Please note that the answers provided to the listed questions are designed to answer simple questions concerning disability benefits. To receive a full explanation concerning your situation, you should consult an experienced attorney. Please feel free to contact us at 301-495-6665 or 1-866-633-3583 for a free, no obligation, phone consultation. You may also e-mail us by firstname.lastname@example.org.
|you are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury, and you have a 20% or more loss in your indexed monthly earnings due to that sickness or injury. The reason for such specific and deliberate language is that the insurer has purposefully created an artificial definition of the word “disability.” The reason for this is simple. Insurers need to set forth language which seems plausible to get people and employers to pay premiums for the policy yet remains legally restrictive enough so as to prevent payment of many claims. This is ingenious work and is obviously the handiwork of many trained lawyers. This language itself should cause any claimant concern and make anyone realize that they have entered a system which requires the assistance of a skilled disability benefits attorney.|
Not Make Admissions of Abilities on the insurance company claim forms.
The company will be very
happy to use any reports of abilities to perform activities
of daily living no matter how seemingly insignificant. They
will make sure to send out investigators with video surveillance
if you tell them that you are performing activities outside
your home such as working out at a gym, jogging, bicycling,
Not Ever Forget that every time you go outside your home that you may be videotaped.
Insurers especially appreciate when you perform yard work or
go to big box stores and lift heavy items. Even better are those
trips to the gym where they will videotape your entire workout.
You may able to justify your activity by giving explanations,
but remember the following: the videotape is not on when you
are in pain the next day or cannot get out of bed. It only sees
what is filmed and if you look good while performing even simple
activities, it can and will be held against you. For this reason,
do not lift any items above the weight or duration which are
not recommended by your doctor. There are plenty of people working
at stores who will be happy to assist you as tipping may constitute
a desired source of income.
If you believe you are being followed, call the police. It is not illegal for private investigators to follow you in public, but the police will question the investigator. This will put the individual on notice as to your knowledge of his/her activities and may prevent further investigatory activity. No matter what, you will feel better by letting them know you do not appreciate their presence.
Investigators will call your treatment providers to verify the dates of your appointments and videotape you on your trip. If you have a scheduled appointment, go see your doctor, but do not make side trips until a couple of days later. Investigators will park outside your home for hours and wait for you. Their tendency is to leave after it becomes dark outside. If you need to pick up something, then do so in the later evening when the investigators “turn into pumpkins.”
to Coordinate Your Work Cessation Correctly.
Your benefits are not payable after you stop working. Therefore,
you need to be fully diagnosed and assessed before you apply
for benefits. If you wait for your physicians to “figure out”
the cause of your illness while you apply for benefits, the
insurer may claim that you were not suffering from the diagnosed
impairment prior to your ceasing work. Check your policy. Your
benefits eligibility ends the day you cease working. Be careful
and seek the advice of counsel in advance to make sure you do
not fall prey to such policy provisions.
Ever let investigators from the insurance company into your home.
If you need to meet with them, then do so at a public place.
The investigators will be happy to ask you questions about household
items or photographs hoping you will admit to activities they
can hold against you. The will record their perception of your
home cleanliness, etc. Many times, claimants meet with these
investigators without a witness. This is also foolish since
the investigator’s report cannot be rebutted by an independent
observer. Our clients only meet with investigators in our office.
At times, I will record the sessions if the investigation turns
unfriendly, its necessity is questionable, or if the investigator
the insurance company will assist you with any disability claim.
Insurance companies will offer you assistance with your Social
Security case. Do not let this happen. You are not required
to use the services of their vendors. More often than not, they
hire non-attorneys (also called “Claims Representatives) or
poorly skilled attorneys to do this type of work. If they lose
your Social Security case, they will use it against you. If
you somehow win your case, they will try to offset your benefits.
No matter what they will do little to develop the evidence in
your case so as to prevent your from acquiring useful information
which will assist you in your case against the insurer who referred
the case to them. So, even if the company tell you the a Social
Security representative will be provided for “free.” At best,
you may only get what you paid for. At worst, you will not receive
disability benefits of any kind.
Some insurance companies will gather your medical documents. Others will not. All policies read that it is the claimant’s duty to submit evidence supporting disability. On the other hand, many companies will be more than willing to submit biased questionnaires to your treatment providers and employer to create adverse evidence to help support a denial of your benefits. Do not let this happen to you.
Many insurance claims representatives will be more than happy to gain your confidence by stating that they are “there to help you” or “are on your side.” Remember who is paying their check. The check is not paid as easily to the employee if that money is being paid to you. Another trick commonly employed is the good/bad cop scenario where the claims representative and claims manager take turns being nice or nasty to you in order to soften you up, acquire information, keep your confidence, and, ultimately, deny your claim.
Our firm knows all the tricks that the insurance companies use and will work hard to make sure that you will not be taken in by their bad faith conduct.
hiring a skilled disability benefits attorney. You can never
get counsel too early. Many of our happiest clients are those
for whom we have prepared disability claims for and which were
approved with comparatively little trouble.
Threatening an insurer that you will get an attorney only tells
them that you do not want to do so. Being cheap with your claim
only reduces your chances of getting the benefits you deserve.
A small investment in the efforts of a skilled counsel can result
in your receiving many thousands of dollars in benefits and
not experiencing many sleepless nights. Remember the old adage,
if you decide to be your own counsel, then you have a fool for
a client. You cannot remove your emotions from the process.
Therefore, get assistance from a skilled attorney who has experience
in the specialized area of law. Too often, claimants retain
lawyers who have very little experience in this area. These
lawyers may come highly recommended by friends or colleagues.
Often, they will tell you that they will “see what they can
do.” Unless the attorney can point to many cases he has or is
prosecuting, it will be too great a chance to take an inexperienced
counsel will be successful in your case. You will not believe
how many calls our firm receives from attorneys who take disability
cases and get in over their heads only to call us for help.
Make sure to question the attorney thoroughly to check for his/her
expertise in the area. Be wary of the practitioner who does
these cases every once in a while as such a person is not keeping
up with rapidly evolving disability law. Be suspicious of attorneys
who will charge consultation fees to speak to you. They tend
to try to make money through their consultations rather than
through their work performance. A confident attorney should
not have to charge for a short consultation as they do not require
such small fees to support their practice. Truly confident attorneys
will take on contingency work since they would rather rely on
their efforts and receive their reward later upon successful
completion of the case. Also, attorney’s offering a free “report”
are offering very little. It usually is nothing but a piece
of self-congratulatory puffery combined with scare tactics designed
to sell their services rather than actually tell you exactly
what kind of experience they have or cases they have handled.
We give all this information for free on our website so you
do not have to contact us and be put on a mailing list. We dislike
being placed on a mailing list for the sole purpose of marketing
as much as you do.
Importantly - Never
file an appeal without the assistance of an experienced long
term disability counsel.
Many aspects of the denial can be challenged
by developing the proper evidence and arguments. Should you
exhaust your appeals, you may not be able to present additional
evidence when you are left with only court proceedings which
will based on the claims file. In ERISA based cases, you will
not be able to present witnesses or testify. The court proceedings
will only be based on your claims file in the form of paper
pleadings. If the necessary evidence has not been made part
of the claims file when you appealed, then you lose forever.