Blindness and visual impairments diminish your earning capacity and can change your life. When you file a long-term disability claim, you expect immediate action and empathetic responses. Unfortunately, the disability claim process is often far more complex and less compassionate.
Whether you have a personal disability policy or an employer-sponsored group plan, you must comply with a long list of policy conditions. Insurers require documentation that meets their standards and confirms your disability. After you provide your supporting documentation, insurers sometimes require independent medical evaluations, reduce your monthly disability insurance benefits, or deny your claim completely.
At DarrasLaw, we have dedicated our practice to resolving long-term disability claims. Our ERISA lawyers have intervened on behalf of our clients at every stage of the claim handling process to ensure that insurers provide wrongfully denied blindness disability benefits. We have resolved coverage, documentation, and blindness disability benefits issues under ERISA-governed and individual disability plans. When necessary, our attorneys have relied on appeal, arbitration, and litigation to push for claim resolutions in our clients’ favor.
Common Causes of Blindness And Severe Visual Impairment
When an insurer considers your visual disability claim, your documentation must confirm the degree of visual impairment and often the cause. They also determine whether your blindness fits within the disability policy’s specific coverage guidelines if any.
Waiting periods, previous treatment, and other issues sometimes exclude blindness disability claims even when they involve these common, easily verifiable conditions.
- Macular Degeneration: Dry AMD and Wet AMD are age-related conditions that affect the retina and alter your vision.
- Glaucoma: When fluid builds up in the eye, it often causes pressure that damages the optic nerve and causes vision loss.
- Stroke: Stroke-related vision impairment occurs in the brain’s visual processing centers. Depending on the damage location, stroke affects visual-spatial awareness, object identification, and other key visual functions.
- Diabetes: The American Diabetes Association explains that diabetics are at heightened risk for vision loss due to glaucoma, cataracts, or retinopathy.
- Accidental Injury: Chemical exposures, excessive heat, and other conditions damage the cornea and eye structures during industrial and military operations.
- Brain Damage: When traumatic brain injury, aneurysm, blood clots, and other conditions damage the brain, they sometimes cause vision problems.
Disability Coverage For Blindness And Visual Impairments
An insurance policy is a contract, so claim handlers approach each disability claim from an analytical point of view. You must supply the supporting medical, occupational, and financial documentation that explains what they need to know about your disability.
Your insurer determines if your disability policy applies by asking these questions about you and your claim.
- Are you a covered insured/beneficiary based on the policy terms?
- Does the policy cover your disability date?
- Does the policy cover your condition?
- Does the policy specifically exclude your condition?
- Do any policy conditions or limitations affect your coverage or benefits?
Insurance professionals identify and analyze these key questions based on policy language and provisions. As an insured, you probably don’t have that capability, yet you have the burden of proving that the policy covers your disability. Both private and employment-related group ERISA policies have stringent claim requirements that sometimes prevent you from successfully making a claim or getting paid.
Federal regulations govern group ERISA disability claims. The Employee Benefits Security Administration monitors group disability programs. Despite agency scrutiny, past EBSA research has shown that 64.5 percent of ERISA-related coverage disputes involved long-term disability claims.
Key Coverage Provisions
Insurers underwrite policies that provide disability benefits while avoiding certain risks.
They often accomplish this by defining key terms, requiring specific actions, and limiting certain disabilities.
- Definitions: Each policy includes definitions with meanings that usually differ from everyday language. These key phrases affect an insurance company’s coverage interpretation. Defined terms often appear throughout the policy in bold print or as capitalized words. Terms such as Insured, Total Disability, Sickness, and Regular Occupation serve to exclude risks and conditions that insurance companies deem uninsurable or unpredictable.
- Schedule of Benefits: Disability policies include a list of the monthly amounts payable based on total disability and partial disability. Compensable “permanent” visual disabilities often require complete, irrecoverable sight loss in one or both eyes. Some total disability “permanent” schedules include eligible injury combinations such as a foot and an eye, or a hand and an eye.
- Proof of Disability: Disability policies require that you notify the company and submit written proof of your claim within a certain timeframe. Insurers sometimes provide a claim submission form. If they don’t provide a form, you must still submit your proof on time.
- Elimination Period: Each policy lists the number of days that must pass before you qualify for disability payment under the policy.
- Pre-Existing Conditions: Often disability policies exclude conditions they perceive as pre-existing. They often base this decision on prior treatment, including diagnosis, care, and medications.
- Other Income Benefits: Insurers often write long-term disability policies in a way that makes them excess coverage over other benefits. They pay your benefit amount less available disability benefits for disability policies, government disability programs, Social Security disability or retirement programs, worker’s compensation disability benefits, wage continuation programs, third party offsets, and others. Some exceptions apply to these offsets.
DarrasLaw – Your Personal And ERISA Group Disability Attorneys
When a visual disability prevents you from working, you shouldn’t have to deal with a challenging claim process. You must seek immediate legal assistance before becoming entangled in a lengthy claim dispute. If you believe you have a valid visual disability claim, reach out to DarrasLaw for a free consultation. Our personal and ERISA disability lawyers will analyze your coverage, discuss your claim, and determine how we can help you.
Contact us at 800-898-7299 or leave a detailed message on our contact page for your free consultation.