ERISA LTD Claims: Definition of Disability, Restrictions, and Limitations

The Hartford Disability Insurance Claim Process: What to Expect | The  Garner Firm | Philadelphia ERISA Lawyer

Suffering from a chronic medical condition or getting injured can be a frustrating ordeal. And while you can file a long-term disability (LTD) claim with your insurance company, the process won’t be straightforward and you must ensure you sustained one of the conditions that qualify for long term disability in the U.S. Many claims are denied every year, mainly due to the claimant not meeting the minimum requirements for injuries or illnesses. If you have LTD insurance through your employer, it is subject to the Employment Retirement Income Security Act or ERISA.

If you have been thinking about filing an LTD claim, you should educate yourself with as much knowledge as possible. Also, you should hire an LTD attorney to help you navigate the complexities of the law. Your lawyer will review your policy to verify the validity of your claim. They know how to decode the complex language of insurance policies to secure the benefits you need. 

Legal Definition of Disability

Usually, policymakers define disability as the inability to perform work because of an impairment that arises from a medical condition. Similarly, it is defined by the U. S. government as the inability to perform work or the reduction in the capacity to work. 

The impairment must be caused by a temporary, permanent, or chronic medical condition. The individual is disabled when they cannot work because of their medical condition and resulting impairment. To determine disability, a medical and vocational analysis must be combined with a legal definition.  Under different policies, the word disability is also defined differently. These definitions include the inability to perform the material duties of their own occupation or any occupation, and the inability to engage in any gainful employment.

Limitations and Restrictions

An ERISA LTD claim, approvals, or denials are usually based on the insurance company’s perception of a claimant’s functional impairment, using “restrictions and limitations. Restrictions refer to activities the person cannot do while limitations are those they can do but not with the same frequency, duration, or intensity they could do before they suffered an injury or illness. A skilled ERISA LTD attorney can help claimants with all of the legal details that can possibly lead to the awarding of benefits.

How to Determine Disability

A person’s entitlement to disability benefits depends on how their policy defines disability. Also, whether their policy is subject to ERISA matters. ERISA and individual policies don’t have a consistent and unwavering standard of disability.