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ERISA Lawyer Answers Disability Policy FAQs: Part 1
15February 18

ERISA Lawyer Answers Disability Policy FAQs: Part 1

What Is ERISA?

ERISA lawyerThe Employee Retirement Insurance Security Act of 1974 (ERISA) is a federal law that covers a variety of employment-based insurance programs, including group health insurance, pensions, and disability insurance plans. If ERISA covers your disability insurance plan, you have specific protections (and must follow specific procedures). An ERISA lawyer can explain your plan and discuss your options.

Are All Disability Insurance Policies Covered by ERISA?

No. ERISA covers disability insurance plans funded by your employer. If you pay the insurance premium, ERISA law does not apply in your disability claim. Additionally, ERISA does not cover government or religious employers.

If you are unsure whether ERISA covers your policy, contact an ERISA lawyer for help.

What Is the Difference Between Short-Term and Long-Term Disability?

Short-term disability (STD) benefits are paid for up to two years (depending on your insurance plan). Typically, there is a very short waiting period before you can apply for STD benefits (0-14 days).

Long-term disability (LTD) benefits are paid to workers who have lengthy or permanent disabilities.  The waiting period for LTD benefits ranges from several months to two years. You may receive benefits until retirement age (depending on the plan’s language).

Does My Employer Have to Offer Disability Insurance to its Employees?

No. Employers do not have an obligation to pay for disability insurance coverage under ERISA.

What Is a Summary Plan Description?

A summary plan description (SPD) explains the terms and conditions of your disability insurance policy. An SPD typically sets out:

  • how the policy:
    • defines disability
    • calculates benefits
    • how long benefits are paid
  • how to file to file and appeal disability claims.

You can request a copy of your policy’s SPD at any time.  The insurance company cannot charge you for a copy of your SPD.

Do I Have to Attend the Insurance Company’s Medical Examination?

If you have an independent medical examination (IME), you must attend the appointment. If you do not attend the IME, the insurance company may deny your claim or terminate your benefits.

However, if you schedule an IME, the insurance company may be preparing to deny your disability claim. You should contact an experienced disability insurance lawyer before the IME. An ERISA lawyer can explain the IME process and guide you through your disability claim.

What Is the Difference Between an Independent Medical Examination and a Functional Capacity Exam?

A doctor performs an independent medical examination (IME). The doctor may review your medical records and performs a clinical examination (which may be physical or psychological). He or she will write a report that describes your symptoms and assigns diagnoses. An IME report may or may not set out work restrictions.

A functional capacity examination (FCE) is a series of objective (or fact-based) tests that gauge a worker’s physical abilities. Typically, an occupational therapist administers an FCE. An FCE always includes work restrictions.

Speak to an ERISA Lawyer

To learn more about ERISA disability, contact the disability lawyers at Uscher, Quiat, Uscher & Russo, PC today.

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