(A FEW MORE) COMMON ERISA MYTHS

Do not believe everything you hear about ERISA (including “free advice” from a lawyer who does not actually handle these very specialized cases).  The bold is for emphasis;  separate the myths from the facts to help navagate the complex world of ERISA that governs many long term disability, short term disability and other employee benefit claims.

A diagnosis is not a “disability”.   A diagnosis, even with a serious condition like cancer, does not guarantee you disability, long term disability or even short term disability under ERISA.   You will likely need additional evidence supporting your disability claim;  most importantly, how does your condition affect your ability to work.

Your doctor’s note stating that you can not work is not enough.

Most disability policies define your “own occupation” as how your job is performed generally in the national economy and not how you perform your specific job. The language is even worse when the policy changes from “own occupation” to “any occupation,” in which other jobs can be offered to you in which you can perform, as long as they pay a certain salary amount (even if you have never done that job before!)   See our prior Blog post on what your “own occupation” actually means under ERISA;  the fact, you are not really insured for your own job!

Do NOT assume that the insurer is there to help, or that completing its forms is enough.  Insurers are not there to assist you in obtaining benefits, and usually require more then a few simple forms.  Other evidence will be required, and you may need an experienced lawyer to help  If you do not provide necessary information during the application and the appeal, you cannot introduce new evidence in an appeal to the court.

I can always get help later.  Group plans that are governed by ERISA have specific administrative review structures that prevent you from introducing  new evidence after you appeal the administrative denial. Court proceedings will only review the administrative record.  Having legal help under ERISA early is often the difference between success and failure!