In order to qualify for a disability pension, your SPD should tell you how many years credit you need with the union. Common SPD terms include proving that you became unable to do your job while active with the union, applying to begin entitlement – no retroactive benefits, and choosing to go through the union’s review process or showing that you have been approved for SSD benefits. If you chose the former, then pension fund trustees usually decide if you are entitled to a disability pension.
As a disability pension is usually governed by ERISA, its application, review, and appeal process is somewhat similar to Long Term Disability claims. However, there are some key differences. A pension benefit is not usually offset by SSD or Workers Compensation benefits, and there is no application form for an employer to complete. There are also normally fewer vocational issues because most of the time it does not matter if you can do other jobs. Furthermore, pension plans do not normally do surveillance or ask you to have an FCE.
We will help you present the strongest application possible. Simply completing the insurance company’s application forms will not usually result in a decision. Even when completing every answer on their forms, the insurance company will normally say that the information submitted is insufficient, and they need more information and time to evaluate your application. Nonetheless, your application forms should provide as much information as possible, even including evidence that is not requested in the application forms. The stronger your application, the more likely it is that the insurance company will move on to another application to deny.
Your application will probably have three parts: one for you, one for your doctor, and one for your employer. If your doctor is willing, we will discuss with them the type of medical information that should be included in their form. Most doctors are unaware of the type of medical information that is significant to insurance companies, and many doctors do not like completing forms. We will help your doctors present the necessary information in a way that cannot be misconstrued by the insurance company. We will also help you gather the treatment records, diagnostic tests, and functional assessments to submit with your application. We will also help ensure that the insurer does not harass you doctors.
Similarly, if your employer is willing, we will discuss with them the type of vocational information that should be included in their form. Employers do not know what vocational information is important to the insurance company, which is usually information derived from the US Department of Labor's Dictionary of Occupational Titles. Your employer may improperly describe your duties, or neglect to mention some of them as well as the physical and mental demands of your occupation. We will help your employer provide the important vocational evidence.
Many if not most people stop working due to progressive disorders, as opposed to traumatic accidents. Your application needs to explain why you could work right up until you stopped working, and there is no box in the application for providing that information. We will help you present that explanation to your employer, if you have not yet stopped working, and to the insurance company, if you have.
Pension Trustee Interaction
Many policies allow insurers to interview you, which can be done over the telephone or in person. Do not be fooled by how supportive the claims representative appears to be because the purpose of the interview is to gather information to deny or terminate your claim. A “field visit”, is when they meet with you in person. A field visit is simply open surveillance, where the insurance representative looks for evidence to use against you.
If we represent you we will insist that the insurance company only contact you through us. If they want to speak with you or your doctors directly, we will insist that they do so only if we are present. If they want to meet with you, the filed visit can take place at our office. We will prepare you for these interviews, which usually follow the same script. In fact, you will frequently be asked the same questions that were in the application or requests for updated information, which shows that the field visit is simply open surveillance. We will also ensure that the insurance representatives do not misrepresent what was said during their conversations with your doctors.