Many ERISA-governed long-term disability benefits plans require that individuals who file a claim for disability benefits also seek benefits through any other available source, including the Social Security Administration (SSA). As a result, a favorable ruling by SSA that you meet its definition of disability, i.e., that you are disabled and unable to work, also should result in the approval of your long-term disability benefits claim. This is particularly the case since SSA uses a very stringent definition of disability. Unfortunately, qualifying for disability benefits through SSA does not always automatically mean that you qualify for benefits through your long-term insurance disability plan.

The law does require your insurance company to consider your favorable SSA decision in evaluating your claim for long-term disability benefits. After all, SSA’s definition of disability requires a finding that an individual cannot perform any type of work in the national economy based on his or her age, education, and work experience. The insurance company is evaluating your medical conditions to determine whether you can perform the duties of the job in which you were working at the time that you became disabled. Therefore, it would seem that the SSA ruling should result in a finding of disability by your insurer, since SSA uses a higher standard. An insurance company that finds that a claimant is NOT disabled, even though the SSA considers him or her to be disabled based on the same facts, must give some sort of rationale for its decision in light of the SSA findings.

In any case, when you are going through the claims process for ERISA-governed long-term disability benefits, you always should ensure that the insurance company has a copy of your entire SSA file, including the decision by SSA that you are disabled and entitled to Social Security benefits.

Bonnici Law Group provides client-focused representation throughout the ERISA claims process. We are here to consider the evidence in support of your ERISA long-term disability claim, evaluate your claim, and develop the strongest and most effective strategy for fighting any denials of coverage that you may receive. Allow us to handle your legal needs while you focus on your physical and emotional health. Contact the ERISA long-term disability attorneys of Bonnici Law Group at 858-261-5454 or help@bonnicilawgroup.com.