3 Major Questions of a Total and Permanent Disability Claim

While most sufferers of chronic back pain are able to recover and return to work in varying capacities, there are many people who experience such severe and debilitating pain that they will never be able to hold a normal job again. Claimants who suffer from such severe conditions are initially approved for their disability benefits, but this may be just the beginning of a long and winding road for claim investigations that can be opened and reopened for years on end. Insurance companies won’t acknowledge what total and permanent represents and require regular and appropriate care for the conditions causing the pain throughout the duration of the claim and can also require other documents ranging from tax returns to activity logs. Insurance companies can also reopen investigations at any time and restart the review process all over again. If you have been approved for benefits and don’t expect to return to work anytime soon, there are several issues you should consider to help reduce the stress going forward in the claims process.

Three of the most common issues we hear about from claimants in this situation are surveillance, settlements, and what the insurance company considers to be appropriate care for the condition. I will touch on each of these topics as well as a few other key issues prevalent in these types of claims. Continue reading

The Doctor’s Corner: Diabetes, Complications, and Disability

Diabetes is a growing health problem in America with over 26 million people suffering from the condition and another 79 million individuals suffering from pre-diabetes such as insulin resistance and Metabolic Syndrome. Only approximately 5 percent of diabetics suffer from Type 1 diabetes with the overwhelming majority suffering from Type 2 diabetes. While many of these individuals are able to work long and fulfilling careers, there are increasing numbers of people whose disease prevents them from continuing in their jobs and are forced to file claims for disability insurance benefits.

Insurance companies will often dispute and deny a disability claim based solely on a diabetic condition even if it’s shown that the condition was the root cause of the inability to work.  It’s important to understand that technically, they may be correct.  It’s not usually the diabetes that disables someone but one or more of the many complications that are caused by this disease. If you’re receiving regular care and treatment and are following the plan of your treating physician, being diabetic in and of itself is generally not disabling.  If you find you’re unable to work and are filing a disability claim, you’ll want to document the nature and extent of the complications and the severity of their impacts on your work abilities.   Continue reading

6 Tips To Keep Your Disability Claim Moving

One of the biggest red flags a claimant can inadvertently create in their disability claim is to move.  While there are many legitimate reasons someone can move, claim examiners have been trained to closely scrutinize a case where a claimant moves.  New sets of arguments and investigative avenues are opened for the insurance company to use against you.  As anyone who’s moved can tell you, moving is difficult at best.  And the last thing someone needs, who is already trying to move while dealing with their disability, are new and additional hassles from their disability insurance company, not to mention the added stress of worrying that their benefits will be delayed or stopped.  If you’re currently applying for or receiving disability benefits, there are several issues we think you should understand as well as a few tips on how to keep the disability claim process moving smoothly during this stressful time.   Continue reading

3 Reasons Your Invisible Disability Benefit Claim Was Denied

When many people think of a claimant who is receiving disability benefits, they picture someone who is visibly and physically unable to work.  Although many claimants suffer from conditions of this nature, some of the most painful and devastating conditions include categories often referred to as “invisible disabilities.”  Invisible disabilities include such conditions as CFIDS, Fibromyalgia, chronic pain and mental illnesses, such as anxiety or depression.  These conditions can be every bit as severe and debilitating as outwardly obvious conditions but are often met with skepticism and distrust by disability claim professionals.  Many claimants who suffer from invisible diseases encounter seemingly unending questions and problems with their long term disability claims and the claims process.  We have seen people make inadvertent errors in how they’re presented their disability claims and simply give up, surrendering their rights to the disability benefits they actually deserve.  Here are the three common reasons that disability claims based on one of these invisible diseases are denied. Continue reading

Doctor’s Corner: Behind a Carpal Tunnel Syndrome Diagnosis

As many professional jobs become more and more computer-based, disabilities that involve nerve, muscle or tendon damage in the hands have become a major issue.  These conditions prevent people from typing reports, replying to e-mails, and completing the day-to-day tasks of their jobs.  These conditions can range from work modifications to a short-term disability, simply requiring a short period of rest away from the office and the stresses of work, to a total and permanent disability.  One common condition causing such disability claims is carpal tunnel syndrome (CTS).  In today’s blog, I am going to walk through the information many doctors will look for and use in writing a report for your disability insurance company.  Even if you aren’t suffering from carpal tunnel syndrome, this article can be useful to show the steps an examiner follows when diagnosing your condition. Continue reading

The Best Practices When Appealing Your Disability Claim Denial

Disability claim appeals are full of complex ERISA rules and requirements that are used by insurance companies to deter insureds from successfully appealing their denials of benefits.  Claimants who file their appeal alone don’t have a very high rate of success and even those who do succeed have to navigate a cumbersome and confusing process to get the benefits they deserve.  This blog has mentioned appeals many times, but the purpose of today’s article is to focus specifically on the options available to claimants appealing the denials of their short or long-term disability benefits and the techniques we’ve seen help insureds successfully appeal for their disability benefits. 

Continue reading

Uncovering the Secrets of Insurance Company Surveillance

Surveillance is an issue that has been mentioned in several past blogs and creates tension and stress for claimants and insurance companies.  Disability claim examiners are trained to recognize certain “red flags,” ranging from incorrect statements on claims forms, to inconsistencies with medical information, to the experiences of a claims handler, that can trigger different types of surveillance.  In response to several questions about specific surveillance techniques and how to handle them, I’d like to explain some of the more common tactics used on a regular basis by insurance companies.   Continue reading

Defining and Decoding “Appropriate” Care

Disability insurance claim examiners often bring up the issue of “appropriate care” when questioning benefit claims and often use this same term as an excuse to deny claims.  Many claimants do not properly understand this term and how it can be used by the insurance company to manage your disability claim.  Older disability policies used to require that a claimant be under the “regular care” of a physician and required little more.  As insurance companies seek more control over disability claims and their direction, this policy language has been changed to “appropriate care,” which has a much more stringent definition.  Regular care was usually based on a time perspective, ensuring disabled claimants were receiving some sort of recurring medical treatment.  The shift to “Appropriate care” has given the insurance companies the liberty to retain their own experts to decide if the claimant’s choice of treatments or physicians is “appropriate” for the condition. 

The motivating factor behind this change is control of your disability claim.  If insurance companies have the latitude to decide what care is (or isn’t) appropriate, they can influence your medical care and treatments with the goal being to reduce the length and amount of the claim, either by discounting the medical support presented by the claimant or by making a disabled claimant return to work no matter the treatment risks or if the claimant is actually ready and able.  Several factors are taken into account by the insurance companies when determining appropriate care.  Knowing these factors and what to look for can allow you to receive the appropriate care from professionals of your choice rather than that dictated by the insurance company.

Continue reading

Disability Insurance Financials, Part 2 of 3: Social Security Awards

The Social Security Disability Insurance program, or SSDI, had a large influence in the private disability insurance world.  From helping determine the diagnosis of an insured to the amount of an insured’s benefit check each month, it is almost impossible to deal with private insurance without worrying about Social Security.  This is why Social Security questions are some of the most common inquiries that come into our office.    In the second blog in this series, we are going to discuss the different ways that SSDI payments have on a private insurance claim and the proper ways for an insured to handle problems. Continue reading

Watch Out for Your Social Media Presence

Post on Facebook!  Tweet on Twitter!  Re-pin on Pinterest! 

Social media is breathlessly changing the way our world communicates, shares news and pictures, and forms relationships with other people.  Recently, there have been several articles in the news about how social media has been used by insurance companies to accuse people of committing disability claim fraud.  Many people do not think about what they put on Facebook, Twitter, or LinkedIn, but claims examiners, field representatives, and private investigators sure do.  These sites are some of the first (and best) sources of information used to delay or decline paying a disability claim.  While Internet searches are not always misused in a claim investigation, the possibility for abuse is there by misconstruing what’s posted or putting information in a wrong or misleading context.  This is why we educate our clients on how to be clear and careful about what they put online and how to have a consistent social media footprint when filing a disability claim.

It might sound funny, but Google yourself.  Get an idea of what may be floating around the Internet about you.  For another example, try Dirt Search and you might be surprised what one free, simple, quick public record search is able to find. Continue reading