What You Need to Know About Your LTD ERISA Disability Claim
If you have any questions about what to do next about your ERISA disability insurance appeal, contact an experienced disability insurance claims attorney. Jason Newfield can help – call for a free consultation today – and allow him to provide some guidance on the issues.
Here’s more information you will need to know.
10 – IN WRITING, tell the claims adjuster you want your file – all of it. You are entitled by law to have the same materials as the insurance company, but most people don’t know this, so they don’t ask. Under ERISA, you are entitled to “all relevant documents”. Your LTD attorney may need to make the call for you, but you should try to get the file first. Sometimes, only portions are provided, and follow-up requests are required to secure the entire file of relevant materials.
9 – Locate your policy document. This is important, as policies change over time. If you signed up for an LTD policy decades ago, your original policy is likely to be far more generous than one from two years ago. Review the policy to see if you can get some key information, like when you are required to file a claim, how long the waiting period is, and any other time-sensitive information. Group policies through work may change, and the employee/claimant is merely a beneficiary of that agreement between the employer and an insurance company. Jason Newfield often reviews policies during a free consultation and is able to parse out the important information you may not know to look for. Call the office for your free consultation, and do not wait. There are often strict timelines.
8 – Medical records are an important element of your claim’s success, but they are not the only part. Your symptoms alone are NOT enough to get a claim over the goal line. How those symptoms impact your ability to perform the tasks of your occupation needs to be thoroughly explained, in a way the insurance claims adjuster will understand. If you have a desk job and a spine injury, your doctor will need to prepare a narrative report detailing your inability to be upright in a chair for more than ten minutes without excruciating pain that limits your ability to manage complex matters, for instance. How it may impact the ability to focus or concentrate may need to be addressed.
7 – You will need to gather all of your medical records from all healthcare providers relating to your claim or impairment. Anyone who has been involved in your healthcare from the date of your disability needs to be included in the information you submit. You will want objective evidence, diagnostic tests, and images or lab reports to support your claim.
6 – If you are also receiving disability income from Social Security, any other disability insurance policy, or any other source, include this information in the packet of materials. If there is other income and the insurance company takes the position that you were hiding it, your claim could be further delayed. While some of these sources may be considered an offset, others may not, and how the issue is addressed may be important.
5 – Develop collateral evidence to support. Ask other people in your professional life to write a statement on your behalf explaining the changes they have seen in you since your disability impacted your life. Even if they are not medical experts, the people who can articulate the difference between your pre- and post-disability performance will add another level of support to your claim. Often, this collateral evidence is important to judges when considering these issues in litigation.
4 – To further these issues, and if appropriate, ask people in your personal life to articulate the changes they have seen in your life because of your disability. Anecdotes about your prior life as a rock climber and current status on the sidelines may be helpful. Cancelled plans, or removing oneself from engaging, can be identified and used as support.
3 – Don’t try to be brave, in your materials submitted or in any doctor visits. Do not tell your doctor you are feeling better when you are not, or the insurance claims manager that you expect to be fine in a few months. If you cannot keep yourself from downplaying your disability, have a trusted spouse, friend, or relative go with you to doctor visits and have an LTD attorney review any materials before you submit them to the insurance company.
2 – Keep track of your activities, doctor’s appointments, and whenever you leave the house. The insurance company is likely to keep an eye on you. By maintaining records, your LTD attorney will be able to protect you from accusations of not being disabled. If you only leave the house to go to doctors’ offices, make sure it is written down. Do not rely on your doctor’s office to maintain these and other records. Be your own best advocate.
1 – Talk to a long-term disability insurance attorney about your claim. Jason Newfield and other attorneys offer free consultations and are able to help you understand your policy, gain an appreciation of how the insurance company is likely to treat your claim, and give you insight into what you can expect in the future. These free consultations are valuable for the information you will receive, even if you decide to tackle your claim on your own.
