Disability Insurance Lawyer Blog

SHORT TERM DISABILITY CLAIMS FLAT DURING RECESSION - WHICH NUMBERS TO BELIEVE

A San Francisco based research organization, Integrated Benefits Institute, recently noted that the number of non-occupational short-term disability claims filed by employees during 2007, 2008 and 2009 were flat. The research was conducted because of IBI's perceived a lack of accurate information about short term disability claims. Another organization, The National Business Group on Health, released a report in January that surveyed 648 midsized and large employers and found that short and long-term disability claims declined at the same time that long-term disability costs surged during these three years.

Both of these items were reported in Business Insurance magazine, with the same reporter's byline. We have to wonder whether these studies are being generated by industry groups with their own particular agendas.

Here's why: during these three years, the economy began to falter, then took a huge nosedive. In our experience, workers who are worried about holding on to their jobs don't make short-term disability claims during tough times because they fear losing their jobs. Any numbers concerning short or long-term disability claims must be considered in the context of what we all know to have been an unprecedented economic environment.

Our recommendation? When you see a research report from a research group, dig deeper. Look to see who is sitting on the board of directors of the group and where the funding comes from. That may give you more insight than the results of any survey.

We have one agenda: to provide short term and long term disability insurance claimants with effective legal representation. If your situation is important, don't wait. Call us now for a free consultation with an experienced disability insurance law firm.

February is American Heart Month - Heart disease is a leading cause of disability

Heart disease has now become the number one cause of death in the United States and is a leading factor in disability claims. Success in winning a heart disease disability claim requires, among other factors, a documented record of being under the care of a cardiologist or primary care physician or cardiac surgeon. Without it, the disability insurance company claims adjuster will be skeptical about the validity of a cardiovascular or heart attack disability claim.

Because of the frequency of heart disease in the adult population, paired with the extremely wide range of cardiac conditions, disability claims decisions are given close scrutiny. Has your capacity been diminished to such a degree that you can no longer perform the material tasks of your occupation? What medical evaluations have taken place that can substantiate this claim?

The medical report will need to clearly show that the heart muscle is damaged and cannot pump enough oxygen enriched blood, or a blockage in the blood vessels leading to your heart makes you unable to function. Any diagnosis must be backed up by EKGs - electrocardiograms - CT or MRI scans, or any of the diagnostic tests used to measure cardiac health.

Be prepared for your heart disease disability claim to be challenged. One person's mild cardiac "event" - even when it leads to the insertion of multiple stents and repeated angiograms - may be devastating to one person, a mere hiccough for another. The nature of your occupation is another factor to consider. A high-pressure floor trader in a national stock exchange can easily demonstrate a strong correlation between a high stress job and a cardiac event. A worker with a sedentary, low-stress job with the same cardiac event may have a harder case to make to win a disability claim.

All too often, we see insurance companies ignoring the stress associated with work, and its impact upon those with heart disease or other cardiac conditions. It is imperative to develop a claim record to demonstrate the stress related issues, and to be able to articulate how and why your condition impacts your ability to work.

Another concern with these claims is that once a claimant stops working, and thus reduces their level of stress, the exercise testing may reveal a greater capacity than when working. Many insurance companies will then rely upon one's "improved" results to terminate a claim.

If you have been fighting to get disability insurance benefits and cannot work in your profession as the result of heart disease, high blood pressure or stroke, call our office at 1-877-LTD-CLAIM (877-583-2524). If you are disabled as a result of a heart attack, the last thing you should be doing is worrying about your disability insurance policy. We can help.

Hartford Reinstates Client Suffering from Chronic Fatigue Syndrome

We are thrilled that Hartford has decided to overturn its decision to terminate our client's long term disability insurance claim, reversing that decision and reinstating her long term disability insurance benefits. Our client suffers from Chronic Fatigue Syndrome, Fibromyalgia, and other conditions, which impacted upon her ability to work as a Speech Pathologist.

In order to succeed with our ERISA appeal, we needed to develop the support of our client's treating medical providers. These providers offered their support for our client's medical impairments, and articulated how and why she was unable to work in her occupation. Our appeal aggressively attacked the underlying basis of the claim determination, demonstrating to Hartford that the decision was an abuse of discretion.

Our 111 page appeal included an attack of Hartford's medical review, the development of claim support through personal statements, vocational analysis, medical support and legal argument. This formula for success was thankfully persuasive enough to permit Hartford to see the error of their ways and reinstate our delighted client.

Disability insurance denials - is your claim in one of these categories?

We were surprised to see that UNUM openly admits to denying almost 10% of all the claims it receives. After all of the years we're in the disability claims area of law, we think it's a bit higher than that. An article originally appearing in Smart Money reports that musculoskeletal injuries - and back pain in particular - sends a big red flag to claims representatives, as do pregnancy related claims and carpal tunnel syndrome. The biggest challenges we see in our practice are mental health claims. The problems are multi-faceted: while recognized as an illness, you can't quantify depression and cognitive impairments from depression are often difficult to measure. Their subjective nature makes it even harder to see on an x-ray or MRI. And because most disability insurance policies limit mental/nervous claims to two years, the claims are problematic to begin with. Fighting with an insurance company to obtain benefits, when you are too depressed to leave the house, is something that no one should have to do alone.

In a related article, also in Smart Money, we learned about a woman fighting complications from breast cancer who received nasty phone calls at 7 AM from case managers at Cigna, asking if she would consider changing doctors or if she had any changes in her symptoms. Her story is emblematic of the worsening state of disability insurance. Employers and insurers are not only cutting back on coverage, but those who attempt to file for a claim are more likely to be denied. At a minimum, one can count on both delays and harassment before getting the claim approved. The reductions come at a particularly bad time: the American workforce is aging and claims for age related illnesses are on the rise. Denied claims are even more frustrating when the cost to employees for their disability policies has taken a dramatic leap. Just as employee contributions to health insurance have increased, employees who want disability insurance today share in a significantly higher percentage of their cost. So you are paying more - and the disability insurance companies are doing whatever they can to pay out less.

If you have a problem with a disability claim, don't wait until the collection notices start piling up in your mailbox. Call us today to learn how we can help, at any stage of the claims process.