Your Eligibility For LTD Under ERISA
Whether or not you qualify for long-term disability benefits under your ERISA long-term disability policy depends on a number of factors. In the paragraphs below, the attorney explains what some of these are under ERISA law and disability law.
Terms Of Your Policy
Assuming that your employee benefits include long-term disability insurance, you and your New Jersey/New York ERISA disability lawyer will need to clearly understand how the policy defines a disability. This is in order to know whether or not you can submit a claim for benefits.
Demonstrating Partial Vs. Total Disability
Normally, long-term disability insurance distinguishes between partial and total disability in that total disability precludes the ability to function in any job. Partial disability indicates that while you may not be able to perform the work you did before, you might be able to perform in an alternative type of work. Whether you are found partially or totally disabled will affect how much you will receive in benefits. In order for you to substantially demonstrate the level of disability resulting from your condition, you will need:
- Physicians’ evaluations
- Treatment records
- Clinical test results
Policy Terms And Specifications
Under all long-term disability insurance policies, you must satisfy some terms before filing a claim. For example, you must demonstrate that:
- You kept your premiums up-to-date.
- You have satisfied the waiting period as specified in the policy.
- Currently, you are still getting treatment for your condition.
- Your tenure with the employer is long enough for your policy to be in effect.
Your policy will specify what kinds of preexisting conditions the policy recognizes and which it does not, and which types of conditions it does not cover. There are also specific rules and limitations which may apply to psychiatric claims, or drug and alcohol disabilities.