A participant in the ERISA program may need to initiate a claim for total disability when he or she suffers through subjective physical pain or a condition of mental illness. Usually, the total disability is the combination of both the constant or continual pain such as the muscles in the back constricting along with a disorder of depression because the agony of the pain is a constant problem. This may cause the individual a prolonged period where he or she is unable to work. Without the proper medication and treatment, this could lead to a debilitating condition.
The Impact of the 24-Month Limitation
The part of the policy that explains there are only 24 months where a mental or nervous issue has a limitation may impact the participant in ERISA negatively. The limitation arises in explaining that the entire 24-month period for the individual is in total and complete disabled due to his or her conditions. This would exclude the ability to work with any occupation from the physical condition that exists. Winning the case and ensuring that benefits are still granted and eligible may require the services of a lawyer to help explain and unravel any confusion about the matter.
Proving the Physical Disability
There are certain severe or chronic conditions that will affect a person to the point he or she is not able or capable of working in any occupation. Back pain, joint pain and migraines are all possible by inducing total and complete disability. However, mental or nervous disorders have a limit of 24 months with disability benefits with some policies. With ERISA participants, continued disability may not become possible if the policy does not provide for a longer period. Additionally, treatment may occur that removes the condition to include mental disability or nervous disorders. Tremors from pain in the back or joints could discontinue if the agony no longer exists.
Proving the disability connected with the mental or nervous condition to the physical is often difficult. The participant will need an evaluation through an Independent Medical Exam or IME. This professional may determine that any mental or nervous issues may not cause physical disability, and this could discontinue the disability benefits after a 24-month period. Then, the individual may need to hire a lawyer to explain to the courts how the chronic pain or other symptoms from mental or nervous conditions affect him or her physically. Working with the lawyer, it is possible to reverse the denial through the IME.
The Burden of Proof
To retain disability benefits passed the 24-month period, the burden of proving this is on the individual participant of ERISA. He or she may need an independent medical review, analysis and assessment from at least one other qualified doctor outside his or her personal physician. It is important to show that any mental condition or nervous disorder does cause the physical disability and inability to continue working at any occupation even beyond the two years provided. This would require a problem such as constant migraines to lack any form of treatment that could resolve the matter which would lead to the person’s incapability to perform simple work tasks without heavy medication.
The physical disability alone is not generally sufficient to continue disability after the 24-month period for total disability under ERISA guidelines with certain policies. This requires the person to prove that both the mental or nervous condition coupled with the physical limitations keep the individual from working due to complete and continuous disability. This also requires the person to prove to the courts that he or she is not able to perform the substantial duties of any job occupation no matter how simple or complex. Without evidence of the matter, the person may face a denial of continued benefits.
Legal Support for the 24-Month Limitation
Due to the burden of proof on the participant, he or she should hire a lawyer to support the claim. Through legal representation, it is possible to gather enough evidence that the claim has sufficient proof for continued disability benefits due to both mental or nervous conditions and physical disability.