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Are There Disability Plans That Are Not Governed By The Erisa Statute?

erisa disability plans

The Employer Retirement Income Security Act of 1974 governs employee welfare benefit plans, including disability insurance plans.ERISA is not a plaintiff friendly statute and, fortunately, there are plans that are not governed by ERISA. These include plans by:• Churches; • Government; • Entities; • Plans maintained for the purposes of complying with Workers’ Compensation; and • Plans maintained outside the United States for the benefit of persons for non-resident aliens.The great news is that if you’re employed by a government agency such as state or a local government, your long term disability benefits are not governed by the ERISA statute.You can learn more about...

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How Can I Obtain A Copy Of My Disability Documents?

disability documents

Your employer should be able to provide you with a copy of the summary plan of description (SPD) which provides you with a description of the benefits that you may be entitled to as a result of disability, the definition of disability and how to make a claim for benefits.You can also request relevant documents from the plan under a 29CFR Section 2560.503-1(N)(8) if your benefits have been denied. Long term disability carriers are required to provide you with a copy of documents to:• Rely on in making the benefit determination; • Submit, proceed or generate in the course of making...

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Why The Definition Of Disability In Your Long Term Disability Policy Is So Important

definition of disability

Long term disability carriers don’t make it easy for those who have disability policies get the benefits that they deserve. There are many important provisions in your disability policy including the definition of disability, duties and regular occupation. You should read your policy closely before you apply for disability benefits so you understand these crucial terms.The definition of disabilityThe definition of disability will determine the scope of the coverage provided by your disability carrier. Normally, the policy provides for disability payments if you’re unable to engage in your “own occupation” which is usually the first 24 months of disability. After...

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Help! My Claim For Long Term Disability Benefits Has Been Denied

disability help long term disability

If your disability benefits are covered under a group disability policy through your employer, your claim is probably governed by the ERISA statute. If your claim has been denied, the ERISA statute provides that you must file a claim within 180 days of the denial or you won’t be able to file. If you don’t file it timely and then try to file a lawsuit, the disability carrier will claim that you haven’t “exhausted” your remedies.Filing multiple appealsMany long term disability policies will also provide for a second level appeal to allow you to once again challenge the disability carrier’s...

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What Is Erisa And Why Should I Care That My Long Term Disability Carrier Might Be Governed By Erisa?

erisa lawyer disability tampa st petersburg

What you need to know about the claim formsERISA is shorthand for the Employer Retirement Income Security Act of 1994. It’s Federal legislation that governs how insurance companies handle disability claims and it gives disability carriers a “get out of jail free card.”In most ERISA governed claims, a court can only overturn the long term disability carrier’s decision if you prove that the denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil court and it’s the “get out of jail free card” that disability insurance companies, like UNUM Provident, MetLife, Cigna/LINA, Aetna, Lincoln Financial, Prudential...

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How Long Term Disability Carriers Will Use Functional Capacity Evaluations To Deny Your Claim

long term disability insurance claims

Long term disability carriers play hardball on claims and one of the ways they play hardball is to have you undergo a functional capacity evaluation. Why? If the long term disability carrier can show that you’re capable of engaging at least sedentary work, they will have legitimate grounds to deny your claim for disability benefits, notwithstanding what your physician has said about your restrictions and limitations.What is a functional capacity evaluation?It’s a 3 to 5 hour confidence evaluation used to determine your current ability, strength endurance, sensation, hand function and gross and fine motor coordination. They will evaluation the appropriateness...

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What Are The Five Reasons Disability Insurance Companies Wrongfully Deny Or Terminate Long Term Disability Benefits?

5 reasons long term disability

If you purchased your disability policy through your employer the policy is most likely governed by the ERISA statute. The Employer Retirement Income Security Action (ERISA) of 1994 is Federal legislation that has given a “get of jail free card” to disability insurance companies.In most ERISA governed claims, courts will only overturn the insurance company’s decision if you can prove that denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil case and it allows insurance companies to “play hardball” on claims.The most common reasons that long term disability carriers wrongfully deny or terminate benefits are:1....

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SOCIAL SECURITY DISABILITY BENEFITS AND ACUTE LEUKEMIA

If you’ve been diagnosed with acute leukemia you may be entitled to Social Security disability benefits. The Social Security Administration uses a 5 Step sequential evaluation to determine if you are entitled to Social Security disability benefits.[caption id="attachment_5175" align="aligncenter" width="250"] Leukemia social security disability[/caption]How does the Social Security Administration decide if I qualify for disability benefits for leukemia?The Social Security Administration will consider whether or not your leukemia is severe enough to meet a listing at Step 3 of the sequential evaluation process. There is a medical listing 3.06A for acute leukemia. The Social Security Administration will want to see...

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How Developing Your Exertional and Non-exertional Limitations Can Help You Win Your Long Term Disability Claim

non exertional limitations

Many long term disability carriers will deny policyholder’s claims on the basis that there isn’t an objective basis for any physical restrictions and limitations and/or there is no causal relationship between those restrictions and limitations and your inability to your own occupation or any occupation.It’s crucial that you develop both the exertional and non-exertional limitations that affect your ability to your own or any occupation. Exertional limitations for Long Term Disability Claims Exertional limitations affect your ability to do the physical demands of the job. Most exertional limitations are strength related and they affect your ability to:• Sit; • Stand;• Walk; • Lift; • Carry; •...

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What Every Social Security Disability Applicant Must Know About Non-Exertional Limitations

non exertional limitations

In evaluating your claim for Social Security disability benefits, the Social Security Administration (SSA) will consider how your exertional and non-exertional limitations affect your ability to work. Residual functional capacity forms.Residual functional capacity forms (RFC) are detailed reports your physician completes that discusses how your impairments impact your ability to perform work related activities. The Social Security Administration has never told you about these forms! Your doctor probably doesn’t have one in their office.Having a properly completed residual functional capacity form is crucial to winning your Social Security disability claim. Exertional limitations Many Social Security disability applicants have exertional limitations that impact their...

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