Can severe burns qualify for ERISA disability benefits?

On Behalf of | Sep 9, 2023 | ERISA Disability Benefits

Severe burn injuries are relatively rare but often quite debilitating. They could occur because of a house fire, car crash or work incident. Those who work in certain sectors, like the oil and gas industry, operate at a higher risk for major burns. Whether someone suffers a burn injury at work or in their own home, they may require extensive medical care to treat the injury and prevent infection. They may then have a long road to recovery ahead of them. Oftentimes, people spend months away from work when they’re recovering from burns. When burns cause disfiguring scars, nerve damage or chronic pain, people may not be able to continue working at all.

Those in established blue-collar professions or well-compensated white-collar careers may have benefit packages that include employer-sponsored disability benefits. Such insurance coverage is subject to rules created by the Employee Retirement Income Security Act of 1974 (ERISA).

Some burn injuries may qualify for ERISA benefits

Unfortunately, there is no black-and-white answer about disability benefits and whether any specific medical condition will automatically qualify. Someone’s career, the severity of the symptoms in their case and even the duration of those symptoms can all influence whether or not they will actually qualify for disability benefits.

Most workers hospitalized for an injury or treatment can qualify for short-term ERISA disability benefits. It is only when treatment extends beyond the applicability of someone’s short-term disability policy that eligibility becomes a concern in most cases. Whether or not the circumstances warrant long-term disability benefits will depend on the severity and extent of the burn damage, the lasting symptoms they present and how long someone will need to undergo treatment. Their prognosis or likelihood of recovering will also influence whether or not they qualify.

Those denied benefits when they initially apply do have appeal rights guaranteed under ERISA. They can potentially gather more evidence about the severity of the burn injuries and how they affect their daily life.

Evaluating a condition to determine whether or not someone likely qualifies for disability benefits can be a smart step for those who have ERISA policies provided through their employers and believe they may be in a strong position to file a claim.