If you suffer from chronic pain, you know well that the pain, itself, is not your only problem. The pain may prevent you from exercising, from taking care of your home and family, and — importantly — from doing your job. But these limitations from pain are only part of the story. The other problem chronic pain sufferers often face is that doctors, employers and others may not believe how bad the pain is. There is, after all, no simple way to measure your experience of pain. This can reasonably make you worry that you will not be able to get time off work or disability benefits for chronic pain.

Man with chronic back pain at doctor's officeThe good news is that medical diagnosis and tests are getting better at confirming self-reported pain caused by many things from fibromyalgia to Chronic Fatigue Syndrome to other injuries and illnesses. The bad news is that insurance companies still often deny employee disability claims based on chronic pain, since it is harder to measure or prove than more obvious illnesses and injuries.

If you are an employee who is unable to work because of pain, you may apply for long-term disability benefits (LTD benefits) through your employer's LTD policy. Knowing how LTD policies and insurers address chronic pain claims will increase your chances of having your claim approved. Given how hard it can be to successfully show you can't work because of chronic pain, you should also consider getting the help of an experienced long-term disability benefits attorney.

Chronic Pain as a Disability

What is chronic pain? It is often defined as pain that continues longer than normally expected after a major illness or injury — roughly more than 3-6 months. Chronic pain can be local; showing up in specific body parts such as the head, back, or joints. Alternatively, chronic pain suffers may experience pain in the muscles, or nerve pain all over the body. It may be related to an injury or illness, or there may be no clear explanation as to the cause. In these cases, sufferers and their doctors may share frustration and anxiety as they work to find answers that can be elusive.

You can be diagnosed with a pain disorder, or, you may have a disorder that causes chronic pain. Some common examples of chronic pain conditions include, but are certainly not limited to:

  • Amyotrophic Lateral Sclerosis (ALS)
  • Benign chronic pain syndrome
  • Cancer pain
  • Cervical/Neck Pain
  • Chronic Fatigue Syndrome (CFS)
  • Chronic Regional Pain Syndrome (CRPS)
  • Cluster, Tension, or Migraine Headaches
  • Degenerative Disc Disease (DDD)
  • Fibromyalgia
  • Gout
  • Irritable Bowel Syndrome (IBS)
  • Joint Pain
  • Lyme Disease
  • Neuropathy pain (nerve damage)
  • Osteoarthritis
  • Psoriatic Arthritis
  • Reflect Sympathetic Dystrophy (RSD)
  • Rheumatoid Arthritis (RA)
  • Sciatica
  • Shingles

If chronic pain is keeping you from doing your job, you may qualify for long-term disability (LTD) benefits. But applying for benefits is not quite as easy as saying, “my pain is so severe that I can’t work." Here are some of the reasons it is difficult to get LTD benefits for chronic pain — and things you can do to increase your chances of being approved for benefits.

LTD Limitations on "Self-Reported" Pain Symptoms

Tests such as X-rays, MRIs, and CT scans can show that you have an injury, but they do not show the actual pain that you feel. In addition, the experience of pain from a similar condition or injury can vary from one person to another. So proving whether you are in pain — and how bad that pain is — often has to be based on "subjective" or "self-reported" symptoms. In other words, your doctor simply has to believe you when you explain where it hurts and how badly it hurts. It is always important to report your pain to your doctor.

For obvious reasons, disability insurance companies are often suspicious of claims for self-reported conditions. They reason: how can they really know that your pain is so bad it stops you from doing your job? What if you're lying about your pain just to get benefits? So, when you file a disability claim for a self-reported condition like chronic pain, it is very likely that your initial claim will be denied. Insurance companies are more likely to employ "fraud" tactics in chronic pain cases, like hiring private investigators to follow you around for a few days to see if you're really as limited as you claim.

Even if your claim is approved, benefits for disabilities based primarily on self-reported symptoms may be limited to 24 months, even if the symptoms are a result of a proven illness or injury. Even if your claim is approved, some policies have specific limits on how long you can receive benefits for disabilities based primarily on self-reported symptoms. It is important to read your own policy — or get legal help in reviewing your policy's terms — to see what limits apply to your situation.

LTD plans usually have a non-exhaustive list of what the plan considers self-reported symptoms. Some common examples include headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness and loss of energy. If you file a claim for disability benefits on these kinds of symptoms, it is very important to have enough medical evidence to show that your symptoms are real.

Making Your LTD Case for Chronic Pain

When you claim LTD benefits for chronic pain, LTD claims examiners look at your physical and mental limitations to determine whether your disability limits you so severely that you are unable to work full-time. Unfortunately, the claims examiners often don't trust that an employee is telling the truth about self-reported pain conditions. Another problem is that doctors who diagnose or treat disability applicants commonly do a bad job of documenting a patient's levels of pain in their treatment notes or stating what the effects might be on the patient's ability to work or do normal daily activities (this is especially true for doctors who utilize electronic medical records that often report no symptoms unless your visit is explicitly scheduled to discuss that problem). So how do you go about proving your pain?

Credibility is King

The believability of the patient generally becomes the driving force behind the approval or denial of a disability claim based on chronic pain. The disability insurance company, of course, considers the doctors' opinions, clinical notes and records, physical examinations, diagnostic imaging, and the type of treatment you have received. But often a claims examiner, and the reviewing nurses who help them, put a lot of thought into whether the patient is credible — that is, if he or she seems to be telling the truth — when the patient describes how bad the pain is. The consistency of the complaints and reasonable connection to the underlying disease or injury is critical to this analysis.

Continuous Medical Treatment

Receiving continuous medical treatment is very important to establish your credibility. Your disability insurance carrier will doubt that you have been in severe pain if you have not received treatment for your pain on an ongoing and continuous basis. Treatment may include medical as well as non-traditional methods of pain relief such as massage, physical therapy, acupuncture, exercise, nutrition, herbal supplements, yoga, and meditation. It is not necessary to seek narcotic pain medications to be taken seriously. It is, however, absolutely critical not to give up on getting medical help, even if it seems like there's "nothing else to do." Be sure to document everything you do to relieve your pain in your application for disability benefits.

Keep a Pain Journal

Keeping a pain journal can help you record important facts about your chronic pain over time; after all, only you can know when and how much it hurts. When keeping a pain journal, the following details can be important depending on the kind of chronic pain:

  • Date and time the pain occurs
  • Severity of pain (scale of 1-10)
  • Type of pain: sharp, dull, achy
  • Location of pain
  • Duration of pain
  • Possible causes of pain: physical activity, particular movements, over exertion
  • Additional or related symptoms
  • Pain management: limit activities, medication, massage, psychotherapy, etc.
  • Effects of current treatment
  • Changes in treatment
  • Changes in underlying medical condition associated with chronic pain
  • Lifestyle factors that can affect pain: diet, exercise, quality of sleep
  • Emotional and psychological effects of pain, such as depression and changes in mood

It is important to pay close attention to how your chronic pain limits your physical and mental activities. Can you stand or walk for an hour or less, but only by clenching your fists against the pain? Do you have to lie down or put your feet up periodically? Do you find it difficult to learn or remember new information because you are distracted by pain? Or maybe it is hard to get along with supervisors and coworkers because your pain makes you irritable and impatient? When documenting your pain, you need to be realistic about how your pain might limit you in a full-time job. If you can only stand for an hour at a time by suffering a tremendous amount of pain, chances are you probably won't be able to stand for an hour every day to do a job. Share your pain journal with your doctor and make sure that it is part of your medical chart that gets sent to the LTD insurer along with your long-term disability claim.

Getting Help with Your LTD Claim

Because it can be so difficult to prove total disability based on chronic pain, we recommend working with an experienced attorney. The long-term disability attorneys at Bross & Frankel are highly knowledgeable about chronic pain claims and familiar with the tactics disability insurance companies like use to deny benefits. For a free consultation with a lawyer about your disability claim, contact Bross & Frankel today.

To learn more about chronic pain, check out the following sites:

American Chronic Pain Association

U.S. Pain Foundation

American Pain Society

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 Depression

Although 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

You can apply for benefits from both LTD insurance and Social Security disability (SSDI) if you are disabled due to a mental health condition. But LTD and SSDI differ in important ways, including how you quality for benefits and how long those benefits may last.

As previously mentioned, LTD policies often limit the length of a disability claim to 24 months when the disability is based on a mental health condition. The insurer may still apply this time limit even if you also have a physical disability. These policies may include language indicating that they can apply this limitation if your overall disability is "contributed to" by your mental health. 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.

SSDI benefits for mental health conditions, on the other hand, are not automatically limited to a specific length of time. Once approved, your SSDI benefits won’t stop after two years. But they may be subject to Continuing Disability Reviews. Importantly, if you do not have any significant physical disabilities that affect your work, it can be hard to prove disability for SSDI benefits based only on mental health issues unless your condition is included in the Social Security Administration list of mental disorders. 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.

Checklist to Apply for Long Term-Disability BenefitsIf you are disabled from working, you may well be depending on receiving long-term disability benefits (LTD benefits) through a policy provided by your employer. Knowing the right steps and timeframe in which to apply for LTD benefits can make all the difference in being approved for benefits when you need them most. 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 (either limited by the policy or near your retirement age). It is very important to understand that LTD benefits usually require a separate application from short-term disability benefits. If your policy provides for short-term benefits, these will usually last for only 1-6 months — exactly how long they are available depends on the particular policy. If you continue to be disabled and unable to work after your short-term benefits expire, you usually need to apply separately for long-term disability benefits.

Applying for LTD Benefits in 7 Simple Steps

1. Examine and Understand Your LTD Policy

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 will generally define what it considers a "disability," as well as what does not count as a disability for purposes of receiving benefits. For example, many policies do not cover inability to work due to substance abuse or pre-existing conditions. Further, benefits may be time-limited if your disability relates to a mental health condition — like depression — or to "subjective" conditions that are hard to measure or document with conclusive medical tests, such as fibromyalgia, chronic fatigue syndrome or migraine headaches.

2. Ask Your Employer for an Application

Your employer's Human Resources department can be an invaluable resource throughout the application process. Someone in your HR department should be able to provide you with an LTD application and important instructions to complete it. You may also be able to find the forms 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. It will generally require you to provide information such as:

  • Your address and phone number
  • The name of your employer
  • Your occupation
  • Your birthdate
  • Your Social Security number
  • Your work history
  • Your educational background
  • The date your were injured or your illness started
  • The last day you worked
  • A description of your disability
  • The names and contact information for your doctors/medical providers
  • Any medications you take
  • Any other income you may be eligible to apply for
It is important to answer 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 and 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. This may include information about dates of treatment, symptoms, findings, diagnoses, determination of whether your injury or illness is work related, types of treatment, opinions about your current limitations and 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 doctor 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

LTD claims can be complicated and are often denied for all sorts of reasons. For this reason, many disabled workers choose to work with an attorney right away to get help with the LTD application process. An experienced LTD benefits attorney can help you increase the chances that your LTD benefits will be approved by ensuring that you do everything right with your application, including submitting the most complete evidence of your disability. If your application for LTD benefits has been denied and you want to appeal the denial, it is important you act quickly and follow each required step for an appeal — which generally includes contesting the denial in writing to the insurance company and, if you need to sue in court, meeting strict filing deadlines. An attorney is especially helpful during the appeal process. 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. When you need to draw on your disability coverage, it can make a difference if your policy is governed by the federal Employee Retirement Income Security Act, better known as "ERISA." This is because ERISA, unlike an insurance policy you might purchase yourself from an insurance agent, provides legal protections to employees, as further discussed in this article. Most group disability plans provided by your employer are governed by ERISA. But private policies you purchased on your own are not.

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 don't know whether your disability coverage is governed by ERISA, you can start by asking the human resources department at your place of employment. However, if your disability claim has already been denied or terminated, it may be time to speak to a disability attorney to help you advocate for your rights under your policy and ERISA.

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.

Contact a Disability Benefits Attorney

Bross & Frankel, P.A. is dedicated to representing employees and individuals who have had their disability benefit applications wrongly denied or terminated. We encourage you to contact our office for a free, no-obligation consultation to discuss your rights and the next steps in your case. You have a limited amount of time to appeal the denial of your application, so it is advisable to act quickly. A claim review can bring you great peace of mind — at no cost to you.

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.