Robinson + Warncke https://www.disabilityinsurancelawfirm.com Fri, 23 Apr 2021 16:57:26 +0000 en-US hourly 1 https://wordpress.org/?v=5.7.2 Does Alzheimer’s Disease Qualify for Long-Term Care Insurance Coverage? https://www.disabilityinsurancelawfirm.com/alzheimers-disease-long-term-care-insurance/ Fri, 23 Apr 2021 12:38:01 +0000 https://www.disabilityinsurancelawfirm.com/?p=1726 Six-and-a-half million Americans are actively suffering from Alzheimer's disease in 2021. By 2050, it's estimated that this number will reach 12.7 million. Long-term care insurance is necessary when it comes to providing Alzheimer's patients with the resources that they need during this confusing time in their lives. If you have long-term disability insurance and your [...]

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Six-and-a-half million Americans are actively suffering from Alzheimer’s disease in 2021. By 2050, it’s estimated that this number will reach 12.7 million. Long-term care insurance is necessary when it comes to providing Alzheimer’s patients with the resources that they need during this confusing time in their lives.

If you have long-term disability insurance and your claim was denied by an insurance provider like Guardian, MetLife, or Unum, our attorneys can help you file an appeal. We handle both long-term care and long-term disability claims and can help you fight to win your claim. 

Continue reading to learn more about Alzheimer’s disease and if it qualifies for long-term care insurance benefits. 

What Is Alzheimer’s Disease?

Alzheimer’s disease is an illness that damages (and eventually destroys) brain cells causing problems with memory, thinking, and behaviors. This illness is aggressive and progressive. It develops slowly over a span of several years. It gets worse over time as the damaged brain cells die off.

Alzheimer’s Disease Symptoms

Alzheimer’s disease presents itself through several different symptoms. Every person may deal with different symptom representations. Usually, someone with Alzheimer’s will struggle with:

  • Memory problems
  • Word-finding issues
  • Mood swings
  • Visual/spatial issues
  • Impaired reasoning and judgment

Those struggling with Alzheimer’s can be aggressive. They can be resistive to caregivers, combative even.

Alzheimer’s Disease Stages

Alzheimer’s disease develops in stages and can range from mild to moderate to severe via stages depending on the severity of the illness. 

Early-stage (mild) Alzheimer’s allows the individual to still be mostly independent. They are still able to work and drive while performing other everyday functions. They might have memory lapses and have trouble coming up with the right word or someone’s name.

Middle-stage (moderate) Alzheimer’s is the stage that lasts the longest. This is where a greater need for care comes into play. Memory problems are more pronounced while adding unprecedented anger or frustration to the mix. Unusual behaviors might also become commonplace. This is the stage where the brain cells are becoming more damaged.

Late-stage (severe) Alzheimer’s is the final stage in the disease. This is where dementia is so severe that Alzheimer’s patients:

  • May no longer respond to their environment
  • Some may be unable to communicate with others (communication may become painful)
  • May no longer move on their own

Patients in late-stage Alzheimer’s may need additional help with everyday activities. It is vital in this stage to continue to engage with them while making preparations for hospice. Helping them maintain dignity and comfort at the end of their lives will make a world of difference to Alzheimer’s patients and their families.

Alzheimer’s Disease Causes

Scientists don’t yet know exactly what contributes to Alzheimer’s in patients who have dementia. However, they know that several factors can cause it to work together to influence a change in brain cells. This might include factors like age, genetics, environment, and lifestyle.

Alzheimer’s Disease Treatment

Because there is no cure for Alzheimer’s, treatment depends on making the patient as comfortable as possible throughout their lives. 

Is It Covered by Long-Term Care Insurance?

Coverage for long-term care is a solution for the families of Alzheimer’s patients because it can help ease the financial strain that comes with their need for in-home or nursing home care.

Long-term care insurance coverage can be given to a patient once they’ve proven that they meet all of the qualifications. The illness must be certifiable through medical reports and clinical evidence. Patients needing long-term insurance care must be chronically ill or have a severe cognitive impairment. Alzheimer’s can include both of these.

Medicare doesn’t cover long-term care for people with Alzheimer’s, but it can help cover some long-term care planning costs.

For benefits to become payable under most long-term care policies, the patient must prove that:  

  • The patient has a “severe cognitive impairment” such that she requires substantial supervision by another individual for her safety or.
  • The patient requires hands-on or standby assistance to perform at least two of the six daily activities listed under the Activities of Daily Living (ADLs)

The Activities of Daily Living refers to an individual’s inability to do the following without assistance:

  • Bathing
  • Continence
  • Dressing
  • Eating
  • Toileting 
  • Transferring

Severe cognitive impairment refers to the deterioration or loss of intellectual capacity required by another person to protect themselves and others from their behaviors. It must be proven by clinical evidence and standardized tests. The cognitive functions are likely to begin deteriorating before the motor skills do.

Why Was Your Claim Denied?

Insurance companies priced their policies too low in the 80s, 90s, and 2000s. As these policyholders are getting older and developing health problems later in life, insurance companies are in a position to lose billions. 

Insurance companies routinely deny claims for long-term insurance care in an ongoing effort to cut their costs. The reasons for denial can include:

  • Technical requirements within policies
  • The decision that benefits holders are getting more care than necessary
  • The decision that benefits holders are in the wrong type of facility

To deny a long-term care claim, insurance companies have records reviewed by clinical consultants who never examine the client. These consultants then deem the case as invalid. These cases may be seen as weak because the psychologist’s and psychiatrist’s diagnosis might contradict a physician’s diagnosis.

For cognitive cases, insurance companies may have these claims reviewed by a medical professional who will decide that there is not enough evidence for cognitive impairments. 

Essentially, it can be a long haul before getting the proper insurance coverage, but your disability claim lawyer can help you with your long-term care insurance claims.

How Can We Help?

Alzheimer’s disease is devastating to the host and their loved ones. There is no cure, and it is fatal, but that doesn’t mean that your loved one can’t be comfortable while they are going through it. When insurance coverage for your loved one’s long-term care gets denied, a knowledgeable insurance attorney will be able to help correct any possible errors and submit proof of cognitive testing on your behalf. 

Our goal is to make sure that you or your loved one gets the insurance coverage promised at the time of policy purchase. Our attorneys are experts. We understand the complexity of insurance policy requirements. We can get your loved ones the long-term care coverage that they need.

Contact Evans Warncke Robinson LLC today for your initial consultation. The sooner you understand what your long-term care policy requires, the sooner your loved one can start receiving the care that they need.

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Long-Term Disability Claims for Cognitive Disorders https://www.disabilityinsurancelawfirm.com/long-term-disability-claims-for-cognitive-disorders/ Wed, 07 Apr 2021 15:53:10 +0000 https://www.disabilityinsurancelawfirm.com/?p=1721 Sometimes referred to as “invisible” medical conditions, cognitive disorders are illnesses or injuries that impair such intellectual or cognitive abilities as memory, concentration, planning and problem solving, reasoning, verbal and written communication, and other logical processes.  Cognitive injuries or disorders can also impact emotional regulation and tolerance for stress.  Many people suffer from neurocognitive disorders [...]

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Sometimes referred to as “invisible” medical conditions, cognitive disorders are illnesses or injuries that impair such intellectual or cognitive abilities as memory, concentration, planning and problem solving, reasoning, verbal and written communication, and other logical processes.  Cognitive injuries or disorders can also impact emotional regulation and tolerance for stress. 

Many people suffer from neurocognitive disorders (NCDs), which can include symptoms such as loss of memory, basic perception and problem-solving skills, and, in some cases, a person’s ability to speak.  These cognitive and mental impairments can be particularly challenging to prove when filing an LTD claim. Mild cognitive impairments that can result from things such as concussions, ischemia, stroke, medical illnesses or long-term medication use are especially difficult to identify by clinical exam alone or through basic objective medical testing commonly used by physicians. Nevertheless, even mild cognitive impairments affect a person’s ability to work and function in various capacities.  This is especially true for highly intelligent people who rely on their sharp intellect to perform in mentally demanding occupations.  For these people, the types of subtle changes and impairments that are hard for others to even notice can interfere with the ability to perform at a high level.  NCDs may be caused by:

  • Alzheimer’s disease 
  • Dementia
  • Parkinson’s disease
  • Huntington’s disease
  • Autoimmune disorders like multiple sclerosis (MS) or systemic lupus erythematosus (SLE)
  • Chemical brain injuries, commonly after chemotherapy (“chemo brain” or chemo fog”
  • Concussion or other traumatic brain injuries
  • Bipolar disorder, borderline personality disorder
  • Substance abuse disorders
  • PTSD

The above are some of the disorders preventing thousands of women and men from performing their work effectively on a day-to-day basis. If you are suffering from a cognitive disorder and want to consult an attorney about a possible claim, give us a call to discuss your options. Do not hesitate to take action; we can help. If you have already filed a claim and been denied, please call us immediately. You do not want to risk losing your appeal.

What You Need To Win Your Long Term Disability Claim.

A claimant who suffers impairment will need to offer as much “objective medical evidence” as possible to verify and quantify the disabling diagnosis and symptoms. Objective evidence is anything that does not rely solely on the patient’s self-report. This can include clinical observations from your treating physician noted in medical records, abnormal clinical test results, lab work, radiology findings (MRI, xray, CT scan, or functional scans like CPET or diffusion tensor imaging (DTI), or cognitive examination results via neuropsychological testing. Depending on your condition, you will want to present various types of evidence with your claim. We understand dealing with any cognitive or mental disorder is overwhelming on many levels. The personal toll it takes on you and your families’ lives can seem overwhelming. Dealing with medical providers, drug companies, treatment centers, counselors, and various other resources is enough of a burden for anyone. This is why we recommend you partner with our long-term disability attorneys to help you file your initial claim.

Many professionals have tried and failed to present their case to their insurance provider, and this can limit your options in the claim’s appeal phase. Understanding what to submit to the insurance carrier is critical when trying to win your case. It is important to remember that insurance companies do not want to pay your claim and, in many cases, are trained to reject claims that should be approved. 

A skilled ERISA law firm will help the claimant put together a convincing application package and work with him on appealing a denial. There are many factors that insurers review with your application, so you must work with an experienced attorney specializing in long-term disability claims.  In many cases this will include Neuropsychological Testing that is designed to measure and detect cognitive impairments that may not be obvious in a routine medical exam.    

Insurance companies have attorneys working hard on their behalf, and they will likely do everything they can to deny your claim. In many cases, they will ask the claimant to undergo an IME or Independent Medical Evaluation or Neuropsychological Evaluation by a doctor or psychologist of their choice. They choose doctors and psychologists who commonly favor the insurer instead of the policyholder and may try to make it appear you are exaggerating your problems.  Choose not to attend the medical evaluation and it will look as if you are not cooperating with the insurance company’s requests, giving them another reason to deny your claim.

Insurance companies also like to do video surveillance of your day-to-day activities and present their findings during the hearing. What does this mean? If you claim cognitive or emotional impairments, but they have a video of you engaging with others and performing normal activities such as banking and shopping, this may be used against you to suggest your impairments are not genuine.  An experienced attorney specializing in long-term disability claims can help you understand what you should and should not be doing as early as possible.   

If you are struggling with your insurance company and would like our experienced long-term disability attorneys to review your case, please call or email us directly today. We will evaluate your claim and give you an assessment based on the information you provide. We have taken on all the major providers and know what it takes to win, and we will work with you to make sure you get the best outcome for yourself and your family.

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Using a Functional Capacity Evaluation to Support Your ERISA Disability Claim https://www.disabilityinsurancelawfirm.com/functional-capacity-evaluation-erisa-disability-claim/ Mon, 29 Mar 2021 10:07:22 +0000 https://www.disabilityinsurancelawfirm.com/?p=1718 When you find yourself unable to perform your job duties, it can be a terrifying situation. You may be struggling with medical conditions and an increased need for time off. You may be worried about losing your job. However, most private employers must provide you with time off if you are suffering from a medical [...]

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When you find yourself unable to perform your job duties, it can be a terrifying situation. You may be struggling with medical conditions and an increased need for time off. You may be worried about losing your job. However, most private employers must provide you with time off if you are suffering from a medical condition that renders you disabled. Even if you have disability insurance through your employer, some of your financial needs may not be met during that time.  It can also be challenging to prove to the insurance company that your conditions are so severe that you cannot perform relevant job duties and qualify for disability benefits. If you are physically disabled by pain or any other anatomical problem,  a functional capacity evaluation (FCE) may be the best way to prove your disability. 

What is an ERISA Disability Claim?

If you have disability insurance through your private employer, that claim likely falls under the Employee Retirement Income Security Act of 1974 (ERISA). Although there are a few exceptions, most employer-sponsored disability plans, both long and short-term, must comply with ERISA. ERISA protects plan participants by mandating that insurance companies treat all participants fairly and provide necessary information to file appeal claims. Your insurance provider should give you all the necessary information to file a disability claim, and they should work with you to submit appropriate evidence. However, it can still be challenging to determine exactly what your insurer needs to approve your claim. 

What is a Functional Capacity Evaluation?

Simply put, a functional capacity evaluation is the “gold standard” for objectively measuring and proving physical work restrictions (ie., how long can you sit/stand/walk?; how much can you lift and how often?; how much can you type or use a computer).  Depending on who is performing the test, an FCE can take anywhere from two to four hours, and some providers test two days in a row to measure the after-effects of the first day’s activities. 

An FCE helps in the assessment of the level of work you can do.  In a disability setting insurers routinely refer to the “job demand classifications” defined by the United States Department of Labor  – heavy, medium, light, or sedentary, which is the lowest level of work recognized in disability law.  If an FCE confirms a patient cannot tolerate full-time, sedentary work, generally speaking that person should qualify for disability benefits under almost every ERISA plan. 

The FCE is only as good as the provider performing it.  FCE’s are normally conducted by physical therapists with additional, specialized training.  The best FCE providers use specific protocols, including embedded validity screens, that have been scientifically tested and peer-reviewed to establish that the FCE test protocol accurately measures what it purports to measure.  Other providers use protocols that barely qualify as science, if they do so at all. 

Some FCE providers exist to serve insurance companies, who are their sole source of referrals and income. Since insurance companies save money when people are “released to work,”  we have seen insurance-oriented FCE providers who rarely, if ever, support a disability – even where the patient has serious problems and a high level of credibility.  One thing an experienced disability attorney can do is make sure you avoid those practitioners. 

During the FCE, you will be asked to attempt a series of physical tasks for as long as you can handle.  The best FCE protocols have built-in measures to detect exaggeration, inconsistent effort and signs of malingering.  For legitimately disabled people, this is good and desirable. When you pass all these tests and measures and still come out disabled, the FCE reinforces the credibility of everything you are and have been saying about your disabling symptoms. 

At minimum, a typical FCE will evaluate your abilities in the following areas:

  • Lifting
  • Pushing and pulling
  • Sitting and standing
  • Walking
  • Crouching and stooping
  • Grasping and manipulating
  • Reaching
  • Following directions

Some providers are able to further customize to simulate the parts of your job that are most difficult given your medical condition.

Part of the FCE process involves the provider observing your posture and the mechanics of your body movements.  Often these break down as tasks are repeated.  The provider will also note your escalating symptoms as you describe them, often with a heart rate monitor that notes escalating heart rates as the pain levels increase. When your increasing pain causes your heart rate to accelerate, we know you are in legitimate pain because this is something that cannot be faked. Medical examinations do not measure dynamic heart rates in this way. So, the FCE is more detailed than the typical medical examination and contains objective measures that are uniquely valuable in evaluating and proving a disability.

Why is an FCE Better Than Other Forms of Evidence?

First and foremost, many insurance companies will accept the results of an FCE for what they are – the best proof of a physical disability that modern science has to offer.  It is a great way to have your claim paid without an expensive, prolonged legal dispute. However, some insurers will push back even against this objective, scientific testing, hiring doctors to invent reasons to ignore the results.  Sadly, it is all too easy for insurers to find this kind of doctor.  There is a cottage industry of them waiting to serve.

Even in the event of a dispute, having an FCE in your corner puts you in an immeasurably better position. Federal courts reviewing disability claims have often recognized that the FCE is the “gold standard” for establishing work restrictions. “A functional capacity evaluation is generally a reliable and objective method of gauging the extent one can complete work-related tasks.” Shaw v. AT & T Umbrella Ben. Plan No. 1, 795 F.3d 538, 548 (6th Cir. 2015) (citation and internal quotation marks omitted); See also, Brooking v. Hartford Life & Accident Ins. Co., 167 F.App’x 544, 549 (6th Cir. 2006) (describing a functional capacity evaluation as “objective evidence” of the claimant’s back pain). The FCE has further been described by the federal courts as the “best means of assessing an individual’s functional level.” Townsend v. Delta Family-Care Disability & Survivorship Plan, 295 F. Appx 971, 977-78 (11th Cir. 2008) (collecting cases) (quoting Fick v. Metro. Life Ins. Co., 347 F. Supp. 2d 1271, 1280 (S.D. Fla. 2004).

In Madison v. Greater Georgia Life, Civil Case No. 1:15-cv-03413-SCJ (NDGA 2016), a recent case handled by our law firm, Judge Jones of the Northern District of Georgia confirmed the value of FCEs as the gold standard for assessing functionality,  writing that a formal functional capacity evaluation, when properly conducted, can be more useful and more reliable than even an orthopedic examination in establishing detailed work restrictions. This was in part because the FCE, unlike an orthopedic examination, “involved occupational abilities tests that measured Madison’s capacity for activities that resembled his job’s.”  Id.  The Court noted that an FCE can be more valuable than an orthopedic examination:

And physical therapists like Navarro are licensed, trained professionals well suited to assessing whether a given injury impacts functional ability. Surgeons, by contrast, better evaluate whether a person has an injury and whether surgical intervention could aid recovery. For example, neurosurgeons may operate on brain aneurysms, but therapists (occupational and physical) work with patients to recover their functionality after surgery.

Id at 32.  The FCE was validated and reliable because it was “consistent with multiple doctor’s clinical evidence (i.e. range of motion, atrophy,” etc.) and because of the several effort verification measures passed by the patient.  The Court found the insurer’s decision to ignore the FCE without justification arbitrary and capricious, and benefits were awarded as a matter of law.

The bottom line is that courts do strongly favor FCEs.  So, even if your insurance company wants to fight the results, it is generally in a weak position being on the opposite side of an FCE.

Among other things, the FCE will also help your doctor, providing a firm, objective foundation for his/her opinions on your work restrictions. In the absence of an FCE, doctors are making subjective estimates of what you can and cannot physically do.  Some treating physicians are not comfortable making these assessments.  Some refuse to do so outright. In our experience, a patient providing the results of a valid FCE helps the treating physician feel more comfortable advocating for you.

How to Prepare for an FCE or Other Examinations

Before undergoing an FCE, you can do the following things to prepare:

  • Keep a Diary – Although your subjective descriptions of your symptoms do not hold weight with the insurance company, your doctor needs to know how your conditions are affecting every area of your life. Your doctor or therapist will objectively determine whether the things you claim make sense according to other findings. In your diary, document your pain on a scale of 0 to 10, all symptoms you experience, and how every area of your life is affected by your inability to function. 
  • Make a List of Prescriptions and Treatments – Any doctor or therapist performing an FCE needs to know your complete medical history. Although your examiner should already know your medical history, an independent doctor may not. They should receive your medical records in advance of your exam; however, you should also jot down a brief history of medications and treatments you’ve received as well as how they have impacted your conditions. This will allow the examiner to have a full picture of your medical history and how it has affected you personally.
  • Understand Your Conditions – Your doctor or therapist will ask you many questions regarding your medical conditions, and it is best if you fully understand what he or she is talking about before answering. If your examiner asks you if you’ve experienced episodes of syncope, you need to know that means “fainting.” Do not be afraid to research your own conditions or ask for additional information prior to your FCE exam. This will allow you to better understand the questions your doctor asks during the exam. 

 

Our Atlanta ERISA Disability Attorney Can Help

Part of the value we try to bring for our clients at Robinson Warncke is recommending testing that is appropriate for your medical condition, that will scientifically confirm and measure your disabling symptoms and your functional restrictions.  Your doctor does not need an FCE to make a diagnosis or to decide know which procedures or medications to recommend for you. In other words, and FCE is not a medical test. This is solely about proving how your medical condition impairs your ability to function, ie. your disability.  

Being a legal rather than a medical test, instead of leaving this to your doctor (who probably knows very little about what evidence is convincing to disability insurers and federal judges),it is better to have this part of the claim process managed by attorneys who specialize in disability claims.  We can help determine whether an FCE is likely to be valuable, can make sure you get to the best providers, help you prepare, and then help your doctor connect the FCE results with your in-office medical findings and test results.

Filing an ERISA disability claim can be complicated. You must comply with all of the requirements and deadlines of your insurance company, which is working to pay you as little as possible. In order to expedite the process, you should contact an experienced Atlanta ERISA disability attorney to fight for you.

 

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Insurers Push for In-Person Health Exams for Disability Claims https://www.disabilityinsurancelawfirm.com/insurers-push-for-in-person-health-exams-for-disability-claims/ Wed, 10 Mar 2021 09:20:32 +0000 https://www.disabilityinsurancelawfirm.com/?p=1713 The global pandemic has created a new opportunity for insurance companies to deny people long-term disability benefits, putting patients in the difficult position of deciding whether to risk losing their benefits or chance catching a life-threatening disease. Benefits attorneys say they’re seeing more requests from insurers for in-person medical exams and evaluations during a public [...]

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The global pandemic has created a new opportunity for insurance companies to deny people long-term disability benefits, putting patients in the difficult position of deciding whether to risk losing their benefits or chance catching a life-threatening disease.

Benefits attorneys say they’re seeing more requests from insurers for in-person medical exams and evaluations during a public health crisis that’s limited the number of doctors available and forced many businesses to shut down in an effort to curb the deadly virus.

It’s an easy way for insurers to deny or terminate disability benefits if the request is refused, attorneys say, but it may not be legal.

Insurers have mostly backed down when people, citing fears of contracting Covid-19, hire an attorney to push back on these requests. But not every long-term insurance recipient has the money or the access to outside counsel to try.

Chris Lunda had been permanently disabled for almost 10 years when Guardian Insurance asked him at the start of the Covid-19 pandemic to go to a physical therapist for a four-hour, in-person exam to measure his functional capacity.

“Initially, I thought ‘Are you crazy? Do you watch the news?’” said the 57-year-old former marine surveyor from Metairie, La. Lunda was injured after falling on the job in July 2010. He wasn’t able to get the spinal surgery he needed until 2012 due to a delay with his insurer approving the procedure, and he suffered permanent nerve damage in his left leg as a result.

Reasonable Request?

Most disability insurance policies give insurers the contractual right to make reasonable requests for in-person examinations under the Employee Retirement Income Security Act (ERISA), said Lunda’s attorney Jeffrey Warncke, founder and partner at Evans Warncke Robinson LLC in Atlanta.

“Reasonable is a real flexible word in the law,” he said. “It’s up to federal judges to decide whether or not these are reasonable requests.”

Warncke argues reasonableness should be viewed by the totality of the circumstances, including the timing of the request.

Outside of a pandemic, attorneys say it’s rare for a judge to interfere with a required examination. ERISA, which is the federal law governing most disability claims and how they’re processed, has a standard of review that requires judges to defer to insurers unless the request is unreasonable.

Guardian said it couldn’t comment on the specifics of Lunda’s claim.

“Numerous courts have recognized that functional capacity evaluations are an important and objective tool to assess a claimant’s occupational restrictions and limitations,” the company said in a statement. “Guardian only requests such examinations if the provider verifies that the examination can be performed safely and in accordance with all Covid safety protocols and regulations.”

But the exam Guardian was asking Lunda to complete didn’t seem reasonable or necessary since Lunda isn’t going to miraculously recover, Warncke said.

“Suddenly, 10 years into the claim, in the middle of a raging pandemic, Guardian is insisting he go for a four-hour physical examination. It didn’t really add up. It felt and feels abusive,” he said.

Lunda ultimately retained his own provider to perform the exam Guardian was insisting on and the company has agreed to continuing paying benefits indefinitely. Though it was a positive outcome, Warncke said it put his client in a difficult position—either risk contracting Covid-19 or lose his benefits.

One attorney said he’s seen requests for independent medical exams (IME) come from insurers who typically don’t ask for them.

Jonathan Feigenbaum, a Boston-based attorney who represents disability claimants, said his client, whose inflammatory disease sarcoidosis presented a high risk for Covid-19 complications, was recently required to submit to an in-person exam.

But the insurer that required the exam rarely requests them and often turns a deaf ear when other claimants ask for them, Feigenbaum said.

“Often when a claimant says, ‘Please send me to an IME if you don’t believe me,’ the insurer ignores the request,” he said. He declined to name the insurer that made the request.

Some insurers paradoxically may be using the across-the-board decrease in in-person medical care that’s been driven by the pandemic as a reason for demanding more in-person exams, said Marie E. Casciari, a shareholder with DeBofsky, Sherman, Casciari, Reynolds P.C. in Chicago.

Insurers sometimes link the frequency of an individual’s treatment to the severity of their condition, which can cause them to equate fewer doctor visits with exaggeration of the disability or even improvement, according to Casciari.

“We’ve seen that a lot,” she said.

disability insurance law firm

Disability rights advocates are concerned about people who receive Social Security Disability Insurance being forced to go in-person for exams, too. The Social Security Administration requires periodic exams during continuing disability reviews. The SSA paused these reviews in March, but decided in August to restart its work.

The Consortium for Citizens with Disabilities sent SSA Commissioner Andrew Saul a letter in October asking the administration to make it clear people can ask to have these exams postponed. In a response letter Dec. 29, Saul assured the consortium that SSA is not ceasing benefits due to a beneficiary’s inability to attend a consultative examination (CE).

“COVID-19 related concerns are a good reason to cancel, postpone or reschedule a CE,” he said in the letter. “We instruct the DDS [disability determination services] to notify claimants and beneficiaries that they may request to postpone their CE without penalty, if a claimant or beneficiary has concerns with COVID-19 exposure.”

But advocates worry it’s not clear to beneficiaries that’s an option when they get these requests from the SSA.

“For everyone with a disability, losing these benefits is really terrifying,” said Bethany Lilly, senior director of income policy at The Arc, a nonprofit that advocates for people with intellectual and developmental disabilities.

Lilly is hoping the commissioner will reconsider and issue updated guidance making it clear in-person exams can be postponed.

People who have a disability and who are at a higher risk of catching Covid-19 shouldn’t have to go to doctors’ offices where they might be exposed, she said.

More Requests

Most disputes with private insurers don’t make it to a courtroom. Life Insurance Company of North America, however, has had two cases brought against it for trying to force an in-person IME during the pandemic.

Arizona resident Jenifer Ahring accused the Cigna Group Insurance subsidiary in a Jan. 8 suit of being “extraordinarily aggressive” in demanding in-person medical exams to assess long-term disability claims since the beginning of the Covid-19 pandemic. She said she believed it to be a “deliberate, bad faith practice of Cigna to try to manufacture reasons to terminate legitimate LTD claims.”

In a lawsuit filed in June, Windy Nesti, of Colorado, said LINA terminated her disability benefits and dragged out her appeal by requesting an in-person IME. The company “has instituted a new procedure and practice of requesting a substantially greater number [of] medical evaluations (so-called IMEs) in recent weeks and months, during the internal appeal phase, knowing that such in-person medical evaluations could not likely be conducted on a timely basis during the ongoing Covid-19 pandemic,” her complaint said.

In an answer brief, LINA denied that it has instituted a new practice of requesting a greater number of IMEs during Covid-19, but gave no further response.

Both Ahring and Nesti ultimately dropped their lawsuits, which signals they reached some sort of an agreement with Cigna. Cigna declined to comment on the cases or its recent requests for IMEs during the pandemic, saying in a statement it has no information to provide at this time.

Successful Strategy

In most cases, insurers back off when they’re challenged on the request, attorneys say.

“When complying with an IME request would put my client in harm’s way (when the client is immunocompromised, for example), I have pushed back on the necessity of the IME and each time the insurance company has caved and canceled,” said Michelle Roberts, a partner with Kantor & Kantor LLP in Alameda, Calif.

Because many disability policies require compliance with requests for in-person exams, Roberts said she’s hesitant to advise clients to refuse “carte blanche.” Instead, she asks insurers to justify why the increased health risk is necessary and requests that they accept liability for any fallout.

“So far, this strategy has worked,” she said.

Edward Dabdoub, managing partner at Dabdoub Law Firm in Miami, Fla., said his firm has had about six clients get requests for an in-person IME during the pandemic. In every case, he said the insurer backed off—but not without a good fight first.

“I have to wonder how many people don’t have a savvy attorney in this practice area,” Dabdoub said.

Claimants who aren’t represented or represented properly may feel compelled to go for the exam or risk having their benefits terminated for failure to cooperate with a provision of their insurance policy, he said.

“It’s your ultimate David vs. Goliath situation.”

—With assistance from Shira Stein.

To contact the reporters on this story: Lydia Wheeler in Washington at lwheeler@bloomberglaw.com; Jacklyn Wille in Washington at jwille@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloombergindustry.com; Cheryl Saenz at csaenz@bloombergindustry.com; Carmen Castro-Pagán at ccastro-pagan@bloomberglaw.com; Karl Hardy at khardy@bloomberglaw.com

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Are the “independent” medical examinations or IMEs really independent? https://www.disabilityinsurancelawfirm.com/erisa-independent-medical-examinations/ Mon, 18 Jan 2021 10:22:58 +0000 https://www.disabilityinsurancelawfirm.com/?p=1709 Most long-term disability plans and insurance policies give the insurer the right to have the claimant “examined” by a physician or other professional of its choosing as a condition to approving benefits.   The “independent” medical examinations or IMEs are usually far from independent.  IMEs have become a very profitable enterprise for companies that arrange the [...]

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Most long-term disability plans and insurance policies give the insurer the right to have the claimant “examined” by a physician or other professional of its choosing as a condition to approving benefits.  

The “independent” medical examinations or IMEs are usually far from independent.  IMEs have become a very profitable enterprise for companies that arrange the examinations for insurers and the physicians they assign to perform them.  Today, a physician can typically make far more money per hour performing IMEs for insurance companies than seeing patients of her own.  To ensure repeat business from insurance companies, the companies that arrange the IMEs have the incentive to select physicians with a propensity for findings that claimants are not too impaired to work.  The ERISA attorneys at Robinson Warncke recently met with one physician who decided to stop performing IMEs and paper record reviews for insurers after being asked to revise his conclusions to favor an insurer.  

You don’t have to take our word for it.  The medical profession itself has noted in peer-reviewed journals the questionable quality of many IME’s, including direct questioning of their so-called “independence”:

IMEs are generally neither objective nor of superior quality.  Although called “independent,” the examiners are dependent on their corporate clients for their livelihood.  Changes brought on by reform allow employers to choose the IME companies and the companies to choose the physicians providing the services.  This has resulted in a captive audience of workers/patients sent to these providers with cost reduction as the measure of measuring success.  Lax, M.  Independent of what?  The independent medical examination business.  New Solutions.  2004; 14(3):  219 – 51.

Therefore, physicians devoting the majority of their practice to performing medical-legal evaluations have the greatest potential for bias.  In this context, the doctor “knows who is paying the bill.” Far more IME’s are ordered by insurance carriers and defense attorneys than by claimants and plaintiff attorneys.  Over a period of time, the IME physician develops a certain reputation based on his or her track record.  These experts have in a sense already settled on their position before weighing the facts and science of the case.  Schofferman, J.  Opinions and testimony of expert witnesses and independent medical evaluators. Pain Med. 2007;  8(4): 376 -82.

Likewise, the New York Times did a story on insurance exams in 2009, with some notable insider testimony detailing the poor conduct of allegedly “independent” medical examiners who consistently found against claimants no matter how injured they were.  As one interviewed examining physician stated, “If you did a truly pure report, you’d be out on your ears and the insurers wouldn’t pay for it. You want to give them what they want, or you’re in Florida.  That’s the game, baby.” The article also quoted a medical review of cases finding a routine tilt toward the benefit of insurers by minimizing or dismissing injuries.  This was accompanied by a comment by Dr. Stephen M. Levin, Co-Director of the Occupational and Environmental Medicine Unit of Mount Sinai Medical Center that “There are some noble things you can do in medicine.  This ain’t one of them.”  “Exams of Injured Workers Fuel Mutual Mistrust”, New York Times (4/1/09) 

In addition to the financial incentives, a physician performing an IME does not have a traditional doctor-patient relationship with the claimant.  So, unlike a treating physician, the IME doctor has virtually no professional liability or risk of consequences for “overlooking” important signs, symptoms, or medical evidence or for misdiagnosing the claimant during the examination.   

Certain insurers such as Hartford and Aetna have traditionally ordered IMEs.  Today, however, we have seen a recent uptick in IMEs ordered by several other disability insurers, including Cigna, Prudential, and Guardian for claimants who are already on benefits often providing the insurer an excuse for terminating benefits.  

Unfortunately, under ERISA, federal courts have generally found that an IME gives the insurer a stronger basis to deny or terminate benefits than a paper peer review, even where a claimant’s disability is supported by treating physicians.  This is particularly true in the case of psychiatric conditions or medical conditions that are difficult to assess through objective testing and depend on the patient’s credibility in describing subjective symptoms such as pain or fatigue.  With an IME, the physician or psychologist selected by the insurer can claim to have assessed the claimant’s credibility by detecting signs of symptom exaggeration during the examination.  In a recent neuropsychological examination, a psychologist selected by one insurer used 8 different validity tests so that while the claimant passed 7 of those tests, the IME psychologist could point to the one validity scale in question as evidence the claimant must not be giving his best effort on the testing and must be faking.       

In the context of a disabling medical condition that does not produce mechanical bodily impairments but instead prevents the claimant from engaging in sustained work due to symptoms such as progressive pain, fatigue, or sleepiness, a 30-minute examination by an IME doctor cannot be expected to reveal anything meaningful about the claimant’s disability.  For instance, in a recent IME ordered by Prudential for a claimant with chronic fatigue and fibromyalgia, an IME physician who admitted the claimant’s reports of chronic pain appeared credible, nevertheless refused to assign any work restriction because in his words “the problem is not capacity but rather a tolerance” based on the fact that activity caused her significant pain.  In other words, no matter how painful something is, if you can possibly do it in spite of the pain, you have no work impairment.  Prudential used this unreasonable theory to terminate benefits.      

A claimant’s refusal to cooperate in attending an IME can by itself justify termination or denial of benefits.  There are some things a claimant can do with the assistance of an attorney to try to mitigate the harm associated with a biased IME.  The claimant can request to have a witness present, preferably a licensed nurse to observe what the IME physician does and fails to do and report anything untrue in the IME report.  A claimant can put the insurer on notice if the physician selected has a reputation for bias.  A claimant might be pre-emptive in scheduling her own IME with an unbiased physician.           

Especially in the context of a disability based on psychological or cognitive impairment, it is important to read the specific policy language as some policies only allow the insurer to have the claimant examined by a physician rather than subject herself to testing by a psychologist.  

Contact us for a free, no-obligation phone consultation.

If you have been notified you are being subjected to an insurance medical examination, an expert in ERISA long term disability insurance can help minimize the risks inherent to this process.  Contact us for a free, no obligation phone consultation.

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COVID-19 Complicating Your Long Term Disability Claim https://www.disabilityinsurancelawfirm.com/covid-19-complicating-your-long-term-disability-claim/ Fri, 20 Nov 2020 14:10:15 +0000 https://www.disabilityinsurancelawfirm.com/?p=1699 It is true that COVID-19 and the national quarantine have complicated long-term disability claims. But it’s also true that American workers were facing serious economic issues even before COVID-19 shut down the economy. Few had enough savings to survive an economic disaster, loss of work, or injury that prevented work. Fewer still had adequate health [...]

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It is true that COVID-19 and the national quarantine have complicated long-term disability claims. But it’s also true that American workers were facing serious economic issues even before COVID-19 shut down the economy. Few had enough savings to survive an economic disaster, loss of work, or injury that prevented work. Fewer still had adequate health insurance or the ability to pay for a serious medical event. And today, employers are paying for long-term disability packages far less frequently than they have in the past. 

While the federal government has stepped in to help those who have lost their job due to COVID-19, those protections will run out. Economic insecurity will become a serious problem in the coming months. Employee disability packages are one way that workers can protect themselves, their families, and their incomes against the sickness that prevents work.

If you need to speak to our Atlanta disability attorney about your Long Term Disability Claim, we are here to help.  

Why This Matters

A large cross-section of the American population does not have any form of disability coverage provided by their employer. In fact, they have no health insurance either which is why the three most common causes of consumer bankruptcy are: Medical debt (26%), job loss (20%), and illness or injury in the family (15%). 

Today, millions of Americans have lost their job and along with it, they’ve lost their health and disability insurance too.

Claims Under Quarantine

Employees who have lost their job due to COVID-19 may still be able to file claims on their employer’s benefits package so long as their employer still exists, continues to pay the premiums, employs the worker, and you’re still eligible under the terms of the policy. However, if your employer is shut down, it may be difficult to figure out how to file a disability claim on your employer’s policy. 

In these cases, employers should direct their employees on how to make such claims. An employer is responsible for ensuring their employees have the means to file such claims.

The Impact of COVID on new and existing disability claims

Our disabled clients are finding that the pandemic is creating additional challenges with the claims process, in addition to all the other impacts on their daily lives. New applicants for disability benefits and those already on claim having one thing in common – they need to submit medical proof of their new or continuing disability.  As is discussed consistently throughout this website, disability insurers can be very exacting in the forms of proof they require. Most disability insurers place very little weight on the patients complaints.  Insurers will not always take you at your word that you have a disabling set of symptoms at a certain level of intensity, frequency and duration.  They may not even give you the benefit of the doubt.  Disability insurer’s place a great deal more emphasis on “objective findings” like test results and imaging studies that verify and quantify your problems.  Objective findings also include notations in your records as to things that your doctor personally observed during a clinical examination.  The problem during this pandemic is that you cannot get “objective evidence” without risking an interpersonal encounter.   This has created something of a Catch-22. 

For most clients, early during the pandemic they could not schedule in-person appointments for anything other than life-saving measures.  As of the writing of this article, several months into the pandemic, some of our clients still have not seen a doctor in-person having been limited to telemedicine visits.  This has added an extra layer of challenge to keep our longstanding clients on benefits, much less proving new disability claims.

We are also seeing disability insurers making unreasonable demands on our clients, for instance threatening termination of longstanding approved benefits unless our clients subject themselves to sometimes hours-long, in-person testing.

This is a new frontier for everyone concerned.  Our Atlanta disability law firm is rapidly gaining experience as we go – just like everyone else in the medical-legal community.  So far we have been able to maintain our successful track record assisting disabled clients despite the additional challenges presented by COVID.

COVID-19 Wage Reductions

One of the biggest issues facing employees right now is that their companies are only bringing in a small fraction of what they used to. This has resulted in layoffs for a number of workers, but more still are taking pay cuts that can go as high as 40%-50% of their income.  

Since long-term disability plans pay out a specified percentage of your income, it’s creating conflicts under the law. Should the LTD policy payout the disability claim as agreed to before COVID-19 struck? Or should the policy take into account any pay cuts implemented after COVID-19? 

In some cases, the top brass may be bringing in no income at all if their income is tied to the profits of the business. This is true for small business owners as well who depend on profits from their business to pay for employee insurance packages. 

Force Majeure

The term “force majeure” describes unforeseen circumstances that prevent one or both parties from fulfilling the terms of a contract. These unforeseen circumstances include war, riot, Act of God, or even a pandemic. This means that if some calamitous event occurs that makes it impossible for either party to fulfill their end of the contract, then the contract itself would be nullified without any liability by either party. 

This, of course, is not what you as an LTD policyholder want to hear when you’re filing a claim against your employer’s LTD insurance policy.

Working from Home

Now that more and more Americans are able and required to work from home, it’s throwing a wrench in the works for several folks who are filing long-term disability claim. Traditionally, it has always been difficult to prove to an LTD provider that you are disabled enough to prevent you from working. Now that everyone is working from home, it will be that much more difficult. 

Secondly, this throws another wrench into the 30-hour workweek criteria that policies generally have. Total disability claims generally require that an individual be engaged in no work for profit whatsoever and are seeing doctors on a regular basis. 

The Bottom Line

While insurers are required to operate in good faith, they also have a tendency to exploit loopholes in the law, ambiguities in evidential records, and terms of their policies in their own favor. This could mean that millions of Americans who suffer an unforeseen medical event, car accident, or other major trauma have no back-up plan in place to supplement their income.  

Further, employees who are still covered by their employer’s disability plan may find themselves suddenly on the exclusion list, be unable to prove that they are totally disabled because they work from home, or find their contract voided based on unforeseen circumstances. 

If you’ve experienced a medical issue that prevents you from working, even from home, call the Atlanta disability attorneys at Robinson & Warncke today to learn more about how we can help. 

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Red Flags on Your ERISA LTD Application https://www.disabilityinsurancelawfirm.com/red-flags-on-your-erisa-ltd-application/ Fri, 19 Jun 2020 22:53:37 +0000 https://www.disabilityinsurancelawfirm.com/?p=1677 If you are  unable to work, you may qualify for long-term disability (LTD) benefits under your employer’s Employment Retirement Income Security Act (ERISA) plan. An ERISA LTD plan can provide you with financial security while you are unable to work due to a serious medical condition. Your employer and/or insurance company should provide you with [...]

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If you are  unable to work, you may qualify for long-term disability (LTD) benefits under your employer’s Employment Retirement Income Security Act (ERISA) plan. An ERISA LTD plan can provide you with financial security while you are unable to work due to a serious medical condition. Your employer and/or insurance company should provide you with an application and all necessary information to apply for LTD benefits.

An ERISA LTD application can be complex and may require significant details regarding your medical conditions. Although your employer does not have a legal right to details regarding your medical condition, the insurance company that may be providing you with LTD benefits can request certification of your conditions. It is your responsibility to complete all application materials and to provide medical proof of your condition. However, in doing so, there are many issues that can raise red flags that will cause your insurance company to investigate further or request additional information.

When completing the application, avoid these common mistakes:

  1. Missing deadlines. Your employer and the insurance company will have deadlines by which you must notify them of your medical condition and submit your application and supporting information. Do not miss those deadlines. Make sure your medical provider knows that you need supporting medical information by a specific date. If you cannot meet a deadline, contact your employer or insurance company and make sure they know the information is on its way.
  2. Failing to keep copies of documents and medical records. You will submit multiple documents related to your LTD application and supporting medical information. You will also have to obtain medical records and provide copies to your insurance company. You may also have to submit to a disability evaluation by your medical provider or an independent provider. You should keep copies of everything you give to the insurance company and all correspondence you receive from them.
  3. Choosing the wrong last date worked (LDW). Your insurance company will need to know the last day you worked in order to begin processing your LTD claim. You must have evidence from your employer and your medical provider regarding your LDW. Your employer should provide information about when you became unable to perform the essential duties of your job, and your medical provider should offer information about when your condition became so serious that you were unable to work. Those dates should coincide. If they do not, your insurance company may inquire further and may even deny your claim.
  4. Only providing documentation on forms provided by the insurance company. Although your insurance company will provide you with forms to document your disability, you should also provide medical records, test results, and any other medical documentation that proves you have a serious medical condition and are unable to work. The insurance company forms don’t provide much space for you to describe your condition. You’ll need to attach additional sheets to provide an adequate description. The more information you provide, the more likely you are to be approved for benefits.

 

  1. Relying on advice from your human resources department. Although your human resources department can help you when applying for LTD benefits, you should know your rights and responsibilities according to the insurance company. Human resources personnel are not experts on the law or on insurance policies. Legally, your insurance company must tell you your rights and responsibilities. Make sure you review what you need to do in order to meet those responsibilities.
  2. Participating in activities that your doctor prohibited. If your doctor gives you restrictions for physical or mental activities, you must abide by those restrictions both at work and in your personal life. If you take part in recreational activities that appear inconsistent with your work impairments, you may be denied benefits.  Insurers look for evidence of such activities on social media or through surveillance.  . 
  3. Failing to seek legal help quickly. If you apply for LTD benefits and are denied, you should immediately seek the assistance of a disability attorney to represent you in an administrative appeal. Don’t wait until your next step is federal court. Better yet, get an attorney involved before you apply. Your chances of success dramatically improve  if you submit a thorough, timely, and professionally prepared application. Making an ERISA LTD application may seem straightforward, but it’s easy to make errors that can result in denial of a deserving claim. The application can be complex and the medical information needed to prove that you are disabled may be confusing. Our experienced ERISA disability attorneys can help you at every step of the process. We will help you complete an application and answer any questions you have about your rights and responsibilities. 

Our Georgia insurance firm has an impressive 95 percent success rate in recovering benefits  on individual and ERISA disability claims, and we have recovered in excess of 50 million dollars in claims for our clients after an initial denial by their insurer. Call us today for a free case evaluation and to learn how we can help.

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Long Term Disability Claim https://www.disabilityinsurancelawfirm.com/long-term-disability-claim/ Mon, 28 Oct 2019 09:30:13 +0000 https://www.disabilityinsurancelawfirm.com/?p=1664 How to Win a Claim for Cigna Long-term Disability There is no guarantee that you will win any long-term disability claim.  Up to 75% of long-term disability claims are denied.  Do not let this keep you from applying though.  With these tips, you will have a better chance at winning your Cigna long-term disability claim. [...]

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How to Win a Claim for Cigna Long-term Disability

There is no guarantee that you will win any long-term disability claim. 

Up to 75% of long-term disability claims are denied. 

Do not let this keep you from applying though. 

With these tips, you will have a better chance at winning your Cigna long-term disability claim.

 

Review Your Cigna Long-Term Disability Policy

Reviewing your policy should be your first step.  You need to know what conditions the policy will cover as well as any deadlines you may have to apply.  It should also discuss whether or not there is a waiting period between the time you are injured and the time you can start receiving benefits.
 

Complete All Questions Accurately 

When filling out the form for Cigna long-term disability be sure to answer all the questions and make sure they are all answered accurately to your best knowledge. Do not leave anything out.  The more information you give on your long-term disability questionnaire, the better off you will be.

Give Detailed Information About Your Job 

This bit of advice seems like a no-brainer but sometimes people will put what their job title is but does not explain what they do for their job.  Your job title does not always paint a picture of what you do on a daily basis while you work.  If you have an injury that does not allow you to bend, but your job title is assistant, this does not explain what you do, or how your inability to bend affects your employability.   For instance, as an assistant, you may have to bend over to file folders or pick up merchandise off the floor.  The insurance company will not know this unless you give detailed information about your job.
 

Submit as Much Medical Evidence as Possible 

This is probably the most important thing you can do to help your claim.  You need to submit information from your primary doctor, urgent cares, and emergency rooms that have treated you for your injury or illness.  Lab results, x-rays, and even Physical or Occupational therapy reports should be included as well. You can also get written opinions of your doctors stating how your injury or illness affects your ability work.  Friends and family members can also include letters explaining how you are limited in your day to day life.
 

Be Truthful to Cigna

Whatever you do, do not lie or exaggerate your injury or illness. If you do this and Cigna finds out, then you will severely hurt your chances of receiving benefits.  You should only claim what is truly going on with your health and backing it up with evidence will help keep you truthful.

Remember Cigna Representatives or Nurse Consultants Are Not Your Friends

They may seem friendly and like they want to help, but this can negatively affect your claim.  If you are talking to them like they are your friends, you may divulge information that adversely affects the outcome.  When speaking to them, make sure you are answering their questions precisely and to the point.  If you ever have doubt or are confused, talk to a long-term disability attorney right away!

Consider Hiring an Attorney

Hiring an attorney that has worked with Cigna long-term disability or even just long-term disability, in general, can help make the process a little easier and less stressful.  Reach out to us today.

 

Why Did Hartford Deny My Long-Term Disability Claim?

Why Did The Hartford Deny My Disability Claim?

The Hartford is one of the biggest insurance providers in the United States. 

Millions are covered for short & long-term disability under Hartford policies.

However, they, like many long-term insurance providers, have a long-running history of being involved in lawsuits from claimants that accuse them of incorrectly handling and adjudicating their claims.

Reasons The Hartford Has Unfairly Denied Long-Term Disability Claims

Here are some examples we’ve seen in regards to claims and cases against the Hartford for their unfair and incorrect practices in long-term disability claims.

  • – Denying all or most claims immediately, forcing a confusing appeal for the granting of benefits. 
  • – Repetitious requests for evidence.  This means even being repeatedly asked for the same evidence that you may have already provided. As you may already know this can further delay your case getting a response on whether it is rejected or accepted.
  • – Bringing in intrusive evidence against you.  Intrusive evidence can be video surveillance or even cherry-picked videos making it appear that your disability is not debilitating.
  • – Paying physicians to evaluate your claim and records. 
  • Requiring or requesting an in-home investigation and interview by a Hartford representative. This is hardly needed if sufficient records and proof are provided so that someone dealing with a disability can receive the benefits that are due to them.
  • – The Hartford has contacted doctors without claimant knowledge. This is a way to try gaining admission from your doctors that you are still able to work.
  • – This Hartford has also been known to interview physicians that have never worked with you or your condition to rally “facts” and present them in court.
  • – The Hartford has provided benefits then later used their discretion to decide those benefits are no longer necessary.  Summarily canceling the lifeline of benefits recipients like you. 

 

You Can Beat The Hartford And Get Your Disability Benefits!

When applying for your benefits through The Hartford, you need to follow their strict timelines and deadlines. If you do not, it could be cause for automatic denial. In addition to this, you should carefully review all paperwork you fill out so that you are responding to the necessary requests and providing the answers necessarily, in complete detail.   Anything missed, misleading, or factually ambiguous – even a nondated page – could be cause for the denial of your claim and keep you from receiving the benefits you deserve.
Read the list above, again…  These are not folks that will give you the benefit of the doubt. All of these are deceptive tactics exist to get you to give up. Regardless of the intention, it is unfair, and they keep those who have paid for these benefits and now need them as income. Do not let these schemes intimidate you into giving up on your case.

Your Best Option to Fight The Hartford

Your best option to prevent a denial of your disability claim, or to fight an adverse benefits determination is to seek experienced legal representation.  You need a law firm that specializes in long-term disability law, specifically ERISA.
If you have been denied Hartford long-term disability contact our office today.  We have fought on behalf of people like you against The Hartford and many other insurance providers before.

 

Will Unum Approve My Long-Term Disability Application?

 

Will Unum Approve My Long-Term Disability Application?

If you have applied for Unum Long-term disability, you are probably wondering if they will approve your application.

Let’s look at some things that will help your chances of Unum approving your long-term disability application.

Meeting Your Policy’s Definition of “Disabled” Means Making Sure Unum Has All the Evidence

First, gather all of your medical records from your current doctor, past doctors, emergency room visits, and urgent care clinic visits, and anywhere else that may have treated you for your condition.  Do not forget physical, occupation, or mental health therapists, staff or school nurses, and even your friend the EMT medic that you call on occasion for random aches and pains.  We are talking about digging deep, stack the record, do not let Unum say “no” because they did not have a particular record.   
Unum, in their consideration of your long-term disability claim, may also request you to get a letter from your current doctor or have him or her fill out a form, giving their opinion on your condition(s). If so, your doctor should include how your condition affects your ability to perform any duties at your job and whether or not he believes you can work at any occupation. You can talk to your doctor about this, so do not feel like you have to be in the passenger seat while this information gathering phase is pursued. 

Additional Considerations With Unum Long-Term Disability Claims

Full-time Work
Typically, you are required to be working full-time when you become disabled and apply for long-term disability.  Full-time is between 30 and 40 hours per week.  If you have been unable to work up to that full-time schedule for some time, presumably due to your disabling condition(s), you will have to start figuring out how to say why that is.  It is very likely that your Unum insured long-term disability policy has specific statements and requirements along these requirements. You may want to talk to a successful long-term disability benefits attorney to strategize how to approach this issue. 

Waiting Period
Your Unum long-term disability policy will have a waiting period, often referred to as an elimination period.  The waiting period is the time between when you become disabled and when you can receive long-term disability benefits.  Usually, the elimination period of these ERISA governed policies is between three and six months.  Often employers will offer a short-term disability to fill the gap between the end of employability, and the start of long-term disability benefits.  

Pre-existing Conditions
A pre-existing condition is an illness or injury that occurred 90-180 days before your long-term disability coverage began.  If you have a pre-existing condition, you may not be paid benefits for any long-term disability that happens as a result of that condition for the first 12 months of your long-term disability coverage. This is something you should contact a long-term disability benefits attorney about as well.  These situations are nuanced, and anything that might unduly delay or deny you the benefits you have paid for needs to be carefully looked at!

Excluded Conditions
Long-term disability policies do not cover all disabilities.  Many long-term disability policies have a 24-month limitation on disabilities caused by alcoholism, drug abuse, or various other situations.  If you believe your Unum policy might be in jeopardy because of these conditions or allegations of these conditions, again – reach out to an attorney today!

Hire a Long-term Disability Lawyer

Hiring a long-term disability lawyer will increase your chance of being approved for Unum long-term disability.  As lawyers who specializes in long-term disability, we know the ins and outs of Unum disability claims.  We know how they deny claims, why they deny them, and how to beat them.  If you are facing the uphill battle of getting your claim approved, give us a call

The Importance of Medical Documentation in LTD Claims

The Importance of Medical Documentation in LTD Claims

When you file for ERISA long-term disability, it is extremely important to have complete and up-to-date medical documentation in your file.

There have been claims that get denied simply because one thing did not make it into the employee’s claim file.

Medical Records

Having ample medical records supporting your claim is the most important thing you can do to support your case.  If you have medical documentation from several medical professionals, make sure that when you turn in your long-term disability claim file, you include every piece of literature from them even relating to your condition(s).  
Here is a checklist to help you…Medical professionals you may need to collect medical documentation from:

  • * Primary care doctor
  • * Emergency room
  • * Urgent care
  • * Imaging
  • * Lab
  • * Psychologist/psychiatrist (if a mental condition)
  • * Physical therapist
  • * Occupational therapist
  • * Any specialist such as neurology, orthopedics, etc.

 

Opinion or Notes from Your Treating Doctor

Many people know that you need to submit your medical documentation but what they do not realize is that a letter from your treating doctor or even just notes is just as important. 
For example, if you regularly “walk” into your doctor’s office barely able to move due to extreme pain that is uncontrolled by prescription medication, your doctor should be documenting that. 
Or, if you are experiencing severe side effects from medication that is helping your condition, but it is severely impeding to your ability to work, your doctor should also be noting that.

Beyond observations, you should remember that you are and will be your own best advocate in working with doctors.  Not all doctors will do a complete physical exam or accurately document your conditions during your visit.  Not every condition you present with may be necessary for them to administer care in their specialty.  Regardless, you should communicate your overall condition.   You need to convey to your doctor it is important for you to have a complete physical exam and that you have accurate and thorough documentation of your physical or mental condition during your visit, regardless of the purpose of the visit. 

Be Honest and Think About the Medicine Too!

When you go in for a visit with your doctor, you need to be upfront and honest about how you are feeling and how your condition is affecting you (we just covered this above).  However, you also need to be honest about any side effects you may be having from any of your prescription medications.  If your doctor asks you how you are feeling and you say you are fine even though you may be in extreme pain, your doctor will not be able to document that and it will hurt your claim. 
If your doctor asks how you are feeling, and in response, you state that your condition or ailment has cleared up or is not bugging you anymore, that may be all they note.  But, if your medicine (used to get you to that state) has side effects, those side-effects are very important and may, in fact, be more of an impediment to working than the original condition.  An example, leg pain is your condition.  It’s difficult/impossible to work when it’s acute, but when it’s treated you don’t have any more pain.  However, the treatment doesn’t allow you to drive, makes you dizzy, and you break out in sweats occasionally.  You could argue the treatment makes it MORE impossible for you to work than your condition.  The lesson here…report beyond your condition – to include how the treatment makes you feel too.  

Visit Your Doctor Regularly

Even if your initial claim gets approved you need to continue to visit your doctor on a regular basis and follow any instructions your doctor has given you.  If at any time, the insurance company feels you have improved, they can take your benefits away.
For example, if your doctor tells you not to walk more than a few hours a day or lift anything over 10 lbs, you need to follow those instructions.  The insurance company will argue that your condition improved if they can prove that you did not follow these instructions even one time.   Then, they can discontinue your benefits.
If you have questions about what medical documentation you need for your LTD claim, or just need guidance, please feel free to contact us.

 

How a Functional Capacity Evaluation Affects Your Long-Term Disability Claim

How a Functional Capacity Evaluation Affects Your Long-Term Disability Claim

When you file a long-term disability claim, your insurance company will require medical proof that you are in fact unable to perform work. The tricky part of this standard is that depending on various particulars of the long-term disability policy you are covered by; you may not need to be entirely physically, mentally, or otherwise disabled to rightfully justify claiming your benefits.

So, what do long-term disability insurers do to try to figure out your level of impairment and if it genuinely bars you from being able to work at the level defined in your policy? They schedule you for a functional capacity evaluation.

Why Insurance Companies Use Functional Capacity Evaluations

The results of functional capacity evaluations are often controversial. When long-term disability claims get denied, the evidence used by insurance companies is often directly pulled from these evaluations.
Adding to the frustration of many on this point is the fact that in some policies the functional capacity examination is unnecessary and not required.
In short, these evaluations are meant to determine the limits of what you might be able to do for employment. The examination is often physically and mentally demanding, exhausting, and embarrassing. Moreover, depending on the conditions of the person claiming the long-term disability, the functional capacity evaluation could even lead to further injury.
If you are already being asked to schedule one of these evaluations, reach out to us as soon as possible. We will help you figure out if you even need to do one. If you are required to attend one of these exams, we will help you understand what your rights and responsibilities are before your appointment.

What Can I Expect at My Functional Capacity Evaluation?

A Functional Capacity Evaluation (FCE) uses a battery of assessments to determine whether or not you can perform your duties at work. An FCE may also measure cognitive demands as well as your mental health.
You can expect tests measuring your:  Range of motion, Physical strength, Lifting ability, Flexibility, Stamina, Ability to carry objects, & Other abilities needed to perform your job
To evaluate these, you may be asked to:  Get on a treadmill, Crawl, Move different parts of your body, Handle/manipulated objects, Undergo hand-eye coordination tests, Push or pull, Sit, Balance, Stand, Crouch, Walk, Undergo cognitive tests, Lift weights, Reach, Stoop, Grip, Stack boxes, Kneel, Perform tests of dexterity, Perform step exercises
Your evaluator may also ask you questions about your injury, your pain level and which activities you performed or have performed affect your symptoms.

What Does My Insurance Company Get From My Functional Capacity Evaluation?

Your long-term disability insurance company wants to lock down whether you can in any reasonable or conceivable way return to work in full or even diminished capacity. You might already be able to see that they are losing perspective on all how your disability could be (and is) limiting.
There’s no reason for them (insurance companies) not to contest your claim, and if you are not incredibly careful and they use these evaluations as the fulcrum to deny your claim. For example, if your job requires you to lift 50lb boxes in 8-hour shifts, you can expect that the evaluation will measure your ability to perform lifting tasks. Assuming you can lift a 50lb box a couple of times in the presence of a physical therapist at your FCE, the result of the exam may state that you are indeed able to perform work activity, such as lifting moderate weight. You are not disabled from work. However, what the FCE cannot measure is how well you can perform those tasks for eight hours a day, for five days a week, for weeks on weeks.
This example may be more straightforward and simple than an example that applies to your injury. But, the results are often the same; at an FCE you are asked to do simplified approximations of employment activity and a (questionable) profile of your employability is built from the exam. They have broken your abilities down to a set of numbers that they can use to great effect against your long-term disability claim.

How will an FCE affect your LTD claim?

There are three ways that your Functional Capacity Evaluation might affect your long-term disability claim.
1. The FCE shows that you are unable to perform any duties related to your job. (Will help your claim)
2. The FCE shows that you are unable to perform some duties related to your job, but you can still perform light duties.
(This is a tough situation, you should reach out to us directly to get some advice on moving forward here)
3. Shows that you are fully capable of performing all duties related to your job.
(Claim will be denied, even if the examination results are erroneous)

Protecting Yourself from a Functional Capacity Evaluation

Regardless of what you expect from a functional capacity evaluation, even if you think there is no way it could come back and harm your claim, you should reach out to speak with a long-term disability benefits attorney. The timelines on long-term disability benefits claims are very tight, and the window for steps in appealing wrong determinations are strict.
The absolute best thing you can do is avoid potential pitfalls in your long-term disability claim (such as submitting to an FCE). If an FCE has already burned you, the second best thing you can do is get on board with someone who knows how to fight insurance companies at their own games. Contact us today!

 

 

Additional Information:

Functional Capacity Evaluations

 
 

Do I Need Other Benefits Other Than Long Term Disability?

Do I Need Other Benefits Other Than Long Term Disability?

No matter where you are in the process of applying for long-term disability, you may be asking, “How long does long-term disability last?”

You may also be wondering if you need other benefits along with your long-term disability benefits.

Many different factors determine how long your long-term disability benefits will last. The first step is to figure out when they will start. 

This is most often the biggest determining factor of how long you will receive benefits.

 

Elimination Period

All long-term disability policies have an elimination period.  This is the time from when you make a claim to when you are eligible to start receiving benefits.  There are a few different types of elimination periods.

You also have short-term disability: If you have also have short-term disability, you will have to use this first before receiving long-term disability benefits.  This can be for up to 26 weeks before you long-term disability benefits can begin.

Your policy requires you to use all of your sick leave: Some policies will require you to use any sick leave you have accrued before you begin long-term disability.

You only have long-term disability: If you do not have short-term disability on your plan, then the elimination period can be anywhere from 6 weeks to one year before you begin collecting benefits.

Other Factors

Other factors that will determine when your benefits will start are:

  • Your health: The more health issues you have, the more medical records will need to be requested which can increase the time it takes for the insurance provider to make a decision.
  • Request for follow-ups: The insurance provider may ask you for multiple follow-ups if you do not submit everything they need.
  • Your Doctor:  If your doctor does not fill out the required paperwork promptly, it can delay your decision.
  • Your inial claim gets denied: If your initial claim gets denied, then you will need to appeal which will greatly increase the time it takes for you to start getting benefits. It can add an additional 270 days to your decision timeframe.

You can also read our article How Long Does it Take to Get Long-term Disability? for more information that may help you answer “How long does long-term disability last?”.

How Long Your Benefits Will Last After Approval

Once you are approved for benefits, the amount of time they will last is determined by what long-term disability policy you are/were covered by.
The typical choices for benefit periods are:

  1. Two years
  2. Five years
  3. Ten years
  4. To age 65
  5. To age 67
  6. To age 75 (only if you are still working full time)

On average, an individual long-term disability lasts 2-3 years.

Termination by the Insurance Provider

You could end up needing additional benefits if you do not meet the conditions outlined in your policy.  As you might have surmised this is a common reason to hire a long-term disability attorney.  Insurance companies like to deny claims after the fact, claiming that you are magically better and able to work now. 

Conditions that must be met to avoid an early insurance termination: 

  • Request for medical evidence: At any time your insurance company can request additional medical evidence.  If the insurance company feels that your medical evidence does not support your claim of total disability, your insurance company can terminate your benefits.
  • Getting treatment: If you are not seeking and attending reasonable treatment, your insurance company may terminate your benefits.
  • Not completing rehabilitation plans: If you do not follow through with any rehabilitation plans, your insurance company may terminate your benefits.

 

Do You Need Other Benefits?

Some insurance policies require you to apply for Social Security Disability (SSDI) to continue receiving long-term disability benefits after a certain time.  Once you are approved for SSDI, then your long-term disability insurance will pay you the difference between what you receive from SSDI and what you would receive from LTD.
To truly find the best answer, you should consult with a disability attorney who can look at your long-term disability policy and help you decide if applying for other benefits is needed.  You can contact us for help today!

Three Occupations with Higher Risk of Needing Long-Term Disability

Three Occupations with Higher Risk of Needing Long-Term Disability

The top six reasons people find themselves needing long-term disability, in order, are musculoskeletal or connective tissue (muscles, back, and joints) issues, nervous system related issues, cardiovascular or circulatory issues, cancer and neoplasms (tumors), mental disorders, and injuries and poisonings.

The cause of any of these challenges may not necessarily be related to your vocation; however, what we see when we take a step back and look at the big picture is that certain jobs correlate with higher likelihoods of workplace injuries. In fact, your profession might be a higher indicator of needing long-term disability than many of the other genetic or environmental factors you concern yourself on a regular basis.

If you are in one of the following four occupations you have a statistically higher risk of needing long-term disability benefits at some point in your lifetime.

Professions At Risk of Needing Long-Term Disability: Building and Grounds Cleaning and Maintenance

Building and grounds cleaning and maintenance workers have a higher risk of needing long-term disability due to the physical and unpredictable nature of their work. These employees are often required to walk, stand, sit, climb, stoop, kneel, crouch or crawl, and lift or move up to 100 pounds on a daily basis.
In addition to that, building, grounds, and maintenance workers use tools such as mowers, trimmers, and other powerful devices to fulfill daily functions. Even with proper training and personal protective equipment, proximity and familiarity with power tools come at increased risks of injury.
The manual labor aspect of these professions should not be overlooked either. Repetitive physical activity can cause muscle, back and joint issues from overuse or reoccurring use of the same muscles and joints.
Poisoning is another rare, but not unheard of, injury that can afflict these professions. Especially if the employees work with insecticides, fertilizers, industrial solvents, or other chemicals on a regular basis.

Professions At Risk of Needing Long-Term Disability: Transportation and Material Moving Professions
Transportation and material moving occupations range dramatically from bus drivers and flight attendants to excavating equipment, crane, and dragline operators. Many significant injuries for transportation-related jobs (bus drivers, truck drivers, flight attendants, pilots, etc.) are directly related to vehicle accidents. These injuries could also include non-accident-related muscle and joint issues for long-term sitting or position-holding. Or even cardiovascular or circulatory concerns from partially sedentary-like activity.
Air traffic controllers, transportation managers, and other similar professions may also experience mental health challenges due to the elevated stress of their jobs.
And for the transportation workers engaged in material moving occupations, they are more likely to suffer from injuries resulting from close work with large, awkward, and physically demanding tools and machinery.
Again, poisoning, respiratory issues, and cancers can be a risk for some transportation-related jobs as well. Especially those jobs that are centered around transporting hazardous waste and materials.

Professions At Risk of Needing Long-Term Disability: Personal Care, Healthcare, Nurses, and Doctors

Personal care workers take care of the elderly or disabled. Their jobs include consistent lifting (transfers), bending, kneeling etc. while performing housecleaning duties, personal hygiene duties (showering, bathing, changing). This activity can lead to musculoskeletal and connective tissue issues. Mental health challenges such as depression are also common among personal care workers and healthcare workers in general.
Healthcare workers including Nurses, Doctors, and others are consistently are on their feet, bending, kneeling, lifting, and working in austere conditions. Many healthcare professionals experience musculoskeletal and connective tissue issues, especially in their back and knees. It is also common for doctors and nurses to have injuries related to unpredictable and unforeseeable interactions with patients.
These reasons are just a brief summary of why medical professionals are among the most common workers that find themselves needing long-term disability benefits.

Are You at Risk of Needing Long-Term Disability Insurance Benefits?

Or, have you experienced an injury or illness and now are unable to work at the same level you were in the past?
If so, the unfortunate reality is that you might be in for a fight with your long-term disability insurance provider just to receive the benefits that are supposed to be guaranteed to you.
To ensure you get your long-term disability benefits claim approved or your adverse benefits determination appeal, you should reach out to an ERISA disability attorney.
In fact, contact us here, and we will help you today.

 

 

Additional Resources

BLS: Occupational Employment Statistics

Stress in Air Traffic Control

Disability and Occupation Datasheets

The Disability Disconnect 

 

 

Understanding The Different Types of Disability Claims

Understanding The Different Types of Disability Claims

If you are just dipping your toes into this world of disability claims and appeals, you might be swimming in information that is challenging to make heads or tails of.  One of the big things most people do not realize right away is that there are several different types of disability claims.  Each type of disability has its own purpose and rules for eligibility and appeals.  

Below you will find the four main types of disability claims and a breakdown of what you need to know to differentiate their purpose and applicability to your situation.

And, if you still cannot figure out how or if these apply to you, contact us today and we will be happy to help you figure it out!

 

Long-Term Disability & ERISA 

Our focus is on long-term disability benefits.  These are benefits provided by an employer-sponsored benefits plan or occasionally purchased separately on your own.  Long-term disability benefits are provided by a third party insurance company and usually kick-in after 3-6 months of your being disabled from working (after short-term disability). 
Unlike Social Security Disability (SSDI), which is also available to those who have recently worked, but are unable to do so due to an injury, long-term disability insurance is governed and regulated through an entirely different process.  The regulating standard for employer-sponsored long-term disability policies is known as ERISA.  
ERISA – The Employment Retirement Income Security Act of 1974, was enacted to protect and standardize employees’ employer-sponsored insurance & pension benefit plans. 
ERISA lays out strict guidelines and deadlines that must be followed by insurance companies and the employer providing long-term disability insurance plans. ERISA is enforced and administered by the Labor Department’s Benefits Security Administrations, the Treasury Department’s Internal Revenue Service (IRS), and the Pension Benefit Guaranty Corporation.

Social Security Disability (SSDI)

SSDI is a Social Security program that pays you monthly benefits if you are unable to work due to an injury or illness.   SSDI is funded through payroll taxes and is very much like a government-sponsored insurance program designed to provide compensation to you if you become unemployable due to disability.  To be eligible for social security disability, you must meet the following requirements: 

Work Credits

You earn up to four work credits each year that you work.  How many credits you need to be eligible depends on what age you are when you become disabled.  For example, if you become disabled at age 44, you need 22 work credits (or 5.5 years of work) and at least 5 of those years must have been in the last ten years to be eligible.  A Social Security Disability Attorney can work you through the specifics of work-credits and eligibility.

 

Medical eligibility

SSDI benefits are only given to those who have a severe, long-term, total disability.  Severe means your disability must cause you to be unable to perform basic work-related activities.  Long-term means your disability has lasted at least one year.  Total disability means that you are unable to perform substantial gainful activity (SGA) for at least one year.  If the SSA finds you can perform SGA, then you will not be eligible.

Age requirement

You must be younger than retirement age (65) when you become disabled.

If you are approved for SSDI, you will not receive benefits until you have been disabled for a full five months.  If you are approved right away, you will need to wait until month six until you receive benefits.  If you are not approved for more than five months, then you will receive your benefits and any back pay going back to month six.  If you are denied benefits, you can appeal the decision within 60 days of receiving the denial letter.

 

Veterans Affairs (VA) – Service & Non-Service Connected Disability 

To receive disability benefits from the VA, you must have a disability that was caused by or made worse because of your active military service. This condition could be a physical illness or injury or even a mental-health diagnosis.  Also, you may be eligible even if your conditions do not appear until years after your service ends.
Benefits for service-connected disability are based on a disability rating.  The scale for service-connected ratings is broken up in 10% increments from 0%-100%. The overall rating is designed to compensate for wages lost caused by the injury or illness.  If you are 60% disabled through the VA – the logic is that the compensation you receive at that rating is relative to your loss of function from your injuries.
Eligibility requirements:

  • Service in the Uniformed Services on active duty OR
  • Active duty for training OR
  • Inactive duty training AND
  • Discharged under other than dishonorable conditions AND
  • At least 10% disability rating caused while on active duty or active duty for training or inactive duty training

Evidence Required

  • Medical evidence of current physical or mental disability AND
  • Evidence of service connection between your service and disability

If your disability claim is denied, you have the option to appeal.
VA non-service Connected benefits are similar to SSI (see below).  They provide a baseline level of (emergency) support for anyone who has served honorably. 

Supplemental Security Income (SSI)

SSI is a social security program that is based on needs according to income and assets.  It is funded by general taxes.  This program does not look at your work history, unlike SSDI.
Eligibility requirements:

  • Age 65 or older
  • Blind or disabled
  • Income such as wages, social security benefits and pensions must not exceed a certain amount based on the state in which you live.
  • Resources (savings/checking account, IRAs, etc.) cannot exceed more than $2000 for individuals or $3000 for a couple.
  • Citizen or eligible alien

Children under 18 may also qualify for SSI if they have certain disabilities. You can check with Social Security for a list of approved disabilities.
If you are denied benefits, you can appeal the decision within 60 days of receiving the denial letter.

Need More Clarification?

If you have questions about any of these types of disability claims or need help to apply or appeal a decision, contact us today, and we will point you in the right direction.

 

 

 
 

 

 

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Long Term Disability Attorney https://www.disabilityinsurancelawfirm.com/long-term-disability-attorney/ Fri, 25 Oct 2019 15:41:11 +0000 https://www.disabilityinsurancelawfirm.com/?p=1658 Five Questions to Ask A Disability Lawyer Near You  Not every type of Disability Law is the same. This simple fact confuses potential clients all the time.  So, how can you both find the right type of disability law firm, and simultaneously find the best one for your case? Our suggestion, structure your exploration of [...]

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Five Questions to Ask A Disability Lawyer Near You

 Not every type of Disability Law is the same.

This simple fact confuses potential clients all the time. 

So, how can you both find the right type of disability law firm, and simultaneously find the best one for your case?

Our suggestion, structure your exploration of law firms.

Or to be more direct?  Start with these six questions and move on from there.

Who Else Will Be Involved In My Case? 

Almost every law firm uses a team of attorneys, paralegals, and other support staff to develop your case/claim.  In fact, it’s possible that the paralegal may become your go-to person for updates on your case status.  The reasons for this are simple, the division of labor.  You want your attorney ready to bring your best arguments forward in court.  They need to be abreast of new laws, and the latest arguments.  You certainly don’t want to have them spending time running down records!  But they should have a team that is excellent at this exact thing.  
This isn’t to say you should never talk to your attorney either.  You most certainly should have that chance.  It’s just more true that you will likely develop a great relationship with one of their paralegals or case managers as well.  You might as well ask up front to know more about them!

Does the Firm Have a Communication Policy?

Up front, you should ask how regularly the firm will communicate with you, or how often they ask that you communicate with them.  Some issues in disability law are resolved in weeks, and others are resolved in years!  You might be in this situation for a long time…at some point, you will wonder what’s happening with your claim or case.  Instead of waiting in silence, ask a question, or questions, that will lay the groundwork for how, when, and why you will be getting and giving updates with your disability law firm. 

Does the Firm Do Other Types of Law?

Many firms represent clients in multiple areas of law.  This is not necessarily a bad thing.  In fact, often the types of law that firms represent clients are complimentary.  Disability and Bankruptcy, or Family Law & Estate Planning, for instance.  Within these types of firms, lawyers can wear multiple hats too.  So, it is pertinent in two ways to know what, if any, other types of law your disability lawyer(s) handle.  First, it might be that you need their help in some other facet during the course of your claim.  And second, you should ask, openly, whether their representation in multiple areas will be a conflict at any point, or will be a barrier in any way. 

Can You Guarantee My Claim Will Be Approved? 

This is a bit of a trick question.  No one should be guaranteeing you success in your disability claim or case.  But a good disability law firm will be able to describe to you how they can prepare your case for the best possible chances of success.  In fact, they should have no trouble giving examples and describing a basic strategy to you within a couple minutes.  If someone guarantees success, be cautious.  However is someone describes to you how he or she can bring your case to a point where there is a high likelihood of success, be curious!

How Much Will It Cost Me if My Claim Is Not Approved?

Lastly, you have to ask about the dollars and cents!  There are many different ways that fee agreements might get structured.  Often these are on contingency, and there’s no expectation for a client to pay anything if a case is lost.  Not everyone has the same philosophy on this.  It’s OK to ask, in fact, it’s best to ask this as soon as possible.  While disability law firms want to help you, this is a business too.  Asking about price is to be expected.  

 

Are Disability Attorneys Near Me Any Good?

Are Disability Attorneys Near Me Any Good?

No matter what stage you are in when filing a claim for long-term disability, hiring a disability attorney can be helpful.

Hiring a local disability attorney or hiring a big, law firm from out of state is one big decision you need to make.

Many people ask themselves, “Are disability attorneys near me any good?”.  Let’s talk about what makes a good disability attorney and then compare disability attorneys near you and big law firms that may be out of state.

 

A Good Disability Attorney

What makes a good disability attorney?  There are many traits that you define a good long-term disability attorney.  Here are a few to look for:

  • Professional and courteous – When you call a long-term disability attorneys office, you should be treated respectfully and courteously. You should feel important and taken seriously. Attorneys offices are very busy, but you are too so you should have your phone calls answered or returned promptly.
  • Honesty – A good disability attorney should not promise you that they will get your claim approved. They should be honest about what changes you may have as well as give you a rough timeline of how long it will take.
  • Case Management – You should be provided with a case manager or someone similar who can answer your questions and help you with your case when your attorney is not available. They should also keep you up to date on where your case stands.
  • Experience – You want a disability attorney that has experience in long-term disability cases. They have strict deadlines and guidelines that need to be followed, and if your attorney has had experience, then they will be familiar with them.  There are differences between Long-Term Disability, Social Security Disability, VA Disability, and other types of disability.  You are looking for long-term disability, specifically.

 

Disability Attorneys Near You

What is the advantage of hiring a disability attorney near you?  One of the biggest advantages is that local disability attorneys will know local and state laws.  Another advantage is that local attorneys will also be familiar with the Administrative Law Judges (ALJ) that may be overseeing your case should you go to court.  This is important because if they know what the ALJ is looking for, they know what types of evidence to provide to improve your chances.
Having a disability attorney near you, allows you to meet with them face to face before you hire them and to be able to meet and check in with them during the process as well. However, national law firms have their bonuses too!

Big National Law Firms

National disability attorneys can often still do just as good of a job as a local attorney.  The biggest disadvantage is that you may not even meet or speak to them until you need to go to court.  They may also not be as familiar with local and state laws.  However, they may practice more cases on a per-year basis simply due to the bigger market.  You could be trading contact for experience.  

Whom Should You Work With?

There is no good answer for you on this – work with the firm that makes you most comfortable.  This is a big decision, and you should take the time to get it right.  However, you are under the clock to get your claim and appeal finished, so do not take too long! If you need help, reach out to us, and we will be happy to help.

 

Is There a Difference Between Disability Attorneys?

Is There a Difference Between Disability Attorneys?

There are many types of disability attorneys.

So, is a difference between types of disability attorneys?

The answer is yes…and no.  You might be confused about this answer so let’s break it down.

Some of the Differences

The most significant difference is what type of disability the disability attorneys practice.
There is:

  • Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI)
  • Veteran’s (VA) Service-connected disability
  • Long-term disability
  • Short-term disability

SSI and SSDI are both programs through the Social Security Administration.  The same disability attorneys work with clients for both SSI and SSDI.
VA disability is for Veterans who have a disability that was caused by or worsened by a service connected event.  You want disability attorneys who specialize in Veterans affairs.
Often Social Security disability attorneys work with VA disability as well.  There are a lot of similarities between the two types of disability, from a procedural and practical standpoint. 
On the other hand, long-term and short-term disability attorneys tend to specialize solely in those types of disability. This is mainly because of special laws that apply to those types of disability – namely, the Employee Retirement Income Security Act of 1974, ERISA.  

A Couple More Differences

Even though all types of disability attorneys are familiar with your state’s disability laws, every kind of disability has its own laws and deadlines to follow.
For example, long-term disability attorneys must follow strict guidelines and timelines within ERISA laws.  There are also specific rules for the appeals process, so long-term disability attorneys must understand the ERISA laws and guidelines.
Social Security Disability attorneys need to know not only state disability laws but also federal disability laws.  They also need to understand the strict appeals process for social security.

There are Some Similarities

All disability attorneys are there to help you with your disability claim.  They can assist you in filling it our your initial application, or if you receive a denial letter, they assist you to write an appeal letter.  Disability attorneys will also gather medical evidence to prove your claim and represent you if your case ends up going to court.

How to Know Which One You Need

To determine which type of disability attorney you need, you first must know if you are applying for SSI/SSDI, VA service-connected disability, or long-term/short-term disability.  Once you determine that, you can start looking for disability attorneys who practice in the area you need.
Here is an article from our blog that helps break down how to find a good attorney that will help you
Once you find the right type of disability attorney to help you, set up a consultation, read about the potential issues, and come prepared to ask questions.

 

What is the Cost of an ERISA Attorney?

What is the Cost of an ERISA Attorney?

After you have decided to file a long-term disability claim, your next biggest decision is whether or not you are going to hire an ERISA attorney.

If you are like most people, you may be concerned about the cost of hiring an ERISA attorney.

The cost of hiring an ERISA attorney varies from person to person depending on how much they are awarded for benefits, and from law firm to law firm, depending upon what they charge. 

ERISA Attorney Fees

The majority of ERISA attorneys charge little or no upfront money. They instead work on a contingency basis, meaning they will only collect if you receive benefits.  The percentage of your benefits that will go towards the attorney is usually between 25% to 40% of your settlement amount or monthly benefits.

Understand and Negotiate Your Attorney’s Fees

Before agreeing to any contingency fee, make sure you understand what the fees will cover.   Most fees do not cover things such as copies, long distance phone calls, or postage.
You can also negotiate the attorney fees.  If your attorney quotes you at 40% of your settlement or benefits, you can make a reasonable counter offer.  If you and your attorney cannot come to a number you feel comfortable paying, you can also shop around and see if there is a different attorney that charges closer to what you feel comfortable paying
Remember though, that you may get what you pay for.  A less expensive attorney might not have a lot of experience.
Also, keep in mind that the attorney fee will come out of your benefits whether you receive a lump sum or monthly payments.  Find out if the attorney will be receiving a percentage of past due benefits or future benefits as well.  Make sure you understand everything before agreeing to pay your attorney any portion of future benefits.

Your Long-term Disability Carrier May Pay Your Attorney’s Fees

There have been cases where the long-term disability provider paid attorney fees. In these cases, there has been an unreasonable nature of denial.  You do not necessarily have to win your claim either (you only need to show a degree of success on the merits).   It is entirely up to the judge to specifically order the carrier to pay.
Five factors the judge will look at before deciding:

  1. Did the opposing party act in bad faith?
  2. Is the opposing party able to pay an award of attorney’s fees?
  3. Will an award deter others from engaging in similar conduct
  4. Did the party requesting fees obtain a benefit for other plan participants through the litigation?
  5. What are the merits of the parties’ positions?

The awarded attorney’s fees will not cover the attorney’s time spent on the administrative appeal within the insurance company.

Other Expenses Related to Your Case

ERISA attorneys typically will cover other costs associated with your case but will require you to reimburse them after your case is completed.  Some of these costs are:

  • costs of obtaining medical records or expert opinions
  • travel expenses
  • depositions
  • filing fees
  • postage
  • copying costs, and
  • long-distance phone calls

These are separate from the attorney’s fees and may be required to be paid even if you do not win your case, when you reach out to a long-term disability law firm, make sure you ask about this! 

 

Will My Disability Lawyer Drop My Case?

Will My Disability Lawyer Drop My Case?

If you have hired a long-term disability lawyer, you may be concerned that your disability lawyer will drop your case.

This could not only delay the claims process but cause you to have to find another disability lawyer.

Unfortunately, there are some reasons that a disability lawyer may drop your case.

So, let’s cover those up front and help you retain your attorney for the long-haul.

Not Fulfilling Requests

One reason your disability lawyer may drop your case is if you are not fulfilling their requests.  If your lawyer has asked you to send them the contact information for your doctor and you have not done so, they cannot proceed with your case. Therefore, they may drop you.  Also, if you are not fulfilling their requests promptly or the by the agreed amount of time, will cause your disability lawyer to drop your case.

Not Honest

If you are not honest with your disability lawyer, they will not be able to represent you or help you with your claim.  You need to be completely honest and do not exaggerate the truth.  Not only do you make their job harder, but you make yourself look unreliable which can negatively impact your claim.

Lack of Medical Evidence

If there is not a sufficient amount of medical evidence to back your claim, then you will most likely not win your case.  A disability lawyer may drop your case if they cannot collect enough medical evidence to prove that you are unable to work and need to collect long-term disability benefits.

Alcohol and Substance Abuse

If you have an alcohol or substance abuse problem that is untreated and you are not upfront with your disability lawyer, they will drop your case if they find out.  Most disability lawyers will work with you if you can prove that you are seeking treatment and that your disability would still exist even if you did not struggle with alcohol or substance abuse.

You Went Back to Work or Started Collecting Unemployment

A disability lawyer will drop your case if you go back to work or start collecting unemployment.  Long-term disability benefits will not be given to you if you do either of these things and you will not need a disability lawyer to represent you.

Taking Too Long

Sometimes the claim process takes a very long time especially if you get denied.  Disability lawyers will put a lot of time and effort into helping you with your initial application and then on your appeal.  Sometimes even a second appeal (not all insurers allow 2nd appeals).  Once you get to the hearing stage, there is even more time and effort that needs to be put in to win the claim.  If a disability lawyer feels that the time and effort required does not balance out with the potential benefit (whether you win or not), they may drop your case.

Issues with Previous Lawyers

If you have worked with a previous disability attorney on the same claim, and they dropped you because of something you did or did not do, then your current disability lawyer may drop you too.  If you have a reputation of not being cooperative, lying, or mistreating another disability lawyer and your current lawyer finds out, they will not want to work with you either.
If you have been dropped by your disability lawyer and would like us to look at your case, contact us today.

 

Choosing the ERISA Attorney That Will Beat Your Long Term Disability Denial

Choosing the ERISA Attorney That Will Beat Your Long Term Disability Denial

Have you been denied ERISA long-term disability

If so, you should be looking for an ERISA attorney to help you beat your denial.

In this article, we will show you where to find ERISA attorneys and how to choose the right one for you.

Where to Look for an ERISA Attorney

ERISA is the Federal Law that governs most employer sponsored long-term disability policies.  If you’d like to know more about ERISA and if it applies to your long-term disability claim, take a look at our article, ERISA Disability Denials.

Search Engines

This suggestion probably seems a bit elementary, but there’s an adage with data and search, “junk in, junk out.”  Most people don’t know upfront that there are different types of disability lawyers, so they do a general search for “disability appeal,” or some variation thereof.
Knowing that you need an ERISA lawyer to help with your appeal, you should redo your search in Google, Bing, Yahoo, or whatever other search engine you prefer.  Make sure to filter by location, or just add in “ERISA Lawyer near me,” as your search term. 
The best part about searches like this is that you can quickly review 5-10 disability attorneys in a couple minutes. Here’s an article that breaks down how you can tell who the best one to handle your long-term disability claim will be.

Findlaw, NOLO, and AVVO

There are a lot of websites that exist to match potential clients with attorneys willing to pay for the leads.  Perhaps the most popular are, Findlaw, NOLO, and AVVO.  On each of them, you can choose which location you are looking in and choose what area of practice (in this case ERISA long-term disability).  You will then get a results list that will tell you the name of the attorney, where they are located (along with contact information), reviews, and links to their website if they have one.  This makes it easy to compare each ERISA attorney at a glance.
Again, these are attorneys that pay for your lead, so you may not be getting the whole picture of available help by going to these sites.  One of the benefits with these sites, however, is that they compile reviews and even provide colleague reviews.  Take a look at Jeff Warncke’s Avvo page, for instance. 

Recommendations

Ask around.  Talk to your HR rep, co-workers, union rep., friends, family, Facebook network…  Any one of these people or groups may have had contact or connection with a long-term disability attorney.  Choosing the right ERISA attorney is critically important to your disability appeal!

How to Choose an ERISA Attorney

You should aim to choose around three to five good ERISA attorneys that you think would be best for you. 
Call each office and set up a consultation (most offer free ones) to meet with them.  When speaking with them on the phone and during your consultation things you should look for are:

  • * Courtesy: Are you treated with respect and like you are important from the time the phone is answered until the end of your consultation? If you do not feel comfortable at any point during the process, then that is not the ERISA attorney for you.
  • * Professionalism: Do the attorney and staff behave professionally? Are they organized and prepared when you show up for your consultation?  If they seem unprofessional and unorganized, they probably will handle your case the same way and will not be a good fit for you.
  • * Communication: You are busy, and so are the ERISA attorneys. That is why it is important that you receive a call back promptly if you need to leave a message.  It is also important that if you are unable to speak to the attorney, you are able to speak with a caseworker or someone who will be available to answer your questions.

While meeting with the ERISA attorney, some things you should ask about are:

  • * Experience: Find out how much experience the attorney has with ERISA long-term disability. Do they work exclusively with ERISA or is that only a piece of what they practice?  This is important because ERISA has strict deadlines and guidelines and if the attorney is not aware of these, this can greatly affect your outcome negatively.
  • * Approval rates: Asking what their approval rate is gives you a good idea of not only how often they win cases, but you can also tell if they are going to try to make it sound like you are guaranteed to win your case. No ERISA attorney can guarantee a win.

 

Now What?

Once you have met with the three ERISA attorneys you choose, think about your experience with them and decide which one you felt the most comfortable with.  If you did not like any of them, do not worry.  Just go back to your search results and pick a few more.  Just because you set up a consultation, that does not mean you have to work with them.  You want to make sure that you choose the ERISA attorney that is best for you because that will make it easier for you to be honest with them and ask the necessary questions to help your claim.
Of course, we’d love to make your short list too.  We focus on beating insurance companies at their own game and have helped many people just like you in ERISA long-term disability claims
Contact us today for a consultation of your case.  

 

Do Insurance Companies Work with Long-Term Disability Lawyers?

Do Insurance Companies Work with Long-Term Disability Lawyers?

If you are filing for long-term disability or appealing a long-term disability denial and have hired a long-term disability lawyer you may be wondering if your insurance company will work with your lawyer.

The short answer is no. 

Long-term disability insurance providers will do their best not to have to pay you long-term disability benefits.  They hope you do not lawyer-up and will still make you (and your lawyer) jump through hoops all over the place to get the benefits you have paid for and earned. 

However, having a disability lawyer makes their job of denying your benefits exponentially harder.  Your disability lawyer knows their tricks and will be on your side to counter them at every step.

Here are a couple ways that insurance carriers play dirty and why you want an attorney to fight back.

Unfair or Bad Faith Insurance Carriers

Some long-term disability insurance providers will deny your claim for unfair reasons.  They act in bad faith by:

  • Requiring excessive, unnecessary, or duplicate information
  • Delaying your claim for an unreasonable amount of time
  • Denying a valid claim for invalid reasons
  • Paying lower disability benefits than what is stated in your LTD policy

 

Damaging and Unfair Evidence Collection

Insurance companies will hire private investigators to follow you around and record your day to day activities.  They are trying to “catch” you doing things that you either claimed you could not do or that your doctor said you are not supposed to do.  They will only show the footage that supports their denial.
For example, you could suffer from severe back pain and not be able to bend.  While you were being recorded, you dropped your mail and bent to pick it up.  The insurance provider, whom you’re actively fighting, will use an excerpt from spy footage of this event to their advantage.  They will say, you can bend over, you are lying in your application and can work. 
Of course, they will not show that when you stood back up you were in extreme pain and had to sit down for an hour with an ice pack to recover.

Closed Record

Another tactic that the insurance company uses is not to tell you that your record will be closed when you go to an administrative hearing.  That means that you cannot add any additional or new medical evidence to support your claim.  In this scenario, your lack of institutional and legal knowledge is being used against you in the most frustrating way?  How do you know what you don’t know? 

When to Hire a Long-term Disability Lawyer

So, when should you hire a long-term disability lawyer?  As soon as possible! 
It does not matter which step of the process for obtaining your long-term disability you are in. 
Typically, long-term disability lawyers will give you a free consultation, so you do not have anything to lose.

How a Long-term Disability Lawyer Will Help

Long-term disability lawyers know the tricks that insurance companies use to avoid having to pay you benefits.
Long-term disability lawyers will:

  • Help you gather all necessary medical evidence to help your claim.
  • Fight any recordings the private investigator may use
  • Make sure the insurance company is not delaying your claim unnecessarily or requesting excessive, unnecessary, or duplicate
  • Review your LTD policy for the definition of disabled as well as the benefit amount you should receive.
  • Prepare you for your hearing
  • Question professional witness
  • Hire vocational experts to help determine if you can do your own occupation or any occupation.

Insurance companies rely on the fact that you do not know the rules and procedures and will use that to their advantage.  Beat them by getting an expert of your own!

Get Your Own Long-Term Disability Expert

If you need to speak to a long-term disability lawyer about your claim, we are here to help.  It does not matter what stage of the long-term disability process you are in. 
Contact us today for a free case evaluation.

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Long Term Disability Appeal https://www.disabilityinsurancelawfirm.com/long-term-disability-appeal/ Fri, 25 Oct 2019 13:47:06 +0000 https://www.disabilityinsurancelawfirm.com/?p=1656 Should You Write Your Own Long-term Disability Appeal Letter? You applied for disability and were denied!  Should you write your own disability appeal letter or hire an attorney to help you?  While it is possible for you to write your own disability appeal letter,  most do not feel comfortable doing so.  There is a lot that [...]

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Should You Write Your Own Long-term Disability Appeal Letter?

You applied for disability and were denied!  Should you write your own disability appeal letter or hire an attorney to help you? 

While it is possible for you to write your own disability appeal letter,  most do not feel comfortable doing so.  There is a lot that needs to be understood and put together to write an excellent disability appeal letter.  You should consider working with an attorney to get the best possible letter and strategy crafted.  

If however, you are committed to writing your own disability appeal letter, here are some tips to follow.

 

Read And Understand Your Denial Letter

Your long-term disability denial notice should give you a detailed description as to why you were denied.  It will also provide you with deadlines for appealing your decision as well as requirements for filing.  Here is the timeline you need to know for your appeal.  

Request Your claim File

Request your claim file from your insurance company via certified mail, return receipt requested.  Federal law states that the insurance company must provide you with a copy for free. Looking through your c-file, it may become obvious to you that you are missing certain pieces of evidence that would support your claim.  Start making a list of what is missing from your c-file and what you need to get to stack the record in your favor.  Do not take half steps on this; you want to overwhelm the insurance company with evidence.  Even if some of the evidence is underwhelming, you will not be able to add evidence after the appeal has been finalized. 

Obtain A Copy Of Your Insurance Policy

While you are waiting on your c-file, request a copy of your long-term disability insurance policy from your company’s human resources department.  Federal law states that you must be provided a free copy, and they are used to requests like this, so do not feel like you are imposing.  This is your claim and you have a right to that information.
If you are unable to obtain a copy for any reason, be sure to include that in your request for your claim file.  And get ahold of us, we can help you get past these types of barriers. 
Your insurance policy will tell you what the insurer considers disabled and what requirements you must meet to receive disability benefits.  These are going to help you understand how to frame your talking points and appeal strategy.

Collect All Documentation

Include all relevant documentation from your doctors (this includes any doctor you have seen for the condition in which you are claiming), medical tests, personal statements from friends and family stating facts about your condition, statements from your doctor, and other pertinent forms in your appeal letter.
The goal is to make sure the insurance company has everything it needs to make a decision. 
If you have any new supporting information, include it as well. 
Do not forget employment records stating how your condition affected you at work, including accommodations that needed to be made for your productivity.

Find decisions from other agencies about your disability

If you also applied for Social Security Disability or a for a retirement disability plan and were approved, submit these approval letters with your appeal as well.  This shows that other agencies have found you to be disabled.  In some cases, this must be addressed in denials.  They, the insurer would need to provide a basis why they do not believe you to be disabled from work when Social Security believes you to be.  

Compose Your Letter

Before you compose your letter come up with a list of issues from your denial that you disagree with or think you have documentation to challenge.  When composing your letter, include the items from this list along with the documentation. Your letter should also include:

  • Case or member number of the claimant
  • The reason the claim was denied
  • Short description of the disability
  • Corrections of any errors found in the original claim
  • Facts as to why the denial was wrong (include medical evidence or doctor’s personal statement)
  • Copies of the original application, denial letter, and medical documentation.

 

Meet All deadlines

Your insurance is required you to provide you time to complete your appeal letter and send it to the insurance company.  If you miss this deadline, then you will be unable to appeal.  Even though you have up to 180 days to fully complete the appeal process, it is best to get started as soon as possible.  If you wait until the last minute to start working on your disagreement with your insurer, you very well might end up leaving out evidence that would have decided the claim in your favor…simply because you did not have time to collect it!

Let Us Review It 

Writing your own disability appeal letter is possible, though it may be overwhelming.  If you need help or have questions, you can contact us.  We specialize in long-term disability cases and will help you.  We will be happy to review your work and give you ideas.  

 

Avoiding Common Disability Appeals Mistakes

Avoiding Common Disability Appeals Mistakes

Even if you make no mistakes at all in your long-term disability claim, you still may end up finding yourself denied.  If you have been denied your disability, you are now up against a wall, and a clock is ticking away – slowly but surely closing the door on your opportunity to obtain these benefits.    Many claimants find themselves searching google, and blogs like this, for answers and direction on their disability appeal.  For that reason, we are laying out a list of the most common disability appeals mistakes we come across.  

If you know the mistakes of others, you can avoid them.  And if you need help, reach out to us today.  We are successful in over 95% of our cases!

 

Not Providing Adequate Disability Documentation

One common mistake in Disability claims and appeals is believing that solely because your employer says you are too sick to work, you should be eligible to receive disability.  This reasoning is not, strictly correct. You do have to have a medical reason for being unable to perform your job.  Without a medical reason for being unable to work, the basis of your disability is very subjective and hard to overcome. 
For this reason, your long-term disability claim and particularly your disability appeal needs to include any medical records you have that might be related to your injuries or illnesses.   

You Must Follow Your Doctor’s Advice

Performing activities that your doctor tells you not to do may adversely impact your disability claim.  You cannot purposefully harm yourself or do harm to yourself for the purpose of staying disabled.  Likewise, you cannot lie about how much or little your injuries or illnesses impact you.  
If you do not follow the doctor’s orders, it is a simple argument for an insurance company to say that you are disabled by your own choice, you are, in essence, potentially doing self-harm intentionally.  Had you followed doctor’s orders, you would be on your way to recovery.  So their logic will argue, anyway.  
You should keep in mind that it is also common for insurance companies to hire investigators to follow you around to catch you doing something you are not supposed to be able to do.  Needless to say, make sure you are following the doctor’s orders precisely during your disability appeal.

Do Not Rely Solely On Your Company’s Human Resource Department

Your company Human Resource department may have the best intentions for you by providing you with advice, but they are not trained in disability claims.  They also do not have any influence on the decision of the insurer. Being responsible for your own claim is in your best interest.  If you need advice from someone who handles these cases every day, contact us.  

Document Everything!

Sending letters, or other documentation, through the mail using First Class Mail means that you are one “he-said / she-said” away from a claim that falls apart.  If you send letters, send them confirmed.  Keep a log, request a receipt.  Be borderline paranoid that your communications will be lost in transit.  Why?  Because communications in long-term disability cases do get lost, with alarming regularity. 

Make sure you keep a log of your meetings, and even your phone calls with doctors, agents, insurers, even if you need someone to give you a ride because of your injury.  To help you understand what this might look like, here’s a guide to keeping a disability journal.  

Do Not Forget To Account for Side-Effects and Secondary Injuries

Sometimes, in the hurry to file what we believe would be a self-evident claim, we forget to take into account the full scope of barriers that are present in a disabling condition.  For example, if you have lower back pain, and have to take (prescribed) pain medication daily to manage your symptoms, the way the pain meds impact you should also be part of your claimed impairments.  Drowsiness, dizziness, mood swings, low blood pressure, and more…should be in this discussion.  In addition to the back pain.  

In a similar manner to medication side-effects, secondary injuries should also be something you point out and elaborate upon in your appeal documentation.   For example would, if you have a back injury and it causes you to stoop down, the injury could be causing your legs to hurt and for you to not be able to stand because of the leg pain.  Leg pain, stooping, and other impairments that are secondary to your primary impairment need to be explored in your claim and appeal. 

Waiting Too Long to Appeal or Being Too Hasty

Timing is everything.  If you file your disability appeal too soon, you almost assuredly will not have all of the evidence you need to be approved.  If you wait too long to appeal, you will miss the deadline and be denied again.  Whatever timeline you operate on, just make sure you do not miss your window to appeal!

Not Asking For Help

To avoid these common disability appeals mistakes, ask for help from a legal professional. 
An attorney who specializes in ERISA appeals will help make the process less stressful and will help you meet your deadlines.
If you feel you need assistance filling out your ERISA disability appeals or if you have any questions, contact a legal professional.  

 

ERISA Appeal Basics: Timelines You Need To Know

ERISA Appeal Basics: Timelines You Need To Know

The Employment Retirement Income Security Act of 1974 (ERISA) was enacted to establish a set of minimum standards for pension plans. Covered in this scope of regulation was and is long-term disability policies provided by employer plans.

The good and bad of ERISA is that, in an employer-sponsored long-term disability policy, each step of the initial claim and appeal must follow very well-defined steps. Good, because it gives a timeline that all sides must follow, and bad in that it does not allow for grace should you miss deadlines, even if you did not know there were deadlines in the first place.

The purpose of this article is to help you to understand precisely which timelines are important for you to remember in your ERISA appeal. Whether you are going-it-alone or you have hired a highly capable and experienced team to help, you need to keep these deadlines in mind or risk losing your case. 

 

Your Initial Application for Long-Term Disability

After your initial application for long-term disability, ERISA requires that the insurer of the policy (UNUM, Hartford, etc.) make a determination within 45 days.
If the insurer has a reason to need longer, they can delay their decision for up to 30 additional days. However, they do have to provide you a reason for the delay. The reason provided should specify why they needed the extension and what items, in particular, they need to make a determination on your application.
Often, an insurer will need additional information from you; if they request more information from you, you have 45 days to respond to their request for evidence. This is also a key point that people often start to look for resources and to retain an ERISA appeals attorney.
After receiving the information back from you, or your attorney, the insurer of your disability policy has up to 30 days to issue a determination.

Denied! The Timeline of an ERISA Appeal

After the back and forth process of your initial application, you may end up finding yourself denied nonetheless. When we said ERISA is good and bad – this pattern is a reflection of that statement. For the simple fact that an insurance company will only lose (monetarily) the benefits they would have owed you in the first place, they have no reason NOT to deny you for every grey area and technicality in your policy. If you have been denied for long-term disability benefits, this is not the end of the road for you and this situation can be fixed, with help.  We’ll discuss the details of this in other articles. For now, we are talking about the timeline of your ERISA appeal.
When and if you were denied, you likely discovered this through an adverse benefits determination sent to you in the mail. The timeline associated with the appeal of your determination is very challenging and something you do not want to delay in getting started on.
You have only up to 180 days following a receipt of a notification of an adverse benefit determination to make an ERISA appeal (29 C.F.R § 2560.503-1 (h)(3)(i)), but it is imperative to start as soon as possible! In short, you need to spend these 180 days getting as much information into the administrative record as possible. The reason being that if your appeal is denied, a follow-on lawsuit will only be able to make a determination based on the information that you submit now. You will not be able to add more information to the record later.

Note: This is another critical point to engage an experienced ERISA appeal lawyer.

When you have finished stacking the record on your claim and submitted your ERISA appeal letter, the insurer will have 45 days to make their decision on your appeal. Again, they may require an extension, but they have to explain their delay.

What Now!? My ERISA Appeal was Denied Too

If after your initial long-term disability benefits application, and your ERISA appeal, you remain denied for benefits, you have two options.
The first option, some policies allow for a second appeal. You should reach out to an ERISA appeals attorney as soon as possible to figure out if you have another appeal you can work on.
The second option is filing a lawsuit. Again, you will want to begin talking to an attorney about this option as soon as possible at this point.

Summary – How Long Before I Can Get My Disability Benefits?

If you have just filed your long-term disability benefits claim, you could get a determination within 45 days! However, if your insurer needs an extension, it could be another 30 days (75 total days). If the insurer denies your application, you have 180 days to appeal (255 total days), and the insurer has 45 days to determine your appeal (300 total days). The insurer may need an addition 45-day extension on your appeal determination which means your decision could be drawn out to (345 total days) from the day that you initially filed.
If you have a second appeal in your policy, you will have more than a year from your initial application before a final determination! This timeline alone is a poignant reason to engage the support and experience of an ERISA appeals attorney. Getting these claims approved at earlier stages will save you a lot of effort and frustration in the long term.

 

Tips for Writing an Unum Long-Term Disability Appeal Letter

Tips for Writing an Unum Long-Term Disability Appeal Letter

If you have received a denial letter from Unum long-term disability the good news is that you can appeal this decision.

The first step is to start thinking about how to approach your appeal letter.

In this article, we will give you tips on how to start framing your Unum long-term disability appeal letter.

Read Your Denial Letter

First.  Read your denial letter thoroughly.  Reading your denial letter will tell you the reasons for your denial.  It will guide you to your next steps.  And if you decide to reach out to a good ERISA disability lawyer, it will help guide that evaluation and conversation.

Gather More Evidence

For a majority of the situations in which long-term disability applicants are denied, it is because there is not enough (or the right kind of) medical evidence to prove their claim. 
Gathering medical records from your primary doctor, urgent cares and emergency rooms that have treated you for your condition, labs, and imaging will boost up your evidence and prepare you for the initial appeal and any future actions you may need to take to obtain your benefits. 

Request Your Claim File and Unum Long-term Disability Policy

Talk to your company’s HR, or talk directly to Unum, you need to get your hands on a full copy of your disability policy.  It’s likely that the key to your overcoming the denial is a misinterpretation or misunderstanding regarding your application, but sometimes there are pieces of the policy itself that are in error. 
You should also request from Unum a copy of your initial claim file.   The practical purpose of this step is so that you can look through it to see if anything is missing or if there were any mistakes in the original application.

Include Pertinent Information in Your Letter

Things you should include in your letter are:

  • Your name
  • Your claimant number (sometimes your social security number)
  • Why you are contesting your denial. Be factual not emotional.
  • Point out any missing or incorrect information in your denial letter.
  • Describe any mistakes made in your denial.
  • Copies of the initial application, denial letter, and medical evidence.
  • Facts why the long-term disability denial is wrong (include evidence).

 

Follow Appeal Instructions and Meet Deadlines

You want to be sure to follow any appeal directions provided to you by Unum.  Following the included instructions and any deadlines will keep your appeal from being denied because of a technicality.
You have 180 days to appeal your Unum long-term disability denial. If you miss this deadline, an automatic denial of your appeal will happen.
There will also be several forms you will need to fill out and submit with your long-term disability appeal letter.  Do not leave these out.

Get Decisions from Other Agencies

If other agencies such as Social Security or VA pensions determine you to be disabled, these decisions can be powerful and help with your appeal.  If you have not applied for either of these, then you may want to think about applying.

Hire a Long-term Disability Lawyer that Works with Unum

The appeal process can be a long and difficult one.  Having an attorney experienced in fighting Unum over long-term disability denials will help the process be less overwhelming.  An Unum disability lawyer can help you write your appeal letter, gather additional medical evidence, and can represent you if you end up going to court.
We specialize in long-term disability claims.  Call us today for a free case evaluation!

 

Straight Talk About The Need For You To File a Disability Appeal

Straight Talk About The Need For You To File a Disability Appeal

You have recently applied for your long-term disability, but your claim was summarily denied!  Well…it couldn’t get worse, right?

Unfortunately, disability denials are too common.  In fact, there’s a good chance you’ll be stuck in one during your long-term disability journey. 

But the silver lining here is that you can overcome them, with help. 

        

First things first: You need to Understand Your Denial Letter

Your denial letter will state why your claim has been denied.  It’s possible that the terms in the letter make it hard to understand beyond the basic concept (denial).  If you’re having a hard time making heads or tails of it, reach out to us, and we’ll help you start working on a plan of attack to overcome the decision.  
Fundamentally, the insurance provider believes you do not qualify for long-term disability benefits.  This is often because they claim your medical evidence is unsubstantiated or otherwise doesn’t fully demonstrate that your injuries or illnesses bar you from being able to work.  In fact, they may go so far as to say that you can work and should be able to hold down a job.  
Of course, they don’t know you from Adam, so how could they say that?  Sometimes, they say it, to see how you will respond.  

ERISA Protects a Process, But Not Necessarily You…

Why would an insurance company deny benefits they know you deserve?   Simply put, there is very little incentive for them to say, “Yes.”  And a lot of incentive for them to say, “No.”  If they say no and you do not appeal, they never have to pay out the benefits on your claim.  Moreover, if you ultimately prevail, they’ll be out little more than what they would have originally paid out to you in the first place.  So, dollars and cents here… Say No and save thousands, or Say No and lose nothing, or say Yes and pay out thousands.  It’s a sick type of arithmetic, but you gotta wonder why else would denial rates be so high?  

ERISA Speeds Up the Process

While ERISA lays out a process for administering disability claims, and in so doing also somewhat creates the scenario that we just talked about (wherein the incentive for the insurance provider is to deny at first), it does offer grace in that it formally speeds up the appeal process compared to other types of disability claims.  
Unlike Social Security disability or VA service-connected disability, whose claims can take up to 1 year and appeals can take more than two years (3 total years), your ERISA regulated long-term disability claim and appeal should be over within months, at most.   In the worst case scenario you will end up suing the insurance provider for the benefits you should rightfully be getting, but even then, the timeline is not likely to last as long as an SSDI or VA appeal!

Speed Up Your Appeal By Getting Out of Your Own Way

Do you know the best way to take advantage of every opportunity ERISA will provide for your appeal?  Get help.  An experienced ERISA disability lawyer specializes in streamlining and stacking your appeal.  You will not miss deadlines, you will return fully developed arguments to your insurance provider, and you will even hold their feet to the fire for their mistakes when they make them.  In short, you can turn the tables.  You already know they are hoping you don’t appeal.  They also anticipate being able to beat you in an appeal because many others like you do not hire professional help until it’s too late.  
Do something they haven’t game planned, and penciled in their calculations, hire a disability attorney to take the fight right back to them.  
We’re here to help you today, reach out to us.

Do Social Security and ERISA have the Same Appeal Process?

Do Social Security and ERISA have the Same Appeal Process?

When most people start searching the internet for help with their disability claim, they come across a deep well of information about Social Security Disability.  

Unfortunately, there is much less information about ERISA Long-Term Disability claims and appeals.  

Sometimes, the differences are very confusing.  Here’s what you need to know.

Social Security and Long-Term Disability are Completely Different

If you are actively looking for help with your long-term disability claim and denial, reading up on Social Security disability blogs is going to offer very little help.  There is a caveat; you may qualify for SSDI – a program through social security that operates like an insurance policy for disability as well.  For more information on that, reach out to us here, and we can break it down over the phone or in an email. 
Covering the basics here, Social Security disability comes in the form of two government-administered programs.  One is a social safety net – it is meant for those who cannot work and do not have a recent work history.  This program, SSI, provides a limited amount of financial assistance <$1k per month.   
The other program, SSDI, is similar in function to long-term disability.  SSDI provides compensation like an insurance policy.  The compensation is for those who cannot work due to an injury, but have a recent work history and have paid into the program.  The monthly award is based off several factors, but essentially, your previous income.  
Long Term Disability policies are insurance policies that a private insurer guarantees should you meet a certain criterion (disability from work).  Often they are part of your employer-sponsored benefits.  If so, your policy is likely covered by a law known as ERISA

Governance of Long Term Disability vs. Social Security

Though the programs are different themselves, and for different populations, the way in which the programs are administered is perhaps the most glaring difference between disability benefits providers.  
If you have a long-term disability policy through your employer-sponsored benefits plans, it is very likely to be governed by ERISA.  ERISA regulates these benefits and gets very granular in describing how they must be administered.  ERISA even goes so far as to say an insurance provider must decide your appeal within 30-45 days!
Social Security benefits are governed under a different statute, and in fact, they have a whole court system designated to support appeals of denied claims.  They maintain their own administrative law judges, and whereas ERISA dictates a certain timeline for claims and appeals, Social Security has no such guarantee.  It is very common for an SSI or SSDI appeal to take more than a year.  In fact, if there’s a backlog of claims (such as during a downturn in the economy), the backlog in appeals can move more than two years out!!

Remember, There Are Different Types of Disability

This is the point of this brief article.   You need to recognize there are several types of disability claims, and if you are trying to fight against a long-term disability denial, you should stick around blogs like this.  While there are many excellent VA and Social Security claims blogs, their type of disability law is not what you are looking for.  
If you feel you’re getting conflicting information in your online search for answers… this may be why.  
If you want the straight scoop on your claim or denial, reach out to us today, and we will help you make heads or tails of it. 

How Disability Attorneys Use ERISA Guidelines to Help you Win Your LTD Appeal

How Disability Attorneys Use ERISA Guidelines to Help you Win Your LTD Appeal

Experienced disability attorneys know how to make the right arguments to bring your long-term disability claim under control.

In fact, if they specialize in ERISA claims they will be there to help you prevail in court, too! 

If you are struggling to deal with a long-term disability appeal, it’s time for you to reach out to an experienced ERISA disability attorney.

Here’s Why..

 

The Basics: What is ERISA?

ERISA is a federal law that provides guidelines for insurance companies on how to administer certain employer-sponsored benefits.  Short and Long-term disability benefits being central tenets of these plans, they are covered, or governed and appealed, under ERISA law.  
Here’s our article on ERISA benefits if you need more of a primer.  
The point here is that we convey the importance of working with an experienced long-term disability lawyer.  They will keep you on track (and the claim alive by helping in the following ways:

Managing ERISA Timelines

  • In Long-term Disability claims and appeals, ERISA defines strict timelines that must be followed for claimants and insurance providers.  If you miss these timelines, your case or claim will likely be denied or underrepresented.  Either way, you will likely not get the benefits you have paid for.  One of the most effective things your attorney will do for you is to make sure you hit all your timelines, and to hold the insurance companies feet to the flame by ensuring they meet all their deadlines too!

 

Using Strategy in Developing & Delivering Evidence

  • You will likely need substantial medical evidence to win your disability appeal.  Good disability attorneys will make sure all medical records are collected before any necessary hearing, or request in the case.  In preparation for a potential future lawsuit against your insurance provider, your attorney will be working feverishly to “stack the record” on your behalf too.  This means, they will work to get all possible supporting evidence into the disability appeal so that it can be presented at a later date, should your insurance provider keep denying you. 

 

Identifying Key Insurance Company Mistakes and Exploiting Them

  • Your insurance company may have made a mistake!  No kidding, they denied you, right?  But in seriousness, they may have made a mistake as far back as laying out the terms of your long-term disability policy.  In fact, they may have denied you for a reason that has since been disallowed by law, or court decision.   Your disability attorney will be able to spot these mistakes and find ways to get them to help your claim. 

 

Leveraging Experience With Judges in ERISA Lawsuits

  • If you practice enough ERISA law, you get to know the judges, the insurance companies, their lawyers, and everyone else.  This is not new territory for these people.  Nor is it for us!  Sometimes, what it takes to fix these disability claim challenges, is knowing who it is you’re fighting, and what they need to see to get them to stop fighting you.  There is no substitute for experience.

 

Defending You From Predatory Insurance Company Tactics

  • Insurance companies will not only bring in evidence against you; they will seek it out…sometimes even bringing video surveillance to “prove” your disability is not a debilitating as you claim. Your attorney will fight these low-ball tactics and delve deeper into the investigation to discredit this information.  We will fight back against these tactics.

 

You CAN Win an ERISA Appeal

Remember, everyone is allowed to appeal their claim if they are initially denied.  If you are denied your long-term disability claim, the insurance company wants you to throw your hands up and give up.  Don’t!  There is no good reason not to fight them, especially if you have a strong advocate in your corner.  
We are here to help you win your case.  Reach out to us today!

 

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