Social Security laws and regulations provide a uniform definition of “disabled.” The definition of “disabled” in ERISA long term disability insurance plans varies from policy to policy, varies within a policy based on the time period after the initial onset of disability, and similar policy language can be construed differently in different jurisdictions. Social Security claims will be administratively decided by an Administrative Law Judge, an independent arbiter with no stake in the outcome. ERISA long term disability plans will usually administratively be adjudicated by the very insurer or administrator that stands to gain financially from denying your claim. The Social Security Administration has limited resources to dispute claims, so with each level of appeal, your odds of success increase. ERISA long term disability insurers and administrators have virtually unlimited resources to dispute your claim. The only way to increase your odds of success is to engage an ERISA lawyer who is as familiar with the process as the insurer and its army of lawyers and doctors.
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