Insurance Benefits

Many people believe that claimants of benefits under long-term insurance policies should be able to receive benefits until age 65 or their average age of retirement. However, policies contain various limits as to how long individuals can continue receiving long-term disability benefits based on different variables. For example, individuals may be able to receive benefits for a total of three years or until they have received a specific dollar amount, such as a percentage of their salary.

Furthermore, claimants may not immediately start receiving benefits when they apply, even if they qualify. Most insurance policies contain an elimination period, or a period after the date of the disability, during which individuals cannot receive benefits. This period routinely lasts from 60 to 180 days, depending on the policy.

Contact a Fairmont ERISA Attorney Today

ERISA-governed disability insurance policies can contain many different definitions, someone of which can change over time. Likewise, these policies can include various exclusions, time limits, and other pitfalls that often are not beneficial for claimants who need disability benefits. As a result, contacting a Fairmont ERISA lawyer may be highly beneficial to you.

When injury or illness leaves you unable to work, you should be able to rely on your disability insurance policy for help. Nonetheless, the process of obtaining these benefits is not always as straightforward or easy as it should be. By retaining legal counsel, you may place yourself in a better position to successfully receive disability benefits.