Why are LTD disability claims usually terminated or denied?
Every claim is decided individually, but long-term disability insurance companies often follow the same playbook when coming up with reasons to deny benefits. Finding a long term disability lawyer who knows that playbook can help you respond quickly and effectively to a wrongful denial of your benefits.
Some of the Reasons we see over and over again for denying or terminating benefits:
You can still perform your "regular occupation."
Most policies don't look at your job the way you performed it, but instead, rely on an arcane publication called the "Dictionary of Occupational Titles." Most of the job descriptions in this publication haven't been updated since the late 70s, and so they very rarely accurately portray modern work requirements. By relying on this publication, the insurance companies can find you capable of performing your "regular occupation," even if it barely resembles what you actually did every day.
There are no "objective findings" to support your disability.
This gets used by insurance companies most often when someone is disabled based on pain, fatigue, or other subjective symptoms, even when those symptoms are caused by an objectively diagnosed illness. Denials like this provide almost universal cover for insurance companies to reject any limitations based on symptoms they can't objectively measure. Unfortunately, some policies exclude subjective limitations based on pain, fatigue, or other symptoms. But, if your policy does not contain this kind of exclusion, the insurance company cannot deny your claim simply because there is no easy way to "measure" your disability.
Terminating after 24 months due to a mental health limitation.
This is a very common move by insurance companies. Most policies limit disabilities that are based in whole or in part on mental health limitations to a maximum period of 24-months. After this period, you have to prove that your disability is solely due to physical conditions. This is a convenient cut-off for insurance companies since most people who are disabled struggle with some degree of depression and/or anxiety as they face the reality of no longer being able to earn a living. Showing that any psychiatric symptoms are solely secondary to underlying physical conditions can sometimes be an effective strategy to overcome this tactic.
We help disabled workers fight denials and terminations regardless of the reason for the denial. We have helped other professionals, attorneys, physicians, and executives, who often have a particularly hard time proving disability due to their advanced educations and experience. Likewise we work with clients from team members at Wawa to engineers at Lockheed Martin and everywhere in between. Disabilities don't discriminate and neither do insurance companies in their efforts to deny benefits.
If you suffer from lumbar or cervical spine pain, chronic fatigue or fibromyalgia, Lyme's Disease, Multiple Sclerosis, autoimmune diseases, inflammatory bowel disease (crohn's or colitis), or any other serious health problem that prevents you from working, call or message us today for a free claim review.
One of the areas that Social Security often misses, especially early on in the application process, is limitations of the hands. Social Security staffers and adjudicators are used to measuring a person’s ability to sit, stand, walk, lift and carry, but the use of the hands is often overlooked, especially if the cause is not immediately obvious.
There are a lot of diseases that can impact the ability to use the hands. Carpal Tunnel Syndrome is probably the most well-known, but there are plenty of other impairments that have a direct bearing. Cervical disc disease, for example, can cause a condition known as radiculopathy, where a vertebral disc presses against the nerves that run into the arms and hands. This can result in weakness, burning pain, and loss of sensation in the hands. Similarly, the side-effects of medications may cause hand shaking, or tremor. Continue reading →
If you’re researching this issue you’ve probably read any number of opinions on whether you should hire a lawyer from the beginning of your case or wait until you’re denied. Most of these opinions are probably from other attorneys who would very much like the answer to be "yes." In reality though, the answer as to whether you need an attorney before you file your application really "depends." We posted a similar answer in 2012, but some important factors have changed since then; namely, the increased number of denials, even in very strong cases. Check out both articles for a complete picture. Continue reading →
The Veterans Administration announced yesterday that it has eliminated the use of net worth as a factor for health care programs and copayment responsibilities. This change will make an estimated 190,000 Veterans eligible for reduced costs of their health services within an estimated 5-year period. Effective this year, VA health care benefits are more accessible to lower income Veterans. This is another step in giving Veterans the health care benefits they both need and deserve. The VA will only consider a Veteran’s gross household income and deductible expenses from the previous year, eliminating net worth as a factor. In continuing to make the healthcare process more efficient, as of March 2014, the VA now uses information from the I.R.S. and Social Security Administration to automatically match Veterans’ income information which no longer burdens Veterans with keeping their healthcare eligibility up to date. This new policy is in line with Secretary Robert A. McDonald’s ‘My VA Initiative’ which is fully focused on Veterans’ needs and will make the eligibility process more efficient for all Veterans. More information can be found at www.va.gov/healthbenefits.
According to the Associated Press, the diagnosis of "Asperger's disorder" is being dropped from the upcoming revision to the Diagnostic and Statistical Manual being worked on by the American Psychiatric Association for publication in May of 2013. Continue reading →
One of the first questions I am often asked by veterans when they call me is whether or not they need an attorney at all.
It’s a very important question that is complicated by the fact that many veterans’ service organizations provide free representation to veterans seeking VA benefits. Some members of these organizations believe that no veteran should ever hire an attorney, when their organization provides similar representation for free. It is true that many service organizations assist veterans in filing claims for free, but the old saying “you get what you pay for” applies.
Prior to 2007, a veteran was not allowed to hire an attorney until the VA had denied the claim multiple times and the veteran had no recourse but to file a lawsuit against the VA. In 2007, the law was amended to give veterans the option of hiring an attorney at any point after the VA had made an initial decision that the veteran isn’t satisfied with (either a denial, or a less than fully favorable Rating Decision).
In fact, attorneys representing veterans tend to charge fairly modest fees. Most attorneys charge a “contingent fee,” a fee paid only if they obtain benefits. While some attorneys charge up to a third of retroactive benefits, our firm, and many others limit our fee to 20% of back benefits. Nothing comes out of current monthly benefits. You will usually be expected to reimburse expenses for items such as medical reports and records, but these expenses tend to be very modest. In all cases, fees may only be charged to a client if and when the Department of Veterans Affairs approves the fee. Therefore, because attorney’s fees are strictly regulated, you can get an experienced veterans benefits attorney at a very affordable cost.
Choosing to hire an attorney provides many benefits that working with a service organization may not. Attorneys are typically highly trained in the law and regulations utilized by the VA to decide claims, and disability lawyers are particularly skilled in gathering and developing the medical and other evidence needed to present a claim in the best possible light. An attorney can also help you prepare for, and attend the hearings before decision review officers and veterans law judges. Perhaps most importantly though, when you hire an attorney you gain another significant advantage: motivation.
This simply cannot be overstated. When you hire a lawyer, in addition to hiring someone with the expertise and training in VA laws and procedures, you’re hiring an ally who is directly impacted not only by wining your case, but by securing the highest possible rating and earliest effective date to which you are entitled. This is not to say that service organizations are not interested in helping veterans win their claims. Most service organizations are staffed by passionate employees (many of whom are also veterans) who want nothing more than to do exactly that. However, without the direct relationship you have with an experienced attorney, you can’t be sure that your representative is going to fight for every last dollar you may be entitled to.
Having an attorney is not an absolute necessity to obtaining VA benefits, but for cases where a veteran has been denied, or received a rating well below what he or she deserves, having a highly motivated, highly experienced veterans law attorney can make a world of difference.
The Department of Veterans Affairs provides disability compensation for veterans who were discharged under conditions other than dishonorable, and have a current illness or injury that began during, or was made worse during their service.
The VA pays compensation based on a Rating Schedule with increasing benefits as the level of disability increases (from 0% to 100%). The VA may also pay benefits at 100% if, solely due to service-connected impairments, a veteran is “totally disabled.” The current rates for VA compensation can be found here. A veteran may receive special additional compensation under certain circumstances for very serious injuries.
Additionally, disability pension benefits are available to wartime veterans who are unable to work (regardless of whether their impairments are service-connected), and have limited income.
If you have not applied for these benefits, but believe that you may be eligible, you can apply online by completing the “Veterans Online Application,” at the VA’s “eBenefits Portal” here.
Currently, the law only allows a veteran to hire an attorney after it has issued an initial rating decision. This can be either a denial, or a less than fully favorable Rating Decision. If you have been denied or received a Rating Decision that you are not totally satisfied with, please contact us today. Even if you have not yet applied, one of our experienced veterans law attorneys would be more than happy to discuss your case.
Please don’t hesitate to call and speak with one of our skilled veterans benefits lawyers. You fought for us, now let us fight for you!
By David S. Bross, Esquire
If you read my first two columns about disability insurance, you should now have a basic understanding of both the need to protect one’s ability to earn an income and the essential features of disability insurance policies. What happens, however, if you actually suffer the misfortune of a disability, file a claim, provide all the necessary documentation to the insurance company and then have your claim denied (or terminated)? Continue reading →