What is the definition of "disability"?
“Disability” is defined in Webster’s New World College Dictionary (4th ed. 2002) as: (1) a disabled condition; (2) that which disables, as an illness, injury, or physical handicap; (3) a legal disqualification or incapacity; (4) something that restricts; limitation; disadvantage.

Now, look at the definition of “disability” in your policy. You will immediately notice that hardly a single word matches the dictionary definition. One insurer had defined disability as:

What is ERISA and what effect does it have on my claim?
Most people obtain long term disability coverage as part of an employee benefits plan. Most employee benefits are regulated under a complex government statute called the Employee Retirement Income Security Act of 1974 or ERISA. Look it up sometime, it is huge and unwieldy. This is why few attorneys engage in an ERISA-based law practice. Claimant’s attorneys who regularly engage in ERISA practice have their own definition: “Everything Rotten Invented Since Adam.”

ERISA sets forth a series of regulations which are rarely enforced by the Department of Labor and which the insurance industry attempts to take full advantage. What is most troubling is the standard of review many courts review insurer claims denials: abuse of discretion which is also termed arbitrary and capricious review. Most people are familiar with the civil jury standard of preponderance of the evidence. This means one party is more persuasive than the other party. In the case of arbitrary and capricious review of claims decisions, a claimant must prove that he or she is really right and the insurer is really wrong. This is a very difficult burden and should not be taken lightly. Unless a claimant is able to produce sufficient evidence which is made part of the claims file at the time of review, this burden will not be met and the claimant will forever lose his or her much needed disability benefits. Further, a claimant needs to be able to identify the particular instances of bad faith conduct by the insurer in his/her case as well as has been identified in past case decisions. Since a claimant is not on an even playing field with an insurer, the only way to counteract this distinct disadvantage is to acquire the assistance of a skilled disability benefits attorney. As the law of ERISA is evolving on a daily basis, you need to acquire an attorney who is regularly engaged in this practice. A person who does these cases on occasion will not have sufficient expertise.

Can my employer help me get my disability?
It can’t and, to the surprise of most claimant’s WON’T. Why? If the insurer bought an insurance policy, then that policy will be administered by the insurer or by a different third party administrator. In either case, most employers wash their hands of your disability case once your claim is made. Even worse, you will find some human resource managers who will try to undermine your claim by providing incorrect information about your job activities or about your prior work performance. When the employer is self-insured, you can expect substantial resistance to your application as they benefits will be paid directly from their assets. It is no surprise that the employer would rather keep itself in the “black” by not giving up any of its “green.”

The awful truth is that once you are no longer useful to a company, you tend to become disposable and are forgotten. The way to keep this phenomenon is to take measures to prepare your case for disability in advance. Our firm has helped many clients receive their benefits upon their initial application as well as after receiving claims denials or terminations.

Our firm’s experience is that they are far more “Catberts” than “Drew Careys” when it comes to human resources managers. It is important to take steps to prevent an evil HR person from hurting your chances to receive disability benefits.

Does my doctor know I am disabled?
It does not matter whether your doctor knows you are disabled. The fact that a doctor says your are disabled is not absolute evidence of your disability. The actual findings in your reports including symptoms, tests, diagnoses, and functional restrictions are far more important than a simple pronouncement of disability. Face it, your doctor does not have the policy definition of disability and cannot make a legal determination. This is not the physician’s role. is But, your treatment providers can provide a wealth of information to help support your claim for disability.

Even worse, the Supreme Court has ruled that an insurer does not have to believe the opinion of your treating physician(s). Does this seem fair? We do not think so, but we have other very effective ways of assisting our clients in proving their disability despite what the “Supremes” say.

In addition, the forms used by many insurers are deliberately deceptive. They are purposefully designed to fool your own doctors to give findings which will be utilized against you. Our firm has given several seminar presentations concerning the use of these forms (one such presentation which resulted in Scott Elkind being forever banned from an insurer-friendly conference) and knows all the tricks the insurers have up their sleeves.

Are there "better" disability insurance companies?
Not Really. Just because UnumProvident gets all the bad publicity because it is the largest disability insurer does not make it the worse company for paying claims. There are others which can be worse. The reality is that there are many variables at play when you apply for benefits including the claims representative reviewing the case, any internal guidelines issued concerning your condition or profile, the financial condition of the company, among many others. So, whether your policy is with Prudential, Fortis, Reliance Standard, The Hartford (CNA), MassMutual, ING, SunLife Financial, Liberty Life, GE Financial, High Mark, MONY, Aetna, Cigna, New York Life, MetLife, Paul Revere. Northwestern Mutual or any of the other disability insurers, you should always be careful since their bottom line could dictate your ability to receive benefits. In fact, some of the harshest companies are your own employer when they are self-insured. In these cases, the money comes out of their own pocket and many choose to fight very hard to keep their money rather than pay it to disabled claimants.

Are there certain medical conditions which are more disabling than others?
Diagnosis does not equal disability. It is the severity of a condition which causes a person to become disabled. For example, a small skin cancer lesion is very treatable and, in most cases, will not result in disability. A similarly small brain cancer lesion in a sensitive area can be very disabling. Similarly, some people experience headaches with only minor impairment while others suffer from excruciating cluster or migraine headaches which completely impair them. For this reason, it is crucially important to demonstrate how a particular illness or injury affects the specific claimant. Generalities of diagnosis will not be effective in proving disability as there are plenty of people with the same illness who are still working. The important factor which must be established is proving the limitations caused to you by your particular condition and conveying that information effectively to the insurer or a court.

What is more important is that your medical documentation be complete. For this reason, you should always know the complete content of your medical records before they are submitted to an insurer. The last thing any claimant needs when applying for benefits it surprises (usually bad ones) from their own treatment providers.

There are certain conditions which will raise insurance company’s suspicions. Many of these conditions involve what insurance companies term “self-reported” symptoms such as pain, fatigue and dizziness. Although everyone has experienced these symptoms at some point in their life, these symptoms themselves are not capable of accurate measurement by a scientific instrument. Such conditions which cause the primary symptoms of pain, fatigue and dizziness include connective tissue disorders (i.e. lupus), migraine or cluster headaches, vestibular disorders, fibromyalgia, chronic fatigue syndrome, Hepatitis C and other blood disorders, cardiac conditions, chronic pain syndromes, post-cancer treatment syndromes, musculoskeletal disorders among many others.

What amount of benefits will I receive if approved?
Although your insurance policy will tell you the percentage of your salary that you will receive if approved for benefits, you will need to check the “fine print.” If you are a worker who receives overtime or commissions, you many be limited only to your base salary for the purpose of monthly benefit calculation.

Many policies will contain an offset provision which will reduce your benefits by other benefits paid to you including Social Security disability (not only to you, but also to your dependents...how unfair), other government disability benefits (railroad workers, etc.), workers’ compensation, among others. As you will notice, you are required to apply for Social Security Disability benefits in order to force a reduction of your benefits in order to benefits an insurer. If you were not a high wage earner, the offset may be so drastic that you could receive little in benefits following offset reduction. A small benefit amount actually makes it easier for insurers to deny your claim as insurers know you will have little or no money to acquire a skilled counsel to fight them. We never said anything in this system is fair.

Are my disability benefits subject to taxation?
If you paid for your policy with pretax dollars, then your benefits will be subject to taxation. If the benefits were paid with after tax dollars, then the benefits will be not be taxable. Most people receive their benefits as part of an employee benefits package and receive group rates. Whether paid in part of whole by the employer, these benefits will be taxable. Social Security disability benefits are taxable income also though it may seem somewhat senseless. What the government giveth, the government taketh away.

Can I return to work?
Read you policy carefully concerning partial disability benefits. Once you exceed a low threshold, your benefits will be terminated and you can lose all rights to them. Be very careful when planning a return to work. Such planning should include consultation with both your attorney and physician prior to committing to a new work attempt.

Will the insurance company keep investigating my claim?
If you have to pay someone out of your pocket every month because they claim they are unable to work, would you blindly accept the fact and keep paying good money each month without checking up on the situation. I think not. Insurers will request periodic updates including medical reporting. If they have any suspicion that you do not remain “disabled,” they will send out investigators to verify your condition. This can be by formal interview or private investigation including video surveillance. Many times, you will notice that an insurer is getting more aggressive in their information gathering, this is a strong indicator that they are preparing their case to terminate your benefits. If you feel that you are in any danger of having your benefits terminated, please contact a skilled disability benefits attorney immediately. Our firm has been successful in restoring and/or maintaining disability benefits for many clients.

What type of service does your firm offer?
Our firm is called “The Disability Benefits Law Firm” for a reason. We have the experience and skill to handle both your private, ERISA, and Social Security disability cases. There are very few law firms who possess the necessary skill in all these areas. Our firm has handled thousands of cases including hundreds of lawsuits and appeals in the federal courts. Due to this experience, we will do our best to win your case early on without necessitating the risks inherent in court proceedings. We have the skill to handle your case from beginning to end including: initial application, administrative appeal, federal court litigation, appeals court briefing. We have handled many benefit termination cases and have successfully prevented benefits terminations as well. In addition, our firm has handled many overpayment matters as well as settlement of long term disability claims.

What type of fees does our firm charge?
Our firm prides itself on offering flexible payment arrangements which include flat fees, contingency fees, and hourly fees. We have even created combination of these fees in order to make our services affordable for our clients. As each case is different, we discuss fees with the individual client, basing the fee structure on many factors including the basis of denial, the particular insurance company, the quality of evidence supporting the disability claim, among many others. We offer free consultations for new clients seeking our representation as we firmly believe that we should earn our fees from our work not just by making people come to appointments. More often than not, we will consult by telephone initially as our experience is that our clients have difficulty traveling and they appreciate speaking to us first instead without necessitating an long trip for a personal interview.

What mistakes should I avoid?

Below are listed seven deadly sins that claimants commit: