Most people with long-term disability benefits provided by their employers never need to use them. After all, long-term disability benefits only apply in scenarios where people become incapable of working for weeks or months.
Unfortunately, people who may have seemed healthy previously can start presenting alarming and painful symptoms with minimal advance notice. For example, professionals might start experiencing pain in their backs. After they finally see a doctor, they may learn that they have degenerative disc disease. Their condition may prevent them from continuing to work and might make them anxious about their finances.
Employer-sponsored disability insurance policies are typically subject to the regulations of the Employee Retirement Income Security Act of 1974 (ERISA). Can those with degenerative disc disease qualify for ERISA-governed long-term disability benefits after a diagnosis?
Medical records make all the difference
Like many significant medical conditions, degenerative disc disease exists on a spectrum. Most older adults develop some degree of this condition as they age. The discs that provide cushioning between the individual vertebrae eventually become compressed or damaged due to age and frequent use.
Many people with degenerative disc disease have minimal symptoms or limited pain until the condition reaches an extreme point. That being said, some people have severe degenerative disc disease. Their pain may be intractable and may prevent them from working. They may experience reduced function because of the issues with their spines.
Given the broad range of presentations associated with degenerative disc disease, thorough medical documentation is critical for those seeking disability benefits after their diagnosis. A medical diagnosis alone is rarely sufficient to qualify an individual for ERISA-governed disability benefits. The applicant needs sufficient medical documentation to convince an insurance professional that their condition is severe enough to prevent them from maintaining any gainful employment.
Provided that the applicant’s condition is severe enough, they may be eligible for long-term disability benefits. If the insurance company denies their claim, they do have the right to appeal under ERISA. However, the law only allows for one appeal. That appeal can be critical, as the evidence provided during the appeals process is also the evidence that may support the policyholder if they need to file a lawsuit to obtain their benefits.
Given the risks involved in a failed application or appeal, securing support when pursuing an ERISA long-term disability benefits claim can be the best option. People who have support when applying and appealing can limit their stress levels while simultaneously increasing their chances of success.