Bringing Your Vision-Based Disability Claim Into Focus, Part 2

Today, we’re going to finish our blog series on vision-based disability claims. Last week, we covered Glaucoma and how individuals suffering from this condition can make sure they get the benefits they deserve. The second half of this series focuses on a couple of lesser known conditions that can also affect the quality of life of sufferers and prevent them from continuing in their occupations. If you suffer from one of the these conditions, following the tips below may help you get the benefits you deserve.

Macular Degeneration

Age-related macular degeneration is a condition which usually affects individuals over the age of 50, although rare cases have been reported in younger patients. Due to damage to the retina, macular degeneration can cause loss of vision in the center of your vision field, called the macula. This central loss of vision makes it difficult to do such activities as reading or recognizing faces, although enough peripheral vision is often present to allow the patient to participate in activities of daily life. The initial symptom is often yellow deposits, called drusen, in the retina. The larger and more prevalent the drusen are in the eye, the more likely an individual is to develop macular degeneration. Although it affects the central vision, macular degeneration doesn’t usually lead to complete blindness. The macula compromises only 2% of the retina, leaving the remaining 98% of the vision field unaffected. However, almost 50% of the visual cortex is devoted to processing macular information. In addition, losing central vision is extremely detrimental to basic visual tasks – reading is almost impossible and the loss of contrast sensitivity makes it more difficult to differentiate between colors, contours, and shadows.

There are several tests to determine if you have macular degeneration. These tests measure the presence and size of several different objects in the eye to tell if a patient has the symptoms of the disease. If these issues are present, then there are several different vision tests that can confirm the diagnosis. Once the diagnosis has been determined, the treatment usually consists of injection directly into the eye on a monthly or bimonthly basis. There is no permanent cure for macular degeneration at this time, so controlling the disease is the best choice at this time. In addition to the injections, adaptive devices such as special eyeglass lenses, computer screen readers, and accessible publishing options for books can make the daily life of sufferers easier.

There are several issues that insureds may face when filing a disability claim resulting from macular degeneration. The main issue is the fact that patients can still use their peripheral vision to see certain objects and continue basic daily life activities. Claims examiners can twist this ability into an argument that the insured is still able to perform their job duties. In cases where the insurance company uses surveillance,  the activities on video can be taken out of context if the insured is going into public and completing tasks that may require some vision, but not the detailed abilities that a healthy macula provides. Anyone who is applying for disability benefits based upon macular degeneration should make sure to show how their job functions include tasks that require detailed vision to complete.  Otherwise, this can result in an example of the disconnect between a diagnosis and a disability, discussed in one of our prior blog posts.

Retinitis Pigmentosa

Retinitis pigmentosa is an inherited, degenerative eye disease that can cause severe vision impairment and often leads to blindness. It’s a very unpredictable disease, with some sufferers exhibiting symptoms from birth while others may not notice the condition until much later in life. It can also cause tunnel vision, night blindness, and a loss of central vision. Retinitis pigmentosa is caused by abnormalities in the retina, centered in either the photoreceptors or retinal pigment epithelium. There are no visual symptoms of the disease and sufferers must constantly adapt to less and less vision, eventually causing major issues with the activities of daily living.

Testing for retinitis pigmentosa relies on documentation showing the continual loss of photoreceptor function through visual field testing. In addition, DNA testing is available to detect the presence of a number of different gene indicators that can give advance warning of the condition. After a patient is diagnosed with retinitis pigmentosa, there is little they can do. At this time, there is no cure for the condition, although some new treatments hold promise but aren’t yet widely accepted. Using vitamin A supplements can postpone blindness by years in some cases, and a retinal prosthesis is being tested in several European countries with promising results. Many sufferers  of this condition maintain some form of central vision for a period of time. Some insurance companies have delayed (or denied) disability claims on this fact, asserting that claimants are still able to do sedentary work and work in conditions that don’t require seeing in low light. If you’re suffering from this condition, make sure that the diagnosis and evolution of your condition is well documented and substantiates how you’re prevented from performing your job duties even with “reasonable accommodations.”

Losing your vision is a scary though but is a reality for many people. The last thing someone who is losing or lost their normal vision to differentiate between light and shapes should have to worry about is their ability to collect the disability benefits they deserve. Some insurance companies use the uncertainty in many vision conditions to cast doubt on the claim and find reasons to delay or deny paying benefits. They will say that accommodations can be made even when they’re bordering being unreasonable. The ability of many low-vision claimants to continue doing things like going to the store and completing yard work makes insurance companies suspicious and surveillance videos seem like indictments.

If you’re considering filing a disability claim based off of a vision based disability or are being treated unfairly by the insurance company, please visit our website to sign up for a free consultation or call our offices toll-free at (855) 828-4100.

The Different Definitions of Disability

Deciphering the different definitions of disability is a surprisingly complicated process. Some of these definitions can be found in almost every policy, while some use attachments or riders to tweak the policy language. While the exact terminology may be different, there are five basic definitions of disability that are important to understand if you’re considering filing a claim for benefits or even if you’re just trying to decide what type of coverage to purchase.

1. Own Occupation. Simply put, this definition defines you as totally disabled if you can no longer perform the material and substantial duties of your occupation. Some policies will even consider you totally disabled if you are unable to perform just one of the material and substantial duties of your occupation. If you are being paid benefits under an own occupation disability policy, you may be able to go back to work in a different type of job and still be entitled to benefits as long as you’re unable to perform the job from which you were declared totally disabled. Because of this liberal definition, these policies are usually more expensive and harder to obtain.  
2. Any Occupation. This definition is almost the opposite of Own Occupation. You’re only considered totally disabled if you cannot perform the duties of any occupation. Usually, the policy will include language that takes into consideration your education, training, experience, and earnings level as well.  This prevents the insurance company from trying to envision you in a job for which you’re under-qualified or over-paid just to end your claim. This definition is often found in cheaper, group policies and can be challenging to collect benefits without strong medical evidence and very debilitating conditions.
3. Split Definition Coverage. While this isn’t a definition of disability in and of itself, this definition is very common in disability insurance policies so it’s worth discussing. Many policies have definitions of disability that switch from Own Occupation to Any Occupation after a period of time that can range from 6 months to 5 years. Anyone receiving disability benefits under this type of coverage should be extremely wary leading up to this transition date, as insurance companies often plan for how to stop paying benefits around that time.
4. Presumptive Total Disability. Regardless of your policy definition of disability, certain catastrophic injuries or illnesses are automatically considered totally disabling. These often let you skip some of the requirements that must be met to be considered totally disabled. You’re allowed to receive benefits immediately after the elimination period that will continue even if you return to work. The medical events that fall under this definition include the loss of sight in both eyes, loss of hearing, loss of speech, the use of both hands, the use of both feet, or the use of one hand and one foot. These losses must be complete. Different policies can have slightly different qualifications for Presumptive Disability and not all of the ailments listed above will qualify under every policy.
5. Residual Disability. The first four definitions have been about Total Disability, but this isn’t the only way to qualify for benefits. Some policies include definitions of disability that will pay you a portion (or all) of your benefits if your work level and/or earnings are reduced. Under Residual Disability, claimants are paid benefits based on the relative amount of income they’ve lost due to their disability. This is calculated through a formula that takes into account the disabling condition and the percentage of pre-disability income the claimant continues to earn. Be aware – some cheaper policies include a clause that requires the claimant to have been totally disabled for a while before they’re able to collect residual disability benefits. There are two ways to purchase Residual Disability coverage: you can either purchase a Total Disability policy with a Residual Disability rider or you may purchase what is often called an income replacement policy. Income replacement is another term for residual coverage and can be the cheaper of the two option since it lacks specific Total Disability coverage.
6. Partial Disability. This definition is very similar to but slightly different from Residual Disability. The main difference is that Partial Disability does not consider the loss of income calculations when determining the benefit amounts. Rather, if you’re considered partially disabled, the policy will pay you 50% of the total disability benefit amount. Partial Disability is also not offered as a standalone policy and is either included as a rider to a policy or as the base coverage in some rare policies. Benefits periods for Partial Disability are often much shorter, usually not extending beyond 6 to 12 months.

Even if your injury or illness may fit into one of these policy definitions, it doesn’t always mean you will receive benefits. There are many other policy considerations, such as appropriate care or diagnosis limitations, that can decide whether or not you’ll be able to collect your benefits. If you’re considering filing a disability claim and are not sure of the definitions in your policy, or if you’re not sure if you qualify for benefits under your policy’s definition, please call our firm toll-free at (855) 828-4100 or sign up for a free consultation on our website. We can help you get the answers you need to get the benefits you deserve.

10 Reasons People Neglect Filing Their Disability Claim

At our firm, we have many clients who contact us quite a while after they’ve become disabled and stopped working. These clients are desperate for income to support their family and need their disability benefits approved immediately, which is challenging at best when dealing with an insurance company. In order to avoid such desperate situations, it’s important to begin the process of preparing and filing your disability claim as soon as the doctor diagnoses you and tells you to stop working. This list provides 10 reasons that people delay filing their disability claims and how to prevent these problems from happening to you.  

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.

Medical Disability Durations & The Effect on Return to Work Guidelines

We have encountered several cases where claimants have been denied their benefits not because of incomplete or inconclusive evidence of their medical conditions but solely because their conditions kept them from working longer than the guidelines used by disability insurance claim departments. When evaluating disability claims, claims examiners rely on industry developed resources to determine the expected duration of the claim, regardless of the specific circumstances. Based on these claim management practices that have been put into place by most insurance companies, we’d like to shed some light on the process used to assign expected return to work dates for claims and the extra steps that claimants need to take to protect their benefits if they’re disabled beyond these arbitrary dates.  

Insurance Investigators: An Inside Look At Their Techniques

We’ve often mentioned insurance company investigators and their tactics as extremely adept at developing reasons to deny legitimate disability claims. Insurance companies like to hire former FBI agents and police detectives who have been specifically taught to treat their targets as adversaries and be cynical of any answers – which they innocently refer to as being professional. These investigators have undergone specialized training on how to dig up information and how to conduct interviews that can be twisted against claimants and used by claims examiners to deny disability claims. Due to our connections, our firm has seen some of the confidential training materials used by disability claims operations that help provide insight into the investigative techniques and methods used to interview claimants. This information can be invaluable to claimants, allowing them to more properly prepare for the interview, whether it’s a scheduled appointment or an unannounced visit. Today’s blog is going to breakdown and summarize some of the key points to help you handle an interview and understand the underlying purposes for the questions.  

Social Media and Your Disability Claim, Revisited

We have talked previously in our blog about the dangers social media can pose for your disability claim. As summer kicks into gear and many people enjoy outdoor activities and vacation traveling, it’s important to revisit some of the social media points we’ve made in the past and provide some new insight into how different Internet sites may be able to help your claim and improve your odds of obtaining the disability benefits you deserve.  

Another Success Story!

Every once in a while, we like to feature a story from one of our clients about their personal experiences with the disability claim process. Today’s story is an especially touching one. We spent a lot of time with working with Robert and his wife, and he ended up getting the disability benefits he deserved. The nature of his disability and the circumstances of his claim presented some unique hurdles that we had to work together to overcome, but we were able to provide the level of service he needed to satisfy the demands of his claims examiner and move on with his life. Here’s his story, in his own words:

My consultant, Fred Gosman, really helped with my disability claim! After I suffered a broken ankle, I found myself no longer able to work when the injury took a turn for the worse and turned into Reflex Sympathetic Dystrophy and Complex Regional Pain Syndrome. This is when I decided to file for disability benefits. Being an insurance agent, I thought I’d be able to easily complete the claim forms.  But after attempting it alone, I realized the enormity of my situation and decided to find help.  

I hired a claim consultant who promised lots of help, but instead she became abrasive and overbearing, angering my doctors and not helping my claim.  I had to quickly terminate that relationship and start over.  Once I found Royal Claims Advocates, my experience completely changed.  Fred helped me and my wife from the beginning, making sure I understood what was needed and helping gather all of the information.  He helped make sure my claim forms reflected my situation and worked with my doctors (They loved him!) to ensure they understood what was needed by Reassure America for my claim. 

He has helped make sure Reassure America was treating me fairly.  They asked for lots of records that didn’t apply to me or my claim, but he helped us correct their misunderstandings and provide the information they really needed. 

I’ve struggled through some rough parts of my disability, and Fred was flexible when I needed it.  Everything he’s done helped us move closer to filing my claim with support and documentation. His knowledge of disability insurance and claims helped my claim go smoothly.

Once we submitted my claim, my benefits were approved and paid within weeks, far quicker than I imagined.  Fred and his team at Royal Claims stayed with me to support and guide us through this challenging time.  Their help really has been invaluable to me and my wife.  As a former insurance agent, I appreciate the depth of their knowledge and the quality of their work.  It’s allowed me to focus on my recovery instead of fighting the insurance company for my benefits! 

– Robert S., Philadelphia, Pennsylvania 

Thank you Robert for your kind words!  Stories like these are the purpose we created our firm and the reason we fight so hard to ensure our clients get the disability benefits they deserve.

We’ve helped many others receive their benefits as well. If you or someone you know is in need of help on their disability claim, please contact us. You may call us toll-free at (855) 828-4100 or visit our website to sign up for a free consultation.

Court Watch: Cases Affecting ERISA and Disability Claims

Although we’re not lawyers or a law firm, paying attention to recent court cases and rulings helps us keep up with the constantly changing rules and regulations of disability insurance claims. In the recent past, we’ve seen two cases taken up by the U.S. Supreme Court as well as a few other cases that affect the way the disability insurance companies treat insureds and their claims and the options to be considered by claimants. These court rulings set precedents and rules for many future claims and help form the disability claims process almost as much as claims examiners or company policies.  Today’s blog post is going to explore a few of the more relevant cases and their effects on disability claims.  

Accountant’s Angle: How to Deal With Your Disability Benefits During Tax Season

During this time of year, many people have questions about the tax effects of their disability benefits and how they can be reported on their tax returns.  Many of these questions are addressed by one of our partners, who’s a Certified Public Accountant.  These answers may help you with some of the issues that may come up with your benefits and the related income taxes.