ERISA: Short and Long Term Disability Claims

Pete Mackey

Attorney
(866) 735-1102 Ext 675

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In a previous post, I wrote about ERISA and its effect on your healthcare claim determinations. In this post, we will talk about ERISA and its interplay with your disability insurance. Many people have short term and/or long term disability insurance provided as a benefit of their employment. In most instances, ERISA is the law that governs. Disability insurance covers non-work related injuries that prevent you from working either at your specific job or at any job, depending on how the policy reads.

In the mid 1980s, every insurance company that wrote disability coverage was trying to out do the others by writing very liberal definitions that favored the insured consumer. They were going after the growing market for professional disability coverage because of the big premiums. They ended up paying out more in claims because the policy language was so liberal and many companies went out of business. As the number of companies in the market decreased, so did the competition. As the competition decreased, the claims denials increased. Ask Debra Potter.

Today, if you file a disability claim, expect to be denied. The carriers know that most people will go away, even when they are truly unable to work. DON'T HELP THEM OUT - keep fighting. Talk to your doctors and ask them to write letters explaining why you can't work. Get them to send the insurance company all of your medical records. Load the insurance company up with information. That may do the trick, but remember - ERISA gives insurance companies lots of room to deny. If the company continues to do so, seek legal counsel. If a lawyer who handles ERISA cases is willing to take your case on, the chances are it is a winner.