ERISA Disability Benefits Applications: 6 Common Mistakes

Increase your chance of getting ERISA long-term disability benefits by avoiding these common mistakes.

Reviewed by , Attorney · UC Law San Francisco

If you become disabled and cannot work, you may qualify for long-term disability benefits under an employer-sponsored ERISA (Employee Retirement Income Security Act) plan or another kind of group insurance plan. The application process is crucial to your chances of getting benefits. (To learn why, and how to apply, see Nolo's article Applying for ERISA Group Disability Benefits.)

Applying for ERISA long-term disability benefits can be challenging, and making a mistake in the process could jeopardize your ability to obtain benefits. Here are six common mistakes that people make when filing for benefits and how to avoid them.

Mistake #1: Assuming that you have enough evidence for your claim if your employer says you are too sick to work. The insurance company, not your employer, will be paying your long-term disability benefits. Assuming that your employer's opinion regarding your ability to work is sufficient to qualify for benefits is a big mistake. The insurer will decide when you meet the legal definition of disability under the terms of the policy.

Mistake #2: Relying solely on the advice of your human resources department. While human resources personnel might mean well when giving you advice, they are not trained in interpreting insurance policies, and they have no influence over the insurers for the most part. Taking action to obtain long-term disability benefits will be up to you.

Mistake #3: Documenting your disability claim using only the forms provided by the insurance company. Your doctor must answer certain questions on the insurance company forms. But don't leave it at that -- you may need further explanation or information to prove your disability. Sit down with your physician and explain the terms of your disability insurance policy. Request that your doctor complete a report that fully explains how your sickness or condition is preventing you from performing the "substantial and material" duties of your occupation. Even if your doctor charges you for such a report, it is well worth the money.

Mistake #4: Participating in activities that your doctor warned against. The insurance company will be watching your activities. If you do things your doctor said you shouldn't do, it might look like you are trying to cheat the insurer. If the insurance company sends you an activity log to complete, that only confirms that you are being watched. Follow your doctor's instructions carefully.

Mistake #5: Using the insurance company's lawyers to help you file for Social Security benefits. When you receive long-term disability benefits, you will generally be required to file for Social Security benefits. Sometimes the insurance company's lawyers or an affiliated law firm will offer to assist you with the application process. Think twice before using one of these attorneys. There have been cases where an insurance company's lawyers guide claimants toward choosing certain disabilities on their Social Security disability benefit applications, and later those disability selections make it harder for the applicant to prove his or her long-term disability claim.

Mistake #6: Working with a lawyer who is not experienced in ERISA. ERISA (which governs employer-paid long-term disaiblity insurance) is a complicated law, and many rules govern the disability application process -- from strict deadlines to what evidence is allowed during an appeal. It is important that the attorney you hire to represent you has knowledge and experience in this area of law. To find an experienced ERISA disability attorney in your geographical area, check out Nolo's trusted Lawyer Directory.

by: Ben Glass, a disability attorney with BenGlassLaw. Mr. Glass practices law in Virginia.

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