Are You Being Denied Long-Term Social Security Disability? We Help Fight Denials with Appeals and Lawsuits

More than 150 million Americans are in the United States workforce. Approximately 70 percent of the workforce work for an employer with 10 percent being self-employed and 20 percent working for a self-employed person. These figures include all age groups, including senior citizens who might be of retirement age and teenagers.

Each day, millions of people wake up expecting to go to work to earn a living. Sadly, some of these people will not be able to go to work tomorrow. Something will happen in their lives that will prevent them from working. It is estimated that 22 percent or 53 million adults in the United States have some type of disability. Unfortunately, only one-third of US employers provide long-term disability insurance as part of their benefits package. Some employees decide to purchase private long-term disability insurance policies.

Of the millions of Americans who do have access to long-term disability insurance, many of these individuals will be denied when they apply for long-term disability benefits. A disability policy is supposed to provide a source of income when you are unable to work. It will not pay your full income, but it does pay a percentage of your income to allow you to continue paying your bills and expenses while you are out of work.

Most of the employer-provided group plans that offer long-term disability coverage are governed by the Employee Retirement Income Security Act of 1974 or ERISA, a federal law that dictates how you are supposed to file for benefits and how to appeal a denial. ERISA is a very strict law with specific rules. Under the law, you may not be allowed to file a lawsuit seeking disability benefits or damages until you go through a lengthy appeals process.

Private long-term disability policies are different from employer-provided policies. State contractual laws govern private disability insurance policies. These laws do not require you to go through the appeals process before you can file a lawsuit for an unjustified denial of benefits.

Over One-Half of Long-Term Disability Applications are Denied

Even though millions of American workers apply for disability benefits each year, only a fraction of those applications is approved. Insurance companies unfairly and unjustly deny most of the disability applications they receive each year. Common reasons that a disability claim may be denied include:

• The company uses its medical evaluations that state you are able to work instead of your doctor’s evaluation;
• Alleging you are misrepresenting the severity of your disability;
• Claiming you do not have the “objective evidence” to prove that you are disabled; and,
• Obtaining video surveillance to “prove” you are not disabled.

ERISA claims can also be denied because you do not meet the policy’s definition of being “disabled.” In some cases, a plan may define disability as being unable to perform any of the job duties of your current occupation. However, other plans define disability as being unable to perform the duties of any occupation. If you have a plan that limits the scope of disability to your occupation, most of those plans stop paying benefits after 24 months unless you can prove you cannot work at any job. In other words, many disabled people lose their benefits after two years because the company finds they can perform the duties of some job, even though they are disabled and cannot work.

Another problem many workers face is applying for benefits if they have been laid off or they have missed work because of their disability. Group disability plans are only in effect while you are employed. If your employer terminates employment because you were unable to work or reduces your hours so that you do not qualify for benefits, you will be denied disability benefits because the coverage has stopped.

Hiring an Attorney to Represent You in the Appeals Process

The appeals process for a denied disability claim can be frustrating, lengthy, and complicated. Deadlines can be very short, and deadlines are strictly enforced. If you miss a deadline, your appeal can be denied. Companies administering disability plans are not very cooperative in providing information about why you were denied. Many people have trouble describing their medical condition and why that condition qualifies under the plan’s definition of “disabled.” In addition, employees who file claims for mental disorders, substance abuse, or nervous disorders are often only granted short-term disability benefits instead of long-term disability benefits.

About 95 percent of the disability claims are for reasons other than workplace accidents. One of the most common causes of disability for workers is musculoskeletal disorders including:

• Scoliosis
• Osteoporosis
• Arthritis
• Back pain
• Rheumatism
• Herniated discs
• Sciatica

Other common conditions that give rise to a disability claim include:

• Mental disorders
• Cancer
• Cardiovascular disorders
• Injuries and poisonings

Because many of these conditions are treated with prescription drugs that cause side effects, workers may be unable to work in part because of the medications they must take to treat their condition. However, long-term disability plans do not take this fact into account. They do not consider that you might suffer from chronic fatigue, anxiety, or confusion because of the medication and these side effects prevent you from being able to perform your work duties safely. Therefore, if you do not report these side effects in exactly the right way, the disability plan administrator might use this information to pay short-term disability benefits or outright deny your claim because the plan excludes these types of “conditions” from its definition of disabled.

If your long-term disability application is denied, your employer-sponsored plan requires that you file an administrative appeal requesting that the insurer review the denial. During the appeal, you must ensure that you have filed all relevant documentation and evidence of your disability because the law makes it very difficult to introduce new evidence after the appeal is complete. In addition, if you do not meet every deadline during the appeal, the law interprets your failure to meet deadlines as a failure to exhaust all available avenues of recourse, so you will not be permitted to file a lawsuit.

Individual or private policies do not have the same restrictions. These policies do not require that you go through a lengthy and complex appeals process before you file a lawsuit. Furthermore, you can introduce new evidence at the trial. Lawsuits on individual policies are based on state contract laws. These cases are heard in state court rather than federal court. Some of the allegations in a state court disability lawsuit include bad faith, negligence, and breach of contract. In addition, policyholders are permitted to choose a jury trial instead of a trial by judge.

ERISA cases are tried in federal court by a judge. The policyholder does not have the option to choose a jury trial for these cases. The basis for the judge’s decision in your case is the “abuse of discretion” standard. This standard only allows a judge to overturn a denial of claim if the evidence used to deny your claim is clearly incorrect or if the insurer’s decision was not supported by the evidence.

The amount of damages and the type of damage you can recover in a lawsuit for individual policies and group plans are also different. Pursuant to ERISA, if you prove your case and win, the federal court is only permitted to award the amount equal to the benefits the company owes to you plus interest on that amount.

Under private policies, you can recover an amount equal to your benefits, but you can also sue for compensatory damages, punitive damages, court costs, and attorney’s fees. However, you must prove that your denial was unjustified before you can recover any funds.

How Can Our Attorneys Help You Get the Disability Benefits You Deserve?

We can make a significant difference in the success of your case whether you are applying for long-term disability benefits for the first time or you are appealing a denial of benefits. Our attorneys are skilled, and they understand the state and federal laws that govern long-term disability plans. We know how to use those laws to fight unreasonable denials and faith bad insurers.

Specific ways that we help include:
1. We help you leave your job and still collect your benefits. Depending on the benefits plan, your coverage may end if you leave work. We analyze the terms of your plan to formulate a strategy that allows you to stop working but still receive your disability benefits.
2. We coordinate with the human resources department for your employer, your physicians, and the insurance company to ensure that the claims process proceeds smoothly. It is important to meet all deadlines, complete and file all forms, and provide evidence to prove disability. It helps to have someone handling all of this and keeping the various parties on the same page.
3. We review medical records, interview experts, and collect additional evidence to support your disability claim.
4. We work closely with your medical providers to ensure they provide all information, documentation, and forms needed for your claim.
5. We help facilitate the referral to specialties who are experts in your specific illness or injury. These experts understand how your disability relates to your job duties and responsibilities, as well as your ability to work in another job.
6. We prepare the statement of disability for the insurance company to review.
7. We review all forms from the insurance company to ensure they are completed correctly, and the deadlines are met.
8. We prepare you for the interview with the insurance provider.
9. We help prepare you for the insurance company’s medical examination and examiner questions.
10. Above all, we protect you from abuse and manipulations by the disability insurance company. We protect your rights under the law and help you obtain your maximum disability benefits.

Suffering a disability is a life-changing event. We understand that it can be overwhelming and emotionally devastating. We also understand that the insurance company is more worried about its profit margin than your situation. Our law firm advocates for workers across the country by fighting negligent and bad faith insurers. We have a proven track record of fighting big insurance providers. Contact us today if you have suffered a disability and you need help filing your claim or appealing a denial of claim. Our long-term disability strategies can help you receive the benefits you are entitled to receive under your disability plan.