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.

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.   Continue reading

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.

 

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.   Continue reading

The Disconnects Between Diagnosis and Disability

One of the biggest issues our clients face when filing their disability claim is the lack of clear medical opinions explicitly linking their condition to their disabling restrictions and limitations.  Physicians are skilled at diagnosing a disease or illness, but they may not be the best at explaining why the condition is disabling for the claimant.  This can especially be problematic with mental illnesses or other types of invisible disabilities.  Any ambiguities cause increased scrutiny and in-house referrals by claim examiners and are often used as a basis for a disability claim denial.  Helping your doctor connect the dots between your condition and your inability to work smooths the disability claims process and fosters a quicker claim approval with fewer questions.  We’d like to discuss two perspectives to this issue: the claimant’s and the physician’s.  We’re going to discuss what each party can do to make the disability clearer and the claims process smoother.   Continue reading

Defending Your Claim Against the Insurance Company IME

The most important piece of evidence in a disability claim is the medical basis for the disability.  If there is strong medical proof of the severity and continuation of your disabling condition, then there’s a good chance of your claim getting approved.  However, this may not always be the case.  Many conditions don’t have clear cut tests to prove their existence, and other conditions have testing protocols that either aren’t generally accepted or aren’t always accurate.  Even if appropriate testing exists, claims examiners may try to dispute the opinion of the attending physician.

When these and other issues are noticed in the claim file and want to be explored, claims examiners will often demand that the claimant undergo an IME.   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

Obesity and Its Effects On Disability Claims

Obesity has become a major health problem in the United States, affecting healthcare providers and insurance companies.  Although obesity is seldom a cause for disability in and of itself, it can cause or complicate a number of different conditions that can cause people to become disabled.  In addition to a declining quality of life, obesity can lead to cardiovascular diseases, stroke, cataracts, diabetes, hypertension, arthritis, cancer, pulmonary diseases, and sleep apnea, among other disorders.  If you’re suffering from any of these conditions and are also obese, curing your condition and regaining your life is an on-going battle.  The fatigue and lack of mobility that often accompany cases of obesity make it more difficult to perform the duties of many careers, even without considering the problems caused by any accompanying complicating medical conditions.  Reducing obesity is one of the best ways to reduce stress on your body and your life, but that’s not always an option due to people’s circumstances.  And our discussion is not going to address the relationships between obesity, certain drug side-effects, and/or mental conditions – that’s a topic for another day.  Today, I’m going to approach the topic of obesity in two ways: offering advice on how to deal with your existing disability claim while suffering from obesity, as well as sharing a few basic tips on how to reduce your weight in ways that can help prevent a disability claim in the future.

Continue reading