ERISA Disability Policy: Be Prepared for Limited Benefits for Neuromuscular Disorders
You purchased a disability insurance policy to provide you with peace of mind, but there might be a terrible flaw in your policy that will rob you of that peace of mind and your financial security.
The Two Types of Limited Disability Benefit Provisions in an ERISA Disability Policy or Plan
There are two limited disability benefit provisions that you might find in a disability insurance policy or plan. The first is a mental-nervous policy limitation that will limit the payment of benefits to just two years if the disability is caused by a psychological condition.
The second is a “subjective medical condition” limitation for neuromuscular, musculoskeletal, soft tissue disorders, chronic fatigue syndrome, and other “subjective conditions.”
What Do the Policy or Plan Terms Say?
Let me give you an example:
“If you are disabled due to one or more of the following, we will limit your disability benefits to a lifetime maximum equal to the lesser of 24 months, or the maximum benefit period.
Your disability benefits will be limited as stated above for
- mental or nervous disorders or diseases except for
- dementia, or
- organic brain disease.
- neuromuscular, musculoskeletal, or soft tissue disorders including, but not limited to, any disease or disorder of the spine or extremities and their surrounding soft tissue, including sprains and strains of joints and adjacent muscles, unless the disability has objective evidence of
- seropositive arthritis,
- spinal tumors, malignancy or vascular malformation;
- traumatic spinal cord necrosis; or
- myelopathies, and
- Chronic fatigue syndrome and related conditions.
That’s a pretty broad set of conditions, isn’t it? What happens if you’re a policyholder who has degenerative joint disease with osteoarthritis and have undergone multiple hip surgeries including replacements and revision surgeries. Under the terms of this policy, benefits would be limited to just two years. What if you have migraines and gastrointestinal problems secondary to chronic fatigue or fibromyalgia? Under the terms of this policy, benefits would be limited to just two years.
To qualify for disability benefits, you must continue to satisfy the definition of disability and have other non-limited disabling medical conditions. Otherwise, you are limited to just two years of benefits.
Don’t you want to know that before you stop work and apply for benefits?
Why Cavey Law?
Nancy Cavey understands the pain and disabling potential of “mental-nervous conditions” and “subjective conditions,” as insurance carriers like to call them. She also understands that disability insurance carriers often either misunderstand or else know nothing whatsoever about these diseases. Please call our office at 727-894-3188 for a free consultation and a chance to get the disability benefits you deserve.