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Common mistakes when applying for ERISA benefits

The Employee Retirement Income Security Act (ERISA), enacted by the federal government in 1974, allows for those who become disabled and unable to work to receive long-term benefits. But applying for ERISA benefits is anything but a simple process; these are muddy waters to navigate, and just one mistake in the application process could jeopardize the entire claim.

What are some common mistakes that should be avoided when applying for long-term benefits under ERISA?

Thinking that your employer makes the decision

An employer may determine that an employee is unable to work, but that opinion is not the determining factor as to whether the employee can receive ERISA benefits. The insurer – not the employer – will be paying the benefits, and the insurer will decide whether the claim meets the legal requirements under ERISA. Therefore, any and all supporting evidence and documentation – especially medical records – should be submitted along with the information from the employer.

Engaging in activities that doctors have advised against

If doctors advise you to avoid certain physical activities, then avoid them. Or if your claim states that you can’t do certain things, don’t do them. Make no mistake – the insurance company is watching your activities, and if you are doing things you “can’t” or “shouldn’t” do, it looks like you are trying to game the system. Such activities provide the insurer with a reason to deny or delay the claim. Worse, you could be accused of fraud. Follow doctors’ orders carefully. Even if you start to feel better, observe all restrictions until the claim is settled.

Using the insurer to file the claim

The insurance company will provide you with forms that need to be filled out by you and your doctor. But you shouldn’t stop there. Ask your doctor to write a report detaining your illness or disability, the restrictions it places on you, and why it prevents you from working.

Also, be careful about using insurance company personnel to help you file the claim. They may offer. But remember, the insurance company is looking out for its own interests, not yours. When filing for long-term disability benefits, you will probably have to file for Social Security benefits also. And insurance companies may encourage you to select options on the Social Security application that will make it quite difficult to receive ERISA benefits.

Working with an inexperienced lawyer

To say that ERISA law is complicated would be an understatement; it governs almost every aspect of employee benefits. Regarding disability cases, there are strict deadlines that must be observed, and it isn’t always clear or obvious which evidence is acceptable. Not all attorneys practice this type of law. To have the best chance of winning your case, it is essential to find a lawyer who has significant experience in this field.

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The Law Office of Jessica Taylor, PLLC

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