Qualifying for Long Term Disability Benefits in D.C.

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Qualifying for long term disability benefits if you were working in D.C. is all about your long term disability insurance policy.  If long term disability benefits were provided by your company as part of your employment, the insurance contract and any claims for benefits are covered by a federal law, the Employee Retirement Income Security Act, known as ERISA.

Whether you qualify for long term disability benefits will depend on a number of factors, here are 2 important ones:

  • How does the policy define disability?  Do you have to be disabled from all work, or just your own occupation.  And how does the policy define "own occupation?"  Does it mean your specific job, or your job classification in the general work force and overall economy?

              For example, if you are an ophthalmologist performing intricate eye surgeries and an injury or medical condition to your left hand prevents you from performing surgeries, does your disability policy see it that way?  Or is your occupation (as defined) closer to "doctor" or even "eye doctor"?

This also is critical if you have a medical condition or injury that prevents you from doing most of your professional work, but not all, or if you have a very niched occupation.  You have to check the policy on this.

  • Can you prove you are disabled?  Again, that will be defined by your specific disability insurance policy.  But beware - what your doctor thinks the word means may not be how it is defined.  You have to educate your doctor on the terms, conditions and definitions in the policy - so he or she understands what the insurance company means when it asks for reports or questionnaires to be completed.

Generally speaking, with most medical conditions or injuries you will qualify for long term disability benefits as you meet the definition of disability under your policy and as long as you cannot work.  Some policies restrict or limit benefits for certain conditions, different types of mental illness or addiction.

A lot of times, your injury or illness will allow you to continue working, but is getting progressively worse - and will lead to a point where you can no longer work.  Make sure you understand how ERISA long term disability claims work from the beginning to avoid making critical mistakes that will help the insurance company deny your claim for benefits.

Get all the information you can on ERISA disability claims in D.C. - reach out to us today at (202) 393 - 3320 and we'll get you started.

 

 

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer
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