Disability Insurance Claims Law – How to Handle the Details

If you are filing a long term disability claim when you have been injured or become ill and cannot work, it is helpful to know that disability insurance is more complicated than most insurance. There are very strict rules that must be followed.

Be careful about time limitations and deadlines. In the policy it will say when a claim must be filed. Most policies have a 60 day filing window. Be sure to file paperwork ahead of deadlines, and sending all documents and records by overnight registered mail.

Keep your disability claim information private. Do not post details or comments or complaints on Facebook, LinkedIn, or any disability-related forums, bulletin boards, chat rooms, social networking sites, or other online places. It does not matter if you have just filed a claim or the insurance company has been paying your benefits for ten years – putting this information on the web could lead to your losing the benefits.

Insurance companies monitor social media for their claimants very carefully and more than one person has lost their benefits or had a judge render a different decision based on their online comments. If you are filing for a disability claim and post vacation photos that show you hiking in the mountains, the insurance companies will consider the photos evidence against your claim.

Once a claim is received by the disability insurance company, they will send you forms that are required to process the claim. Among them will be a claimant statement, attending physician statement, and authorization forms permitting access to health, financial and occupational materials from third parties.

Financial records are used to evaluate income, assets and earnings. This feels intrusive and prying but providing the information correctly is important. For salaried employees, tax returns and W2 earnings statements will be simple enough to provide. If you own a business or are a partner in a professional practice or another complex earnings situation, the request for financial records can be overwhelming. It is important to check the specific language of the policy to learn what the disability insurance company is entitled to – and what is none of their business. The policy is the contract that governs the entire process. If you are asked to provide something that is not included in the policy, contact the insurance company to clarify and explain the request. Carefully document questions to minimize non-compliance issues.

Most disability policies require you to undergo an IME – Independent Medical Exam. Keep in mind that the doctor performing the examination is being paid by the insurance company. Disability insurance company doctors are not independent. Be careful! Disability claimants who believe they are speaking with a sympathetic doctor are always shocked when the doctor who seemed so nice reports that they are perfectly able to go to work. Many recent court decisions, including several in our own practice, have found it very clear that the medical exams paid for by the insurance companies are not independent. This inherent conflict of interest is something the courts are watching carefully.

The insurance company may NOT ask that a disability claimant undergo an invasive test or require claimants to travel a far distance to have an examination performed. The insurance company is obligated to schedule an IME within a reasonable distance from your home.

If you are ordered to take a Functional Capacity Evaluation (FCE), be careful. Read your policy closely to determine whether or not it specifically requires you to take this test. If the FCE is not in the policy, the law does not require that you take it. The FCE is used to test maximum effort. If you do go for an FCE and are asked to do anything that you know you cannot do without pain or discomfort, say no and do not perform the action. There is controversy surrounding this test and it can be dangerous. Document how you feel after the test and if you can, go to the doctor to make sure to document what injuries you might have suffered from taking the test.

Common Questions When Considering a Social Security Disability Attorney

For those who have a case involving disability, it may become necessary to hire a Social Security disability attorney. There are a variety of benefits that come with utilizing legal assistance in these cases, and the fees are fairly reasonable. In fact, many lawyers will not charge if a case is lost. Clients and potential clients often have many questions when it comes to hiring a lawyer.

When Is a Social Security Disability Attorney Necessary?

One of the most common reasons for hiring a lawyer for these instances is to improve the likelihood of receiving approval for benefits. While some people are able to have a positive outcome without assistance, those with legal counsel almost always have a better chance of winning a disability case than those who do not.

While these attorneys are most commonly sought out after an initial denial, they can be very helpful at the application stage. In fact, their knowledge and expertise during the application stage may often result in an approval in one application period. On the application, the Social Security disability attorney can help argue that an individual’s condition meets the required list of impairments or provide advice on an alleged onset date of disability. During hearings or appeals, he or she can assist in collecting relevant medical evidence, such as doctor’s opinions, and preparations for any questions that may come from the judge. They can also assist with finding individuals to testify on behalf of the client.

When Should a Lawyer Be Called?

A Social Security disability attorney can be called at any point during the process, but it is best to call one as early on as possible. For those who may be on the fence on whether or not legal counsel is necessary, it is often beneficial to call, as many will provide a free consultation. He or she will be able to examine a case to determine the strength of the case and provide assistance with the application.

Another consideration to think about is final attorney fees. Those who are approved for benefits at the first try will owe smaller fees since there will be no back benefits owed to the client once the benefits are finally approved.

Hiring an attorney after an initial denial can greatly increase the chance of a positive outcome on the second application, and it is also possible to have the case moved through the process more quickly. This is often the case for terminal medical conditions or for extremely dire financial circumstances. However, this tends to be rare, as many must wait for several months before a case is resolved.

For those who are still on the fence about hiring a Social Security disability attorney, there is an instance in which it may not be helpful. For those who have submitted an initial application and are awaiting word, there is no need to get a lawyer yet as there is no point in paying a commission of past-due benefits unless there is a denial in coverage. However, in many other situations, having representation can be incredibly helpful.

How a Denied Disability Lawyer Can Assist You

One of the most frustrating situations for a client with disability insurance occurs when you have to access the insurance you have paid into, often for years, and you are denied the support you are owed, the support you anticipated having available should the worst happen. There are so many loops to jump through to successfully claim disability insurance with most insurance companies – and for many people, the process is so difficult, time consuming, and overwhelming that, at the end of the day, when they are denied disability coverage, they think that is the end and have no recourse. This, however, is not necessarily the case. While there may have been a time when a person who was denied his or her disability insurance claim had little or no further options, this is not always the case today. In fact, with proper legal representation from an experienced disability insurance lawyer, the denied disability claims lawsuit can be fought and even won.

What is Disability Insurance?

Denied disability lawyers come into play for those who have been denied a disability insurance claim, but first one needs to understand the importance of disability insurance. Most of us understand the importance of life insurance, but the reality is that accidents or sicknesses can prevent an individual from being able to work to sustain his or her living. For this reason, disability insurance is just important as life insurance. In fact, a typical 30 year old has 4 times the chance of becoming disabled than of dying before the age of 65.

There are two main types of disability insurance – long term disability and critical illness. Disability insurance will provide a monthly income if an individual is unable to work due to serious injury or illness; critical illness insurance pays out a tax-free lump sum following the diagnosis of an illness noted within the policy. When it comes to filing a claim, the onus is on the claimant to establish that they are disabled within the boundaries of the policy. Proof must be provided by the claimant in order to qualify for the disability benefits, and this proof must hold up to scrutiny. As the reporting on the claim and the interpretation of the said claim is subjective, the potential for denial of said claim can be high in many situations. Once a claim is denied, the recourse is limited to court – denied disability lawyers can help streamline the claimant’s reporting, making it far more likely to be approved and win the settlement.

How to choose a lawyer or law firm

Denied disability lawyers may be found throughout the legal industry, but you want to make sure you choose a lawyer and or a law firm with the best chance of getting results for you with the least amount of initial risk. The reality is that while you are vulnerable and could be easily taken advantage of, your resources will be limited, and this must be part of your consideration. You will find that most law firms or lawyers will ask for payment up front, regardless of the outcome of the case or how much it will cost, win or lose – payment that you probably don’t have considering you are fighting a denied disability claim as it is. But, there are some law firms that will not require payment up front. Some denied disability lawyers will work on a percentage fee basis, and there will be no fees until the claim is settled. Do your research well before hiring a denied disability lawyer to fight your case.

Why Disability Insurance? Chances Of Becoming Disabled Are Greater Than Your Chances Of Not

If you and your loved ones depend on your salary for support, then you probably need long term disability income insurance.

Think about it: if you were to become disabled, even for a few months, how would you and your family manage? Who would pay your bills? Disabling illness or injury is one of the leading causes of bankruptcy in the United States.

Most people do not realize that their chances of becoming disabled are greater than their chances of dying prematurely. Yet they are more likely to buy life insurance than disability insurance. For this reason, people in the insurance industry call disability “the forgotten risk.’ According to statistics from the Journal of the American Society of Chartered Life Underwriters, if you are age thirty to fifty-five, your chances of becoming disabled are two to three times greater than your chances of dying.

If you are thirty-five years old, you have a 50:50 chance of experiencing a disability lasting last three months or longer before you retire. One in seven workers will become disabled for more than five years before he or she reaches age 65.

Many people mistakenly believe that the government or Worker’s Compensation will pay them an income if they become disabled. Actually, more than 80% of the people who apply for Social Security disability benefits are rejected. Social Security does not pay benefits for partial or short-term disability. Your disability has to either last a year or be expected to last a year before you can collect Social Security. Worker’s Compensation pays only if you were injured on the job and benefits are often limited to a few years.

Your health insurance will cover your hospital, doctor and other medical bills, but you will still not have a salary. Long-term care insurance only covers bills from nursing homes or assisted care center. Disability insurance, however, does not pay bills. Instead the insurance company gives you money on a regular basis. It is designed to replace your salary so that you and your family will not experience financial hardship during any period when you are too sick or injured to work.

What should you look for when you are buying long term disability insurance? First, the insurance company itself should have a top rating from Moody’s, A.M. Best, and Standard and Poor. These agencies rate companies in terms of capitalization, growth, earnings and other indicators of financial stability.

Secondly, you should make sure you understand the terms of your policy. Some policies require a waiting period before you start receiving benefits. For example, your policy may have a six-month waiting period before benefits are paid. In this case, your benefits would begin six months from the time of disability.

The waiting period is often called the elimination period. Choices usually range from 30 days to 720 days.

Look for a waiver of premium provision. This means if you become disabled, you will not have to keep paying for your disability policy.

What are the conditions for renewing the policy? If you’re policy is not automatically renewable, the insurance company has the right to cancel it.

Payment period options are another consideration. Some policies will only pay for a certain period of time, sometimes for only two years. Other policies last a lifetime. The most popular policies pay benefits until you reach retirement age, when you can begin to collect Social Security payments.

Most policies have a residual disability clause. If you suffer a disability, very often you will return to work part-time at first. Or because you were off work for a while, it may take you time to build your business back to the level it was before you became disabled. Your insurance should provide income for both these scenarios.

Check over the policy for a recurrent disabilities benefit. A recurrent disability is one that happens after you recover from your original disability. Your insurance should waive a new waiting period and/or not require proof that the two disabilities were related.

When you buy disability insurance, you buy it according to your income level. The more money you make, the larger the benefit of your policy. But you also have to figure that your income will rise as you get older. For this reason you want a future increase rider or automatic increase rider. These riders allow you to keep your policy but increase the amount of your benefits based on your increased earnings as you grow older.

When you buy your insurance, certain factors will affect your price. You will pay less for the insurance if you decide to replace 50% of your income instead of 80%. You also pay less if you opt for a longer elimination period. The insurance company factors in your current health and may exclude preexisting conditions. Women and smokers may pay more for disability insurance because they make more claims than non-smoking males. If you are in a high-risk job, your policy may cost you more.

Disability insurance policies can be confusing. It is always best to sit down with a professional insurance agent to discuss the terms of the policy together and to ask questions until you completely understand the details of the policy quotes being presented.