Bringing Your Vision-Based Disability Claim Into Focus

Vision is a sense that many people take for granted. Although many individuals wear glasses and contacts to correct their vision or may even get LASIK, not may people consider the consequences of having a chronic disease that limits your ability to see clearly even with corrective measures. There are three specific conditions that our firm sees on a recurring basis involving vision losses: glaucoma, macular degeneration, and retinitis pigmentosa. A disability claim based upon loss of vision can be surprisingly difficult, as many insurance companies demand a high level of vision loss before being considered to be eligible for benefits. This, however, does not mean that such people are still able to perform their job. If there is strong medical evidence to back up your claims and an accurate and complete job description to show how you are no longer able to the material and substantial duties of your occupation due to these limitations,  insurance companies will have little choice but to approve you for the disability benefits you deserve. Each of these conditions has different tests and treatments that will be necessary to identify and treat the disease.

Glaucoma

GlaucomaGlaucoma is not a specific disease itself but is the name for a group of diseases that affect the optic nerves and can cause blindness. In fact, glaucoma is the second-leading cause of blindness worldwide. It affects 1 out of every 200 people under the age of 50 and rarely exhibits any symptoms. The two main types of glaucoma are “open-angle” and “closed-angle,” referring to the area between the iris and cornea. Closed-angle glaucoma often has a sudden, painful onset and can cause a sudden loss of vision. However, the amount of discomfort involved usually leads sufferers to pursue treatment before damage becomes permanent. Open-angle, chronic glaucoma on the other hand progresses at a slower rate and doesn’t cause the same level of discomfort. Because of this, many sufferers don’t realize they have lost vision until the disease has progressed significantly. This is the type of glaucoma that causes the most disability issues. Because of the lack of clear symptoms, many sufferers don’t realize their deteriorating condition until it’s too late to restore their eyesight, leading to permanent losses of ability.

Qualifying for short term disability benefits based upon a diagnosis of glaucoma is much more common than qualifying for long term disability. There are a number of effective treatments for the condition, and insurance companies often assume (and/or insist) that anyone who suffers from this condition will soon return to their former health – even though some cases of glaucoma are permanently impairing. This is why it’s so important to follow the proper medical protocols for testing and for treatment during the course of the condition. Testing for glaucoma is a part of most standard eye examinations and include measurements of the pressure in the eye, changes in the size of the eye, and examination of the optical nerve for visible damage. If glaucoma is detected early enough, it can be treated a number of different ways. There are surgical remedies, medications, medicinal eye drops, and even medical marijuana (depending on where you live) that have been proven effective in controlling and even reversing the symptoms of glaucoma.  The best outcome is to successfully treat the glaucoma and recover your eyesight.  But if someone suffers from glaucoma that has permanently damaged their eyesight, then it’s critical to have substantial testing and medical proof for the medical condition, its symptoms, as well as documentation tying the occupational duties to the person’s eyesight. If you’ve been accurately diagnosed with the condition, continue with proper care and treatment, and prove that you can’t perform the occupational duties, you should be able to maintain the disability benefits you deserve.

We’ll go into the other vision conditions that often result in disability claims in our next posting.

Losing your vision can be a terrifying event, and many people expect that their disability insurance company will not question their claim.  But not only are many of these claims questioned – they’re denied using a variety of policy defenses. If you’re considering filing a disability claim due to your loss of vision or feel like you’re being unfairly hassled by the claims process, please visit our website to sign up for a free consultation or call our offices toll-free at (855) 828-4100.

4 Types of Disability Claims Caused By Car Accidents

While a car accident itself may not be a reason to file a disability claim, many disability claims result from injuries sustained in a crash or other type of accident. While you may not qualify for Social Security Disability Insurance if the injuries don’t totally incapacitate you for more than 12 months, many individual and group long term disability policies cover the inability to work due to these incidents as well as almost all short term disability policies. From back problems to broken bones to “whiplash,” there are many different types of injuries that can result from even seemingly minor vehicle accidents, including some that may not become apparent for an extended period of time. Today’s blog post is going to review some of the different types of injuries that may result from these accidents and how to obtain the disability benefits you deserve while recovering from these injuries. Continue reading

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.

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.   Continue reading

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.   Continue reading

Cigna’s Market Settlement Causes Re-Evaluation of Many Denied Disability Claims

Cigna has agreed to a wide-ranging re-evaluation of its disability claim denials from 2008, 2009, and 2010 in California and from 2009 and 2010 in Connecticut, Maine, Massachusetts, and Pennsylvania.

The settlement affects certain long term disability claims in all of Cigna’s units – Life Insurance Company of North America, Connecticut General Life Insurance Company, and Cigna Health and Life Insurance Company.

After multiple complaints to the insurance commissioners in these states, regulators found that Cigna ignored Social Security decisions, discounted the findings of independent physicians, and didn’t consider workers’ compensation records when evaluating claims.  These practices forced Cigna to set aside $77 million for payments to current and past claimants who were improperly denied their disability benefits as well as to pay fines to the states.  In addition, the settlement requires Cigna to:

  • Establish a remediation program in which the companies’ enhanced claim procedures will be applied to certain previously denied or adversely terminated claims for residents of California, Connecticut, Maine, Massachusetts, or Pennsylvania.
  • Enhance claim procedures to improve the claims handling process to benefit current and future policyholders.
  • Participate in a 24 month monitoring program conducted by the insurance departments of each state, involving random sampling and on-going consultations.
  • Undergo a re-examination upon completion of the monitoring period.
  • Pay fines and administrative fees totaling $1.7 million.

“This regulatory action is intended to provide long-awaited relief for consumers who have a right to expect that their carrier will make good on contractual promises.  As regulators, we hold carriers accountable for adhering to laws and regulations of each state in which they conduct business.  This settlement resulted from market conduct exams and encompassed issues of serious concern.  It is a solid example of regulatory cooperation in protecting the policyholders of Connecticut and other jurisdictions.” said Connecticut Insurance Commissioner Thomas Leonardi.

For the official press release from the California Department of Insurance, click here.

For a copy of the Maine market conduct examination, click here.

The full regulatory settlement can be found here.

Although not quite the magnitude of UNUM’s market conduct settlement a few years ago, Cigna’s agreement can have a great impact on those claimants who were improperly denied their disability benefits.

If you think you may be eligible to have Cigna’s denial of your long term disability claim reviewed or have any questions about this settlement, please feel free to contact our offices toll-free at (855) 828-4100 or visit our website to sign up for a free consultation.

 

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.   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