Long Term Disability Appeals Attorney
Is my claim covered by ERISA?
If you have long term disability insurance through your employer, your claim is probably covered by ERISA. ERISA applies to most employers, but there are a couple of exceptions. Most government entities and churches are exempt from ERISA.
If you purchased disability insurance on your own, ERISA does not apply.
What is a Vocational Expert?
Vocational experts assess your ability to earn a living.
They look at a variety of evidence including your medical records, statements from your doctors, and evidence provided by your employer and the insurance company.
Vocational experts also look at your education, training, and experience. They know about the current job market. All of this information is considered together to determine how your disability affects your ability to earn a living.
Your long term disability (LTD) attorney will use a vocational expert to support your claim. The insurance company may also use a vocational expert to try to refute your claim.
What is a Functional Capacity Evaluation?
A functional capacity evaluation (FCE) is a battery of tests, typically administered by a physical therapist or a physician, which is supposed to determine whether you can work. The tests measure things like how long you can sit or stand, how much you can lift, if you can squat and stand back up, and other physical abilities that are supposed to translate to your ability to work.
An FCE ordered by the insurance company is a very dangerous thing. The insurance company plans to use it against you. They pay the person who evaluates you. It is common for the FCE results to say that you are able to return to work when you are not. It is also common for the FCE itself to cause physical harm to the patient.
What is the difference between “own occupation” and “any occupation”?
If you are covered for your “own occupation” you are eligible for benefits if you cannot return to the work you were doing when you became disabled.
If your coverage is for “any occupation” you can be legitimately denied benefits if you can still do some kind of work. Depending on the language of your policy, this can apply even if you are not able to earn nearly as much as you did before you became disabled.
Should I file a complaint with my state’s Department of Insurance?
If your claim is covered by ERISA, your state’s Department of Insurance has no jurisdiction over your claim and cannot help you. ERISA is a federal law.
If you or someone you love is applying for or has been denied long term disability benefits, please call long term disability appeals attorney Fred J. Fleming toll free at 1-800-882-5500 or contact us online to schedule your free consultation.