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Articles Posted in Long Term Disability Claims

Long term disability claims are made when you are injured and unable to perform your work duties without experiencing significant pain. It is not easy to obtain long term disability payments from an insurance company, and even if you are granted the benefits it does not guarantee that you will be able to keep them for an extended period of time.

You may lose access to your benefits for a number of reasons, including missed deadlines, a change in your disability, a change in your doctor’s opinion of what treatment you require or, possibly, the insurance company finding out that you don’t require the benefits consistently anymore.

In order to be eligible for benefits you must be able to prove that you require regular medical care in order to care for a disability that prevents you from performing your work duties. You must be able to prove that your injury or condition fits the insurance company’s definition of “disabled,” which may differ from your own definition or your doctor’s opinion. The insurance company’s definition is the only definition that matters.

Even if you are approved for benefits, this does not mean you are now free from continuing to prove your disability to the insurance company. You must continue to provide documentation to the insurance provider, in a timely manner, which proves you are receiving medical treatment for your disability or condition. In fact, the most common reason benefits are put on hold is because a deadline was missed to send documentation to the insurance company.

You may also have your benefits halted if the insurance company finds out that you no longer require the benefits. In some cases, insurance companies may actually hire or employ agents who check up on long term disability benefits recipients to see if they are truly disabled, and that they are truly encumbered to the level that their insurance claim reports them to be.

For example, if these inspections reveal that you were capable of raking your yard and digging a hole for a new mulberry bush, and you had been receiving long term disability claim benefits due to a back injury that prevented you from working your job as a landscaper, then the insurance company can use this as a reason to end your benefits package. They would, however, be required to notify you of this intention before cutting off the benefits.

If your benefits are suddenly ended

If you suddenly lose access to your long term disability payments, time is of the essence. You have a limited amount of time to file an appeal of this decision, and it will not be easy to prove that you deserve to keep the benefits once the insurance company has decided otherwise.

Certain cases, such as a missed deadline or a missing piece of medical documentation, may be easier to clear up than other cases, such as if the insurance company uncovers some type of proof that you were not as disabled as you once had been, or claimed to be.

The only way to ensure a good chance to continue receiving your benefits package is to consult with an attorney. A good attorney can pour over the details of your specific case, talk to your physicians and your insurance company and work out the specific reasons for why your benefits were cut off.

If there is an avenue to win your benefits back, the experienced legal team at Altman & Altman LLP will find it. We have over 40 years of experience going against insurance companies in court and advocating on behalf of our clients. We can take the necessary steps and time to make sure your case is properly argued and give you the best possible chance for success. Continue reading

Have you become injured and unable to perform your duties at work as a result? Did you apply for long term disability coverage through your insurance company only to be denied? What steps can you take from here? First, it is important to understand why your claim for long term disability may have been denied.

Your injury may not satisfy the insurance definition of “disabled”

Every insurance policy is different, especially policies that are intended to cover large bodies of people, such as a policy used by a workplace to insure their employees. Two common types of policies are “own occupation,” which define a disability by being medically unable to carry out the responsibilities of your specific job. “Any occupation” defines a disability as the medical inability to perform any job.

Certain policies carry certain exclusions as well. Pre-existing conditions are often excluded from long term disability coverage, and other disabilities that rely on diagnoses that aren’t quantifiable by proof – such as certain mental conditions – may only provide coverage for a limited amount of time.

You may not have provided enough evidence to prove your disability

To be granted long term disability benefits you must be able to prove that the benefits are essential to your continued livelihood. You must prove that the benefits will go towards necessary, continuous medical treatment. To do this, you must supply the insurance company with accurate, up-to-date medical records, such as test results.

Further, whether or not you receive benefits can hinge on a written statement of opinion from your physician. This statement should include all the medical reasons for why your disability impacts your ability to work, and how performing those duties would potentially cause you harm.

Appealing a denial

If you were denied a claim for long term disability but feel as though it was a wrongful denial, you may appeal the decision. You should review the insurance company’s long term disability police first and foremost, to make sure you didn’t miss a crucial element when submitting your claim. You can usually obtain a copy of the policy from your human resource department or from the insurer itself. Your right to obtain a copy of the policy is protected by federal law, so do not take no for an answer!

Look over the denial letter for the reason you were denied coverage. You may have missed important information or forgot to supply a key piece of information, like the opinion statement from your doctor. You should also hire an attorney at this point, who will help you organize your appeal. Additionally, hiring an attorney will show the insurance company that you mean business, and will not go away without a fight.

Working with an attorney, you may find that you have a limited time to appeal a decision, and therefore limited time to obtain any medical records, or undergo any additional necessary tests to prove the difficulties caused by your disability.

As with any case involving legal affairs, it is essential that you are working with consummate professionals who understand the law and treat your individual case with special care and attention. That is exactly the type of counsel we provide at Altman & Altman LLP. Continue reading

Long term disability coverage is a provision included in some insurance benefits packages which will pay an employee a significant portion of their salary in the event that they become unable to work because of a lasting disability. This disability may be caused by an accident on the job or, in some cases, by an event unrelated to work. However there are restrictions for pre-existing conditions.

There is, however, a large burden of proof on the individual employee to show that they are indeed disabled and that they are entitled to make a long term disability claim. It is important to note that you must satisfy the definition of “disabled” that is outlined by your insurance company, not your own personal definition of disabled or a doctor’s definition.

If you get your insurance through your Massachusetts employer, you can ask a human resources representative for the information within the insurance policy that defines what a disability is. Insurance policies generally pay out long term disability claims for people who are “totally disabled,” meaning you are wholly unable to perform your work duties because of your disability, but some policies will pay for “partial” disabilities as well.

Proving a disability

In proving to an insurance company that you are indeed disabled in the long term and unable to work, the most crucial factor is getting a thorough and verified testimonial from a doctor who has observed and treated you, and knows the specific circumstances of your disability.

Insurance companies are, obviously, inclined to not just hand out expensive long term disability claims, and so it is crucial to make sure that a reliable doctor can provide a truthful and detailed account of your disability. How did you get it? How does it debilitate you? How did the doctor diagnose the disability? What tangible proof can the doctor show that your disability has a serious impact on your ability to work (x-rays, MRIs, surgery reports, etc.)?

Other information

Another important aspect of long term disability claims is that you must be receiving ongoing treatment to deal with your disability. Even after a claim has been deemed successful, it is important to continue to show that the benefits you are receiving are needed and are going to the cause they are intended to go towards, otherwise the insurance company may have grounds to terminate the benefits.

To receive benefits, usually an employee must have been a full time employee at the time of becoming disabled. Employees will have to go through a waiting period of usually a few months, and may be required to use up sick time and short-term disability benefits before applying for a long term disability claim.

Before applying for long term disability coverage, you should be sure that the injury/disability you suffered if covered by the policy, and is not expressly excluded from coverage. Certain jobs that require dangerous tasks may have more exclusions involving work-related injuries than less dangerous jobs.

In addition to long term disability, you may also be eligible for Social Security Disability benefits and workers’ compensation benefits (if the disability occurred as the result of a workplace injury). Continue reading

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