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Frequently Asked Questions

Long-Term Disability

When should I file a claim for long-term disability/ERISA benefits?

Before you stop working, we suggest that you get a copy of your long-term disability policy and read that portion of the policy that tells you when you must file a claim. Most policies require that you file your claim for long-term disability/ERISA benefits within a certain period of time after you stop working. Different policies require different time periods.

Once you receive a copy of your long term disability policy, The Law Office of Sharon M. Barrett can review your policy free of charge to answer any questions you may have.

Should I retain a lawyer?

If you need disability benefits and have been denied those benefits, then yes, you should retain a lawyer. The Law Office of Sharon M. Barrett has been representing disabled individuals for years and can help you too. Call us for your free consultation.

What should I look for in a law firm?

The bottom line is expertise in disability insurance law and the handling of ERISA claims. ERISA disability claims are very complex and very different than any other type of case and law.

My doctor tells me that I can no longer work. What steps should I take before I stop working?

You should get a copy of your long-term disability insurance policy because the policy will show what steps you need to take in filing your initial application for disability benefits.

You first want to make sure that the condition that is preventing you from working is covered under your long-term disability policy. Most long-term disability policies have exclusions and conditions for which they will only pay benefits for a limited time period. Examples of conditions that maybe limited to 24 months are: mental illnesses, chronic fatigue syndrome, fibromyalgia, and other similar conditions that are not verifiable with objective medical evidence and diagnostic testing.

We at the Law Office of Sharon M. Barrett have often found that people really don't understand the details of their long-term disability policy that they have purchased for two reasons: 1) you are never provided with a copy of the long-term disability policy when you purchase it, or get enrolled in the plan and 2) the policy is never explained to you, either by a representative from the insurance company selling the plan or by someone in the human resources/benefits department of your employer. Unfortunately many long-term disability policy holders don't learn about the policy terms until they became disabled, filed a claim, and been denied benefits.

Once you receive a copy of your long-term disability policy, the Law Office of Sharon M. Barrett can review your policy for no charge to you and answer your questions.

How do long-term disability policies define disability?

It is important to understand how your long-term disability policy defines "disability". For some insurance policies "disability" means that you are unable to perform your "own occupation", while other policies define it as the inability to perform "any occupation". Generally, the burden is on you to prove that you cannot perform your own occupation. It is important to recognize that policies often change the definition of "disability" after you have received benefits for a fixed period of time. For example, you have been receiving benefits for 2 years because you cannot do your own occupation (which is the occupation you were working in when you became disabled and stopped working), however, your policy states that after 2 years of receiving benefits you have to prove that you cannot do "any occupation" to continue receiving benefits.

The Law Office of Sharon M. Barrett will review your policy for no charge to you and answer any questions you may have.

Is it really that difficult to receive long-term disability benefits?

The insurance carriers do not simply pay out benefits without requiring you to provide substantial evidence to prove you are disabled. The claims process can last several months and is very complex. Many disabled individuals assume that a statement from the treating physician indicating that you can no longer work is all that is needed to be awarded benefits. This unfortunately is not the case.

I've filed my claim. What happens next?

Your insurance carrier should acknowledge the receipt of your claim in writing or by phone. If your insurance carrier contacts you by phone, we recommend that you hire an attorney and let the attorney communicate directly with your insurance carrier. Your insurer may ask you a series of questions that you might not know how to answer or you may unknowingly give an answer that is damaging to your case. The last thing you want to do is get confused and misstate your ability to work to the insurance representative. This is just one instance when working with an experienced legal team will benefit you greatly. If you retain The Law Office of Sharon M. Barrett, we will handle all correspondence with your insurance carrier. You will never have to worry about speaking with them directly. In fact, we advise against it.

My claim for long-term disability (LTD) benefits was denied. What should I do?

If you were denied long-term disability benefits, you will have a time period within which to file your appeal. It is very important that you file your appeal within this time period. The insurance company calls your appeal "the administrative" appeal which is your last opportunity to submit new supportive medical evidence to the insurance company. Once the administrative process is complete (once the insurance company makes a decision on your appeal), the record is closed. Nothing else can be submitted on your behalf.

The Law Office of Sharon M. Barrett can review your claim free of charge.

What information should be included in my appeal to my insurance company?

The information in your appeal is, at this stage in your claim, the most important, because it establishes new and material evidence and medical support which will form the basis of any future litigation of your case if the insurance company denies the appeal.

My doctor won't complete the long-term disability paperwork, what should I do?

Find a new doctor who will complete your disability paperwork!

Your doctor can make or break your long-term disability case. If your doctor is unwilling to complete any disability forms or comment about your disability to anyone, then you need to find a doctor who will. This is an unfortunate position in which some people find themselves in. Many people are told by their doctors that they can no longer work, but are unwilling to complete any disability forms or write any disability letters on their behalf. This is a huge problem because the insurance company will require your doctor to complete disability physician statements and may require your doctor to write a letter explaining his findings. The insurance company may also request a telephone conference with your doctor to discuss your disability. Again, if your doctor is not willing to do any of these things, this will make your claim that much harder to prove. The insurance company will not pay you disability benefits just because your doctor writes one letter or fills out one form that says you can no longer work. The insurance company will bombard your doctor with paperwork and forms to fill out and will not stop as long as your claim is on-going.

Should I expect a fight to obtain my disability insurance benefits?

Unfortunately, yes! Many of the leading disability insurance companies are involved in organized strategies to deny individuals of their well-deserved disability benefits. ERISA plans are aided by a law that gives the insurance companies procedural advantages. In addition, insurance companies have the means to intimidate legitimate claimants and drag out the decision making process.

You should expect a fight for disability insurance benefits even when your doctor or doctors support you.

Will I be able to testify at trial and call witnesses?

If your policy is governed by ERISA law, there are very few rights the policyholders have. You will not be able to resolve this dispute with your insurance company in the traditional manner. Policyholders who have policies governed by ERISA law do not have jury trials; are not entitled to punitive damages or compensatory damages; have no right to testify in your own defense; no right to have doctors testify and no right to submit any evidence after the close of the administrative process.

My insurance carrier told me I must apply for Social Security Disability Benefits. Is this correct and why would I need to file for these benefits?

Most long term disability policies have a clause in the contract requiring you to file for Social Security Disability benefits as a condition of receiving your long-term disability benefits. The reason the insurance companies require you to file for social security disability is because your long-term disability policy also states that the insurance company is entitled to reduce the amount of your long-term disability benefits by the amount of any social security disability benefits that are payable.

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