Depression is one of the leading causes of disability in the United States. More than 16 million adults in the U.S. have suffered from at least one major depressive episode in the last year. Clinical depression is a mood disorder characterized by persistent feelings of sadness, hopelessness, and isolation so severe that it interferes with one's daily life. Depression can also have accompanying physical symptoms such as fatigue, loss of appetite, and chronic pain. Depending on the severity, depression can be debilitating both mentally and physically, making it impossible to maintain a regular routine, such as going to work everyday.

Depression as a Disability

Man Unable to Work Because of DepressionAlthough depression affects such a large segment of the American population, long-term disability (LTD) insurers are often reluctant to approve any claims based on mental illnesses. This is due to the fact that many mental illnesses can be exceedingly difficult to prove i.e. there is no objective test for depression. Instead, depression and anxiety are diagnosed clinically by psychologists, psychiatrists, and therapists based on an interview. These mental health professionals rely heavily on what their patients tell them in a clinical setting. Because of this, individuals suffering from depression often look and act normally to others. However, their ability to perform in a work environment with any reasonable consistency is severely limited. Someone suffering from depression may experience some of the following symptoms:

  • Trouble concentrating, remembering details, and making decisions
  • Fatigue
  • Feelings of guilty, worklessness, and helplessness
  • Pessimism
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Irritability
  • Restlessness
  • Loss of interest in things once pleasurable
  • Overeating or loss of appetite
  • Digestive problems
  • Persistent sad, anxious, or empty feelings
  • Suicidal thoughts or attempts
While these symptoms can make even the simplest of tasks overwhelming, they can make maintaining the routine and social interactions required to hold a job impossible.

LTD Limits on Mental Health Conditions

Because of the growing prevalence and awareness of mental health issues, LTD insurers have included language in their policies specifying how these types of claims will be addressed. Today’s disability policies almost universally contain lifetime limitations, capping payments on disability claims based on mental health conditions to 24 months. This limitation is commonly referred to as a Mental Illness Limitation. A Mental Illness Limitation provision appears in almost all employer-provided group plans (ERISA-governed LTD plans) as well as many individual LTD policies. However, unlike most group plans, an individual policyholder may purchase a policy rider that will remove this limitation in exchange for a higher monthly premium. It is important to read and understand your policy and its limitations. The primary reason insurance companies will provide for a two-year limitation is because mental health conditions are considered more treatable than physical impairments. Many physical conditions, whether cardiac, spinal or neurological, are often permanent conditions, and therefore require indefinite LTD benefits. Conversely, mental health conditions such as depression or anxiety can hopefully be managed with medication and counseling. From the perspective of the insurance company, these types of conditions are temporary and thus only require temporary benefits. However, mental illness is often a lifetime battle and so, it is critical to know what your policy says and how it may (or may not) protect you.

Documentation is Key to a Successful Claim

Mental health conditions are unique in that many sufferers do not always seek medical care, only see a doctor sporadically when symptoms get worse, or discontinue treatment or medication when they feel better. However, it is important to keep in mind that LTD insurers rely heavily on medical records and your treating doctor’s opinion to determine whether you are eligible to receive disability benefits. Therefore, it is imperative that you receive regular treatment from a mental health professional, preferably a psychologist or psychiatrist, if you are to have any chance of prevailing on a disability claim based on depression. Remember, if your mental health symptoms are severe enough to keep you from working, the LTD carrier will expect you to be pursuing treatment consistent with a disabling impairment. Always verify that your LTD insurer has received any and all medical documents that address your mental health condition. These documents will include records from any general practitioner, internist, psychologist/psychiatrist, psychiatric facility, and/or hospital where you have received treatment. WARNING: Do not rely solely on your LTD insurance company to request and collect all the information needed to make an informed decision on your claim. It is your duty to provide proof of your disability. The insurance carrier’s requests can be inadequate, abbreviated, or even strategically designed to collect information unfavorable to your case. To ensure that the insurance company receives a thorough understanding of your condition and its subsequent limitations, talk to your doctor about making specific findings regarding your ability or inability to:

  • Be on time
  • Sustain a regular work schedule
  • Understand and remember simple or complex instructions
  • Focus-on and complete tasks
  • Maintain concentration
  • Handle work-related stress
  • Respond appropriately to social interactions with co-workers, supervisors, and the public
While insurance companies rely heavily on medical records to make disability determinations, you may also supplement your claim with information from other parties. Collect and submit statements from your family, friends, co-workers, supervisors, or anyone else that has witnessed how your depression has created difficulties for you at work or in everyday life. Any information that you can provide to bolster your claim will only help.

Long-Term Disability vs. Social Security Disability

Although mental health claims can apply to both LTD insurance and Social Security disability (SSDI) benefits, there are important distinctions between the two. As previously mentioned, it is common for a LTD insurer to limit the maximum duration of a long term disability claim to 24 months if the disability is based on a mental health condition. Even if the claimant also has a physical impairment, the insurer may still apply a limitation for the duration of benefits due to a mental health condition. Although many policies exempt certain mental health conditions from this limitation (ex: Alzheimer’s, dementia, organic brain disease, bipolar disorder), the two-year limitation almost always applies to claims based on depression. In contrast, SSDI claims are not limited in duration due to mental health conditions. Once approved your SSDI benefits won’t be terminated after two-years but they may be subject to Continuing Disability Reviews. The Social Security Administration also considers the combination of physical and mental health conditions when considering if someone is disabled. If someone with a mental health problem does not have any physical impairments, it may be challenging to prove disability unless they meet or equal the listings defined by the Social Security Administration. Otherwise, you will have to prove that you are unable to perform even very simple, routine work, on a regular basis. Even if a disability claim based on mental illness is supported by significant medical documentation, a treating psychiatrist’s detailed opinion, and a statement from everyone you know, a LTD insurer is still likely to deny an initial disability claim and force you argue your case on appeal. In these difficult cases, it is critical to hire an experienced disability attorney who can guide you through the appeals process and, if necessary, file a lawsuit against your insurer. Contact the expert disability attorneys at Bross & Frankel for your complimentary consultation today.
Employers often provide full-time employees with a wide array of benefits including health, life, dental, and vision insurance coverage along with disability insurance. An employee's disability policy may include both short-term and long-term disability benefits. Depending on the terms of your particular policy, short-term disability benefits are usually only available for 1-6 months. Once the short-term disability benefits expire, it is imperative to immediately apply for long-term disability benefits. Depending on the policy, long-term disability insurance pays a percentage of your salary, typically 50 to 60 percent. The benefits last until you go back to work or for the maximum number of the years stated in the policy. Don't make the mistake of assuming your short-term disability benefits will automatically roll into long-term disability benefits. Quite the contrary. In most instances a separate application for long-term disability benefits (LTD) is mandatory.

Applying for LTD Benefits in 7 Simple Steps

1. Examine and Understand your LTD Policy

Checklist to Apply for Long Term-Disability Benefits

If you become disabled and are unable to work for a period of time or indefinitely, it is important to carefully review your disability insurance policy options. If you have a private LTD policy, your policy documents will explain the process for applying for benefits. Your policy defines the disabilities that are covered by your policy. This definition will outline what you have to prove to be eligible for benefits under your policy. Certain conditions, such as those related to pre-existing conditions, or drug or alcohol abuse, are typically excluded from coverage. Likewise, your benefits may be limited if your disability is cause by mental health/psychiatric limitations or, in some cases even a more subjective impairment than on an objectively quantifiable one. Examples of such "subjectively reported" conditions can include fibromyalgia, chronic fatigue syndrome, and migraine headaches.

2. Ask Your Employer for an Application

Your employer's Human Resource department can be an invaluable resource throughout the application process. Someone in your HR department should be able to provide you with an application and important instructions to complete your LTD application. Keep in mind that if your policy was provided by your employer, it is likely governed by federal law. The Employee Retirement Income Security Act (ERISA) regulates applications for long-term disability benefits under these policies. Under ERISA, you have the right to receive a copy of your plan description and policy documents upon written request. If your employer fails to provide you with the necessary application and procedures to apply for LTD benefits, there is a good chance that the forms necessary to apply for LTD benefits will be available on the insurance company or claim administrator’s website. The following are examples of long term disability claim forms taken directly from insurance companies’ websites:

3. Submit the Employee Statement

You will be responsible for completing a section of the LTD application often referred to as the Employee’s Statement. The requirements of the Employee’s Statement vary depending on the insurance company, but will generally include information such as:

  • Your name
  • Social Security number
  • Date of birth
  • Address and phone number
  • Name of your employer and your occupation
  • Your work history and education information
  • Date of your injury or illness
  • Description of disability
  • Last date worked
  • List of medical providers and contact information
  • All prescribed medications
  • Other forms of income that you may be eligible to receive
You will want to complete every question completely. However, the form may limit the space available to respond, so use an additional page if necessary to give full and complete answers.

4. Obtain Your Employer's Statement

The LTD application will also require your employer to provide certain information. Such information could include your hire date, job description, salary, the physical and psychological requirements of your job, the date insurance coverage became effective, last day worked, and the date you returned to work (if applicable).

5. Collect Medical Records & a Statement From Your Doctor

It is important to see a doctor prior to applying for benefits since the insurance company will require medical proof of your disability. You may have to submit a signed authorization that allows the insurance company or administrator to request your medical records. Your signature will let the insurance company get the information about you that they need to determine your eligibility for benefits. Additionally, as part of your LTD application, your doctor will be asked to complete a form or write a statement regarding his or her opinion of your condition. The insurer will usually request that your doctor provide information about dates of treatment, symptoms, findings, diagnoses, determination of whether your injury or illness is work related, types of treatment, objective estimate of your physical limitations and/or mental impairments, an approximation of when you may return to work, and any other information that the physician deems pertinent. If your doctor is not supportive of your claim, it may be very difficult for you to prove your disability and qualify for benefits. It is a good idea to speak with your physician prior to starting your application so you can be sure he or she supports you. To show that your disability is ongoing, you should continue to receive treatment from your doctor while your LTD claim is pending; even after you are approved for benefits. Failure to continue treatment could be grounds for the insurance company to terminate your benefits.

6. Apply for Additional Benefits

If your LTD claim has been granted, most policies will require you to file for Social Security disability benefits as well. Any Social Security benefits you receive will offset the amount the LTD insurance company is required to pay. Thus, your LTD insurance company has a significant interest in seeing you approved for Social Security benefits. Because of this interest, the insurer may refer you to a national company to assist you with your Social Security application. It is important to remember that these companies are focused primarily on saving the insurance company money. They may not be attorneys, and may not put your interests first. Bross & Frankel can assist you with your Social Security disability application. Call (856)795-8880 today to learn more.

7. Consider Contacting An Experienced Long-Term Disability Attorney

Since LTD claims are complicated and frequently denied, you may want to seek advice from an attorney who specializes in long-term disability claims and ERISA. If you apply for disability and are denied, you have the right under ERISA to sue the insurance company in federal court. Please be mindful that a denial of disability insurance benefits must be timely appealed. If you fail to submit a written appeal to the insurance company or administrator, you may forfeit your claim for LTD benefits. An attorney can not only help you submit a LTD benefit application but also knows how to maximize the chances that you will be approved for benefits. If the disability application process has you at your wits end or your claim LTD benefits has been denied, contact the experienced and skillful disability attorneys at Bross & Frankel for a free consultation.
What would you do if an illness or injury left you disabled and unable to work for days, months, or ever again? Every year, thousands of people become disabled before they reach the age of retirement. Disability insurance offers benefits, usually based on a percentage of your salary, during the time you are unable to work. Many employees are aware that they receive health and retirement benefits through their employer, but fewer know if they have disability coverage, or what type of disability coverage they have. Whether you have an employer-provided group long-term disability (LTD) policy or an individual LTD policy that you purchased on your own could impact how you pursue your disability claim and your chances of being approved. Most employer-provided disability plans are governed by the Employee Retirement Income Security Act, a federal law commonly known as ERISA.

ERISA Law NotebookWhat Exactly is ERISA?

The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to set minimum standards for employee group benefits including health, life, and disability benefits. ERISA protects benefit plans from mishandling and abuse, and ensures that employers are acting in the best interest of their employees. ERISA regulates how disability plans are managed by the employer including how disability claims are to be processed, deadlines for filing a claim, and an employee's rights if their disability claims are denied. ERISA also requires accountability and transparency, to guarantee that employees have access to information about their benefit plans. Any employee covered by their employer's disability benefit plan should receive a written summary of their plan detailing key features: how the disability plan works, what benefits are offered, and any out-of-pocket costs to be incurred by the employee for coverage.

When Does ERISA Apply?

An individual may choose to purchase disability insurance on their own or it can be provided by an employer. Some states require employers to provide disability benefits for their employees, including New York, New Jersey, California, Hawaii, and Rhode Island. Employers operating in these states must provide disability insurance regardless of where the employer's corporate offices are located. Employers who do not provide disability coverage in these states may be subjected to fines and penalties. Who provides the insurance may determine whether the disabled individual is covered by ERISA. The protective laws of ERISA only apply to private-sector companies that offer employer-sponsored benefits. It is irrelevant whether the private company is organized as a partnership, corporation, LLC, or a non-profit. Although ERISA provides protection to people who work for most types of employers, ERISA does not ordinarily apply to:

  • Privately purchased, individual insurance policies or benefits
  • Benefit plans offered through state, local, or federal government employers
  • Benefit plans offered through church employers
  • Benefit plans that are maintained only for purposes of complying with workers’ compensation, disability, or unemployment laws
  • Unfunded excess benefit plans
  • Plans that are maintained outside of the United States and are intended primarily to benefit non-resident aliens
If you have any questions about whether your disability insurance program may be covered by ERISA, contact your human resources department. If you have had a disability claim denied or terminated by your employer or insurance company, it may be time to speak with an experienced disability attorney to make sure you get the benefits you have earned.

Why is ERISA Important?

When an injured individual files a disability claim, their insurance company or employer may attempt to deny the employee's claim. The claim may be denied because the employer alleges that the individual is not disabled, they are not covered by the policy, or that the employee failed to follow the proper guidelines when applying for benefits. It is important to understand whether ERISA governs the disability insurance claim because ERISA provides the right to appeal a claim denial and file a lawsuit to compel coverage.

How Does ERISA Affect My Disability Claim?

When an employee is covered by an ERISA-governed plan, the federal law provides a number of protections to help the employee obtain disability benefits. If an employee's disability benefits are denied, ERISA demands the claimant receive copies of any documents, records, or information relevant to their claim for benefits, free of charge on request. Following an adverse decision, ERISA also requires that the claimant be allowed a full and fair review through an appeals process. While ERISA provides certain protections for employees, ERISA has been interpreted in a way that also significantly benefits insurance companies. Perhaps most importantly, if the denial of your claim is upheld on appeal, in most cases, you cannot add additional evidence to prove your disability. In addition, if you have to go to court, a judge may be required to review the denial under an "arbitrary and capricious" standard of review. That means, even if the judge would have found you disabled, he or she can only overturn the insurance company's decision if it is without a rational basis. Simply put, proving the insurance company's denial was wrong may not be enough. There are numerous ways in which ERISA effects disability claims, but the bottom line remains this: the primary purpose of ERISA is to safeguard employees who are counting on benefits that their employer promised them. ERISA is a broad and complex federal statute, and the protections that it affords claimants stated above are by no means exhaustive, and as noted above, ERISA may also negatively impact your rights, making it vitally important that you obtain all the evidence you could possibly need to prove your claim before the insurance company makes a "final" decision. For that reason, it is imperative to consult with an experienced ERISA attorney to explain your rights and fight for the benefits that you deserve.

Disability Benefits Attorney

The attorneys at Bross & Frankel, P.A. have many decades of experience representing individuals and families who have been denied benefits by their insurance company or plan administrator. There is a small window of time to appeal your disability denial, so do not delay. If you have been denied short-term or long-term disability benefits, contact our office for a free consultation.

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.
hands
If you can't use your hands, it doesn't matter how long you can sit at a desk or workstation. Most jobs require you to do *something* while you're there.
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
Completing endless paperwork for Social Security may be the last thing you want to do.
Completing endless paperwork for Social Security may be the last thing you want to do.
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.
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!