A disability attorney is an attorney who specializes in work related injuries and Social Security claims. Disability attorneys are adept in uncovering bad faith practices on the part of insurance companies, specifically, when the insurance company's goal is to save the company money.
A disability attorney also will help a permanently disabled person receive their deserved Social Security disability payments and any back pay. Often, a disability attorney will help fill out an appeal if you have been denied benefits and also will help by going to court with you for your appeal. Sometimes, just having a disability attorney at the beginning of your application process is enough for you to be approved because this shows you are being honest in your medical and financial claims.
In the case of an injured worker, denying their claim is often due to a number of reasons. Those could be, not reviewing the case properly, ignoring the rights of the claimer, expecting to obtain a certain amount of quotas by willfully denying a claim, and simply not reviewing the case at all. This is dishonest and cruel. An injured worker usually cannot work and if he can, it's usually light duty. Incredibly an injured worker who can perform light duty, may also be denied coverage. Even though he may need that coverage to pay his bills and to cover his much needed medication which can be quite high in price. This is why it is so important the disability attorney you contact is an experienced disability attorney.
If you are injured or disabled and cannot work, or can only work light duty, you have enough to worry about with putting food on the table, gasoline in the car, rent or house payments, and paying the utility bill.
Let a disability attorney offer
you peace of mind. A disability attorney wants to assist you in getting
all the back pay and monetary awards you so rightfully deserve. If it
is found your insurance company used bad faith practices in denying
your claim, the monetary reward from the court can be quite large, so
contact an experienced disability attorney today.
Disability Attorney - Dell and Schaefer Attorneys
Common Reasons Why A Disability Insurance Claim Is Denied
More often than expected, many disability insurance claims are denied in the initial stage. When this happens, different reasons for its rejection play in mind.
Here are some of the common reasons why a disability insurance claim is denied:
- Lacks objective findings
- You are not disabled from your occupation
- Pre-existing condition
- Non-fulfillment of the elimination period
- Not under the care and treatment of proper medical professional
- Self-reported symptoms exclusion
The social security reviewer who looks into your application may dismiss your claim on the grounds that it lacked the so-called “objective findings” to substantiate your disability claim. Hard medical evidence such as blood tests, MRI results, x-rays, etc. of your physical or mental condition are sometimes needed by the claims reviewer to decide on your claim. Lack of this vital information often becomes a stumbling block in the approval of a claim. However, some disability insurance policies do not require the absence of objective findings as basis for the denial of a claim. In this case, you will need the help of a disability lawyer to help you pursue your claim.
A claim reviewer may also deny your claim on the basis that you are not disabled as defined in your occupation. You may be experiencing stress at work, but the claim reviewer will not consider this as disability required by your occupation. Sometimes he may even use inaccurate job description to determine your disability and use it as basis for denial. In such case, you must get an explanation from the claim reviewer and consult a disability lawyer.
A claim may be denied due to a pre-existing condition which is expressed in your policy as a period of treatment for a medical condition before the coverage began.
Elimination period is a time between 30 days to 6 months in which a claimant must be continuously disabled to be able to be eligible for benefits.
To be recognized as a credible finding, a claimant must undergo treatment with a certified doctor or medical practitioner who can support his disability claim
Self-reported symptoms are unacceptable reasons which are excluded in some policies as a disabling condition. Headache, dizziness or fatigues are symptoms that are difficult to document by objective findings. Self-reported symptoms of an illness cannot be admitted as reasons in a claim unless they are stated in an official medical statement of a doctor as part of an objective medical finding.
Disability? Don’t Worry!
Fate can sometimes deal a cruel hand. This is especially true for those who become disabled after an accident or sickness.
First of all, there is the difficulty of suddenly being helpless and dependent after being self-assured and self-sufficient. This is a hard fact for dedicated and hardworking professionals who have spent most of their time establishing their financial security. Then, there’s the added burden of worrying how to get by their daily basic needs and special needs as disabled citizens. Things can also get more difficult once the person affected by disability has a family that depends on his or her income for their daily needs.
Although disability has that crippling effect on once-financially secure individuals and families, remember that help is at hand. Governments of various countries offer social security benefits for their residents rendered incapable of earning sufficient income due to disability.
In the United States, the Social Security Act was passed with the main aim of safeguarding the right to social security of residents and their families. Through the years of amendments on its provisions, it has become a comprehensive law enactment. The social security law generally has five major forms. It covers retirement, disability, family matters, survivors and medical/Medicare benefits.
One of its main provisions is specifically directed for people with any form of disability. It involves a set of guidelines on the rights and benefits disabled people are entitled to receive.
Although the social security disability benefits aim to champion the rights of the disabled, not all persons with disability can apply and avail of them. The applicant must have been disabled for at least one year before he or she can be eligible for benefits. The application process involves careful scrutiny of the patient’s medical records, and other pertinent information according to the Social Security Act before being declared eligible and ultimately becoming a beneficiary.
Aside from the disabled people themselves, there is also an extension of disability rights for their families, as well. There is a special provision available for a disabled widow or widower of a person working professionally for a considerable period before his or her death. This provision can also be availed by disabled children whose parents met fatal accidents. However, the child involved should have been disabled before he or she reached the age of 22.
Accidents and sickness always happen unexpectedly. But there is no need to worry if you also have invested on medical/Medicare insurance during the time you are strong and well. The social security provisions on this health insurance scheme come in handy for your medication maintenance. It can also tide you over along with the social security disability benefits you will be receiving.
For those who find themselves disabled and unable to work anymore, stop worrying and start acting on your application for social security disability benefits. Drop by the nearest social security office in your area and file for the benefits you are entitled to have. Also, the Social Security Administration is just a phone call away. You can file for your disability benefit claims by calling their hotline number and presto, your papers are ready to go.
Disability Attorney - Dell and Schaefer Attorneys
Valuable Information on Disability Claims and Workers' Compensation
Attorney Terry Low is committed to the cause of legislative and regulatory change to the ERISA laws that currently govern group disability insurance. While the fight for such change continues, his law firm and practice are focused on helping individuals succeed in filing their valid disability claims under these laws.
In addition, Terry Low counsels and represents clients in all the other areas associated with obtaining benefits after a disabling injury or illness, including Social Security Disability Insurance, workers' compensation and private occupational disability insurance policies. His writing and educational work in these areas are intended to help those in need obtain the benefits they deserve in order to have a fulfilling future after disability strikes.
Read 11 Ways to Assure the Success of a Disability Claim to learn about the Employee Retirement Income Security Act of 1974 (ERISA) and the advantages it gives to insurance companies who deny benefits to people covered under employer-purchased group disability insurance plans. This article offers practical advice for anyone covered by such a plan, along with major considerations for anyone who must file a claim.
Read Irrational Predispositions for an intriguing account of a young worker seriously injured in 1995 and the subsequent progression of his workers' compensation case. Attorney Terry Low has a long-standing interest in the application of laws that enable wage benefit adjustments in cases involving young workers, as well as other appeals for deserved benefits based on liberal, broad interpretations of the law.
Unum Provident Approves and Physiologist’s Claim for Disability Benefits
Following bilateral hip surgery, a physiologist that had an “own occupation” disability policy hired our firm to help him better understand the terms of his policies and see if he was eligible for benefits. While he was no longer able to perform the substantial and material duties of his specialty, this doctor did not want to sell or forego his practice. Instead, he planned to hire another doctor and simply monitor the progress and treatment plans of his patients. Additionally, he wanted to seek medical director positions with nursing homes and other healthcare facilities in order to stay active in the medical field. After gaining an understanding of this client’s duties, his medical specialty and his restrictions and limitations, we agreed to represent him during his application for disability benefits and throughout the evaluation process.
All documents and information in support of our client’s eligibility for disability benefits were provided to the insurer. We further advised the insurer that while this doctor could no longer perform the substantial and material duties of his own occupation, he would continue to work in a completely different and much more sedentary capacity. After much back and forth with the insurer, including in depth conversations about the subject disability contract and the law, they agreed that he was disabled under the terms of his disability policy. As such, this doctor continues to receive monthly disability benefits while working as a medical director for a number of facilities and keeping track of his patients. Because the insurer continues to seek information and proof of disability, this doctor still retains our firm to represent him in his ongoing claim for benefits.
After receiving long-term disability benefits from Prudential beginning on April 17, 2000, for thoracic outlet syndrome, pronater teres syndrome, and carpal tunnel syndrome, Wayne Urso’s benefits were cut off, despite support from his doctor. Mr. Urso’s doctor gave him restrictions that prevented him from continuing to work in his position as a computer programmer. Prudential claimed that Mr. Urso was no longer disabled under the terms of the plan and cut off his disability benefits on April 17, 2002.
Because of his job loss, Mr. Urso sold his house and moved from Manchester, New Hampshire, to Errol, New Hampshire, approximately three hours away, in an effort to reduce his expenses and ease his financial burden caused by his inability to work. Prudential claimed that Mr. Urso was still able to work, and found positions in Manchester where Mr. Urso could have work, and reasoned that he could have continued to work in Manchester had he not been disabled.
Mr. Urso appealed this decision in March of 2002, but Prudential denied him again in April 2002. Through his attorney, Mr. Urso appealed again, but was denied a second time on October 29, 2002. Prudential claimed that neither physical conditions nor his depression kept him from working. In the meantime, Mr. Urso was approved for Social Security Disability Insurance in July 2002.
In making its decision to deny Mr. Urso his disability benefits, Prudential performed a review of his medical records and conducted surveillance of him, but did not elect to have Mr. Urso examined independently. Surveillance revealed that Mr. Urso was the president-elect of his Kiwanis club, and was performing some work independently. Dr. Cowl, who performed the review of the medical records, felt that Mr. Urso could work in the positions identified for him by Prudential, although with some restrictions.
After suit was filed, Prudential performed another review and found that Mr. Urso was entitled to two years of benefits for his depression. However, disability benefits for mental conditions were capped for two years, and Prudential refused to pay benefits beyond the two-year limit. Mr. Urso then filed suit again. At trial, the court found that Mr. Urso had carried his burden to show that he was disabled according to the plan terms, and Prudential did not have sufficient evidence to show that he could perform any occupation. In approving Mr. Urso’s claim for long-term disability benefits, the court noted that Prudential had failed to perform a vocational assessment of him.
Reverses Denial on Second Appeal & Pays $260,000 In Past Due Disability Benefits To OBGYN
Our Client, an OBGYN (hereinafter referred to as “Dr. OBGYN”), was employed by a hospital when he began to experience anxiety and depression following the filing of a malpractice lawsuit. Our client began drinking alcohol on a daily basis and was subsequently hospitalized for three months as a result of alcoholism, anxiety, depression and suicidal thoughts. Prior to claiming disability Dr. OBGYN’s substantial and material duties involved the delivery of babies, gynecological surgeries and on-call requirements.
Procedural History
Our Client’s disability plan was provided as an employee benefit from his employer, which meant that his disability plan was governed by ERISA. As a result of having a disability plan governed by ERISA, our client was required to exhaust his administrative remedies and file two written appeals with Prudential before he could he file a lawsuit. Attorneys Dell & Schaefer was retained on this case following Dr. OBGYN’s initial denial of benefits by Prudential.
In Prudential’s initial denial letter they claimed that Dr. OBGYN was disabled during the three month period of time that he was hospitalized, but that he was capable of returning to work immediately following his hospital discharge. Prudential’s opinions were reached based upon a paper review of Dr. OBGYN’s medical records by a doctor employed by Prudential doctor. Prudential denied the first appeal on the basis that Dr. OBGYN was only disabled when he was drinking and therefore he should be capable of working. Prudential completely ignored the fact that a substance abuse disorder is a disabling condition. Prudential never examined Dr. OBGYN in order to evaluate his medical condition.
Through a coordinated effort between our law firm and Dr. OBGYN’s treating doctors, we were able to present Prudential with additional medical information in support of the claim for long-term disability benefits. The additional medical information and our extensive second appeal letter were submitted to Prudential in a timely manner. Within 45 days of receiving the second appeal letter, Prudential reversed their previous two denials and determined that Dr. OBGYN was eligible for disability benefits. Since Dr. OBGYN suffered from a mental nervous and substance abuse disorder, the disability policy limited him to two years of disability benefits. Dr. OBGYN was awarded more than $260,000 in past due disability benefits.
Source
Disability Attorney Insurance Disability Benefits Lawyer
US Supreme Court Attempts To Clarify The Standard of Review In Denial of Long Term Disability Benefits
On June 19, 2008, the Supreme Court of the United States finally issued their opinion in the case of Wanda Glen v. Met Life. In a 6 to 3 decision announced Thursday, the US Supreme Court ruled that benefit denials by such companies must be examined with caution when circumstances suggest a high likelihood that financial considerations affected a benefits decision. While Ms. Glenn won her case and Met Life was ordered to pay long-term disability benefits, the Supreme Court did not make any significant findings that will change the way that Federal courts must interpret disability benefit denials. The Supreme Court had an opportunity to modify the standard of review to "de novo" (complete review) in all conflict of interest disability claim denials, however they did nothing to give employees a better chance of securing disability benefits that have been denied.Judges must approach medical disability and health insurance disputes with a skeptical eye when they involve insurance companies that both evaluate and pay employee claims.
The court added that an apparent conflict of interest is only one of many factors that a reviewing judge must consider.
The ruling is important because it offers guidance to federal judges presiding over lawsuits challenging medical disability and health insurance determinations in group policies.
"When judges review the lawfulness of benefit denials, they will often take account of several different considerations of which a conflict of interest is one," writes Justice Stephen Breyer in the majority opinion.
The decision, in Metlife v. Glenn, comes in the case of an Ohio woman diagnosed with a severe heart condition, who had her disability benefits withdrawn by the Metropolitan Life Insurance Co.
A federal judge upheld the denial of benefits, but the Sixth US Circuit Court of Appeals reversed that finding, ruling that the judge had not fully considered the impact of MetLife's potential conflict of interest in both administering the plan and deciding which claims to pay and which to deny.
Justice Breyer said the appeals court followed the correct "combination-of-factors method of review." He said judges should examine the record for potentially inconsistent positions taken by a company, and whether the company gave due weight to the entire record or favored certain reports while downplaying others.
Three justices dissented. Justice Antonin Scalia wrote that the court was giving too much weight to an appearance of conflict. He said that under the law of trusts "[A] fiduciary with a conflict does not abuse its discretion unless the conflict actually and improperly motivates the decision." He adds, "There is no evidence of that here."
Dissents were also filed by Justices Anthony Kennedy and Clarence Thomas.
In passing the Employee Retirement Income Security Act of 1974 (ERISA), Congress authorized insurance companies to both evaluate and pay claims. ERISA also authorizes employees to file a lawsuit in federal court challenging an unfair denial of benefits.
But ERISA doesn't set a clear standard for judges who are called upon to decide disputes over benefits.
In 1989, the Supreme Court ruled that judges hearing such lawsuits must apply a more rigorous standard of review in cases in which the plan administrator served as both the evaluator and payer of claims.
But the court did not explain what constitutes a conflict of interest or how federal judges should weigh such a conflict while considering a particular case.
Thursday's decision stems from the case of Wanda Glenn, a sales manager at a Sears store from 1986 to 2000. In 2000, her physician diagnosed a severe heart condition. He advised that she no longer work. She applied for disability benefits under Sears' plan, administered by MetLife.
On the basis of the diagnosis and the physician's recommendation, MetLife found that Ms. Glenn was totally disabled and began paying benefits. With the help of MetLife, she also applied for and obtained disability payments from the Social Security Administration.
After two years, the MetLife policy required a new assessment of whether Glenn could perform any job or was still totally disabled. Her physician had repeatedly verified the severity of her condition, but at one point he checked a box on an evaluation form indicating that Glenn was able to work in a "sedentary physical exertion level occupation."
Three months later, contrary to the checked box, Glenn's physician again stated that he did not believe she could handle any kind of stress at work.
In evaluating Glenn's disability claim, MetLife focused on the checked box and decided to stop making disability payments to her.
Glenn challenged the decision and eventually took MetLife to court.
In siding with Glenn, the Sixth Circuit said MetLife cherry-picked certain aspects of Glenn's medical records, while ignoring others. This selective review, combined with MetLife's conflict of interest in both evaluating and paying claims, rendered the decision arbitrary and capricious, the appeals court found.
In affirming the Sixth Circuit, Justice Breyer said: "All of these serious concerns, taken together with some degree of conflicting interests on MetLife's part, led the court to set aside MetLife's discretionary decision. We can find nothing improper in the way in which the court conducted its review."
Source: Disability Attorney
