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5 Causes of Long-Term Disabilities You May Not Have Considered

Wed, 05 Aug 2020 17:42:07 GMT

When you think about the causes of long-term disabilities, depression, anxiety, arthritis, and various types of injuries may come to mind. And while these things certainly do create long-term disabilities for many people, they aren't the only sources.

Learn about five causes of long-term disabilities — some more common and others less — so you can determine if you might be owed financial compensation through an insurance claim.

1. Strokes

Strokes are often unpredictable, and the complications afterward can vary from next to nothing to life-altering conditions. Some of the most severe consequences of a stroke include paralysis, memory loss, and speech problems. You can imagine how difficult it might be for you to maintain a normal pre-stroke routine with these types of issues.

Although an accepted insurance claim won't minimize the stroke symptoms that affect your mental and physical condition, it will help lift the financial burden these conditions create.

2. Diabetes

According to the American Diabetes Association, 34.2 million Americans had diabetes in 2018. That's about one in 10 Americans. And in 2015, 88 million Americans were in a prediabetes condition. These statistics indicate that a lot of people are or may soon be susceptible to long-term disabilities through this condition at some point.

The long-term disabilities that diabetes can lead to include cardiovascular disease, kidney damage, Alzheimer's disease, hearing impairments, and nerve damage — all of which can significantly impact your way of life. If you suffer from any of these conditions, an attorney can help you determine if you are eligible for an insurance claim.

3. Digestive Disorders

Digestive disorders can create serious complications for those who suffer from them. Some of these conditions include irritable bowel syndrome, gastrointestinal hemorrhaging, and liver disease. If you have a digestive disorder, you may experience intense abdominal pain, weight loss, and unpredictable changes in bowel movements.

Severe digestive problems can impact your life in a big way, and the symptoms can make it difficult to hold down a job. If you have a digestive disorder that interferes with your ability to function normally, an insurance claim may be the answer you need to make ends meet.

4. Back Disorders

Back pain will impact almost everyone to some degree, but it can also lead to symptoms that make it nearly impossible to live your life. For example, some common symptoms include pain and difficulty when you bend down, lift something, walk, or recline. These movements are involved in most actions you can physically do, so this type of disorder can affect your life quickly and comprehensively.

You may have a back disorder that will allow for financial compensation from an insurance company if you suffer from cancer, osteoporosis, scoliosis, arthritis, or ruptured or bulging disks.

5. Joint Diseases

Joint disorders aren't just for athletes, although athletes especially may put themselves at risk if they train too forcefully. In reality, anyone can experience a joint disease or disorder — in fact, one of the more well-known conditions is arthritis. Other conditions include bursitis, fibromyalgia, osteoarthritis, and bone cancer.

If you have a joint disease that may lead to an accepted insurance claim for long-term disability, you are likely to experience chronic, painful sensations at one or more joints. You'll also find that rest, ice, compression, and elevation may only eliminate the symptoms temporarily.

You may suffer from a long-term disability, but that doesn't mean you have to bear the financial burden alone. At Scott Shaffman Attorney at Law , we represent clients who suffer from chronic disabilities and need compensation from an insurance company. Our team will do everything we can to help you get the money you need to live your life without a financial burden.

Occupation Limitations, Duties, And Disability Claims: What You Need to Know

Fri, 28 Feb 2020 03:26:08 GMT

The language in a disability policy can vary from one insurance company to the next. This can make it difficult to determine exactly what your disability benefits are when you have sustained a serious injury.

Two common areas of confusion in long-term disability policies are the definitions of occupation and job duties. Legal arguments in long-term disability claims often center on the definitions of occupation and job duties, so you need to be able to understand the language in your policy if you want to know your rights.

Own-Occupation vs. Any-Occupation

When it comes to defining a disability, most policies will provide benefits for either an own-occupation disability or an any-occupation disability. If your disability policy can be classified as an own-occupation policy, you will be able to obtain benefits if you sustain an injury that prevents you from performing the duties associated with your current occupation.

This means that even if you are able to obtain a position in another occupation, you can still apply for disability benefits because of your inability to continue to work in your chosen field.

Many long-term disability policies are categorized as any-occupation policies. If the language in your policy refers to any-occupation coverage, you will only be able to access benefits if you are unable to work in any capacity.

You may need to work with your attorney to have the court qualify your policy to require the insurer to provide you with benefits if your injuries prevent you from obtaining a job for which you have sufficient education, training, or experience.

The level of disability required to obtain benefits differs between an own-occupation and an any-occupation policy, so you should know which type of language is used in your policy before you file a claim.

Material Duties vs. Substantial Duties

Long-term disability insurance policies will often state that benefits can only be obtained when a claimant is unable to fulfill the material and substantial duties of their occupation. Though it sounds like these duties are lumped together, many insurance companies evaluate them on an individual basis.

Material duties are categorized as those tasks that must be done as part of an occupation. In other words, if you couldn’t complete the material duties of your job, it would be impossible to do your job the right way.

Substantial duties are important to job performance but don't encompass the entire job description. For example, if you were a sales representative who had a stroke and lost the ability to speak, you would be unable to perform the substantial duties of your job. You may still be able to interact with clients via email, however, so not all aspects of your occupation would be impossible.

There is a lot of overlap between material and substantial duties. Your attorney should be able to establish the specific duties that you fulfill at work each day if you file a disability claim. Showing how your workday differs from a watered-down and generalized job description will help you prove your claim more effectively.

The outcome of a disability claim depends, in large part, on the specific language used in the claimant's insurance policy. Occupation descriptions, essential job duties, and what defines a disability can vary from one policy to the next.

An attorney can help you better understand whether your policy uses own-occupation or any-occupation language, and whether or not your disability limits your ability to complete material duties, substantial duties, or both.

Contact Scott E. Shaffman, Attorney At Law to schedule a free consultation so you can learn more about the specifics of your long-term disability policy.

3 Common Types of Disabilities That May Qualify for Long-Term Disability Benefits

Wed, 15 Jan 2020 15:31:30 GMT

While many Americans are healthy enough to work, disabilities make it difficult or even impossible for some people. In these cases, long-term disability benefits can help. But first, you have to prove you need them. If you are worried about your financial future because of a disability, check out these three common types of disabilities that may qualify for long-term benefits.

1. Mental Disorders

Many Americans suffer from one or more mental disorders, but some of the most common include anxiety disorders, depression, bipolar disorder, psychosis, and PTSD. If your anxiety or depression flairs up every now and then, but doesn't prevent you from living and working, you aren't going to qualify for any disability benefits.

However, if the condition limits what you can do, especially if it limits your ability to leave the house or work, you may have a case. Depending on the condition, you must meet some qualifications first. For example, if you do suffer from anxiety, you need to prove it is persistent with symptoms, it causes constant irrational fears, or it is reoccurring and unpredictable.

2. Chronic Diseases

Many chronic diseases make it difficult or impossible for you to live a normal life and work a normal job. These include HIV/AIDS, leukemia, lung disease, lupus, cancer, cerebral palsy, and many more. In many cases, proving a chronic disease is easier than proving a mental disorder because there are tests that can measure your disability.

If you have HIV, the doctor can run blood tests to prove you have the disease. With a mental disorder like PTSD, however, the symptoms are less visible and harder to measure. In fact, in many cases, people with chronic disease have been suffering so long, they have years and years of tests, consultations, and results that can help show how the disease is progressing.

Even when a chronic disease first starts, it can impact your life, making it difficult or impossible to work a regular job.

3. Chronic Pain

Chronic pain is another culprit that makes it hard to live a normal life. In some cases, chronic pain can be easire to prove. For example, you may go to the doctor with severe, chronic back pain, and x-rays reveal you are suffering from arthritis. These x-rays can be used as evidence that you are in pain.

Soft tissue pain on the other hand isn't measurable on x-rays or other tests, so it's up to the patient and doctor to prove your chronic pain. Naturally, if your doctor can also prove you have a chronic disease, it may be easier to prove the pain. If no one believes you are in chronic pain, but your doctor finally diagnoses you with a serious disease or injury, the pain may become more believable to others.

Another complication with proving chronic pain is when you have lots of little chronic pains. A single severe back injury, such as a herniated disc may be enough to get you on disability, but if you have a little arthritis, a little stenosis, and a bit of soft tissue damage, all the pain combined may make life difficult, but because you don't have one major problem, getting disability may be difficult.

In a perfect world, your doctor will have the perfect diagnosis for your disability or pain, but proving long-term disability is incredibly difficult. For this reason, you need an entire team, including a qualified attorney to help you win your claim. For more information about disability benefits, contact us at Scott E. Shaffman Attorney at Law today.

Get Your Doctor on Board Before Filing Long-Term Disability

Thu, 12 Dec 2019 00:00:00 GMT

You didn't ask to be put in this position, but you now have a long-term disability and it's time to move forward with your life. A long-term disability claim may be able to help you. But a successful long-term disability claim must include a complete medical picture if you want to have any chance of success.

Most insurance providers or government entities who review disability cases put a large amount of emphasis on the medical details. A long-term disability claim without the full support of your doctors or hospital is destined to fail. Here's how and why you should get your medical team on board with you before you move forward with your claim.

You Need to Tell Your Doctor Before You File

Don't file for disability and then tell your doctor or doctors afterwards. Once the application is on its way, your doctor may not be able to add anything to it. But if you talk to your doctor in advance, you can get them to look at your medical documentation and fill in any holes that might cause a problem.

For example, if your medical documentation is not fully legible, the person reviewing your case might send it back or just deny you because the information is not clear. This will, at the very least, lead to a delay. Your doctor can make sure your current documentation is accurate and clear to anyone who reads it.

You Need to Ask for an Additional Letter

Once the medical documentation is in order, you might think you are ready to file your claim. But if your doctor is on board with you, you could bolster your case by asking him or her to write an additional letter of support.

Filing a successful long-term disability claim is all about creating a narrative in the mind of the case's reviewer. Your doctor can spell out in a new letter exactly what all of the previous medical documentation actually means. A letter of support will give an account of how you have suffered and how the disability affects your daily life.

You Need to Continue Consistent Treatment

Long-term disability cases can sometimes take weeks or months to review. When a reviewer finally gets to your case, they may reach out to your doctors or medical team for an update. This is why it is very important to continue with your recommended treatment even after you file the claim. You want to establish a record of ongoing medical care for your disability.

If the person who reviews your case finds out that you have stopped treatment, this might be a red flag to them. They will want to know if this means you are actually getting better or are not quite as disabled as your claim states.

Talk to your doctor about your plans going forward and what you can do to ensure ongoing treatment. Continue to add new medical documentation to a dedicated file even after you send in your claim, as you might need this new data at some point in the future.

Medical documentation can make or break your long-term disability claim. This is why you need to talk to your doctor or medical team before you file. If your medical professionals know you will be filing a claim, they may be more careful or include more details when documenting your condition. You may also be able to get an additional letter of support to bolster your narrative.

Scott Shaffman Attorney at Law has years of experience assisting people just like you with long-term disability claims. If you are in the process of filing or want to appeal a denial, contact us today for a free consultation that could improve your odds of success.

Long-Term Disability: 4 Mental Disorders That May Qualify

Wed, 13 Nov 2019 20:10:33 GMT

Many employers offer long-term disability coverage. This is beneficial for employees who get injured or who suffer an illness that renders them unable to work for a period of time. In some cases, long-term disability pays up to 70% of an employee's salary if they are unable to work. Some long-term disability policies provide coverage for 5 to 10 years.

Other policies provide coverage for as long as the employee is disabled or until they turn 65. Some of the most common diagnoses for long-term disability claims are musculoskeletal and connective tissue disorders, nervous system disorders, cardiovascular disorders, and cancer.

Since mental health issues can also inhibit one's ability to work, certain mental disorders are another common reason employees file for long-term disability. Here are four specific mental disorders that may qualify for long-term disability.

1. Affective Disorders

Affective disorders are commonly referred to as mood disorders. People who have affective disorders have a general emotional state that is inconsistent with their circumstances. This type of disorder commonly interferes with a person's ability to function, including in the workplace.

Common examples of affective disorders include:

Major depressive disorder
Bipolar disorder
Persistent depressive disorder

Affective disorders often affect more than a person's mood. Their sleep, behavior, weight, and cognitive function are also usually affected. In order to qualify for long-term disability, employees with mood disorders need to prove that they cannot function in the workplace even while receiving treatment.

2. Anxiety Disorders

Anxiety disorders are conditions in which a person has repeated episodes of feeling intense anxiety. They may feel panic, terror, or fear, even in normal situations. Common symptoms of anxiety disorders include having a sense of doom, increased heart rate, rapid breathing, sweating, trembling, and trouble concentrating.

The five major types of anxiety disorders include:

Obsessive-compulsive disorder (OCD)
Social anxiety disorder or social phobia
Post-traumatic stress disorder (PTSD)
Panic disorder
Generalized anxiety disorder (GAD)

To qualify for long-term disability, an employee with an anxiety disorder needs to prove that their symptoms prevent them from functioning in a typical work or social environment.

3. Personality Disorders

For most people, their personality stays the same over time. For people with this type of disorder, their personality changes based on experiences or their surroundings. Some of the most common types of personality disorders include:

Paranoid personality disorder
Antisocial personality disorder
Borderline personality disorder
Avoidant personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Obsessive-compulsive personality disorder

Any of these types of personality disorders can prevent one from being able to function in the workplace.

An employee with a personality disorder who is seeking long-term disability benefits needs to prove they have certain symptoms including autistic thinking, seclusion, inappropriate hostility, aggressiveness, or constant mood disturbances.

4. Psychotic Disorders

This type of severe mental disorder causes abnormal thinking and perceptions. People with psychotic disorders lose touch with reality. Examples of psychotic disorders include:

Paranoia
Delusional disorder
Schizophrenia

Those who get diagnosed with psychotic orders have hallucinations, delusions, and off-the-wall or disorganized behavior.

Psychotic disorders are also characterized by incoherent and chaotic speech. People with these disorders may say things that are inappropriate. In order to qualify for long-term disability benefits, employees must be able to prove that the symptoms of their psychotic disorder interfere with work.

Other mental disorders that may qualify employees for long-term disability benefits include organic mental disorders, somatoform disorders, attention deficit hyperactivity disorder (ADHD), Asperger's syndrome, chronic insomnia, and eating disorders.

If you are suffering with a mental disorder and have been denied by your insurance company for long-term disability , there is still hope. Contact Scott E. Shaffman Attorney At Law. Attorney Shaffman has successfully represented clients on long-term disability claims for over 35 years.

Tips for Suing an Insurance Company

Fri, 18 Oct 2019 20:39:50 GMT

When you face a long-term disability claim denial, many thoughts begin to rush through your mind. What are you going to do now? Should you sue your insurance company? If you do intend to sue your insurance company, you have a lot to consider. These tips will help you ensure you receive what you are entitled to without making a mistake that benefits your insurance company if you need to take it to court.

Know When to Be Concerned

Has it been months since you filed your claim, but you've received no payment? The insurance company could deny your claim. Many people receive approval within a reasonable time, so you are right to be concerned if you have been unable to receive payments for such a long time.

Back Up Your Information

Treat all documentation as important, which means you should keep all photos, medical records claim, documents, and other correspondence in one location. You must be able to prove you are disabled from working – a letter from your doctor helps out insurance companies and doctors too!

In addition, keep a log of your communications with the insurance company. Document phone calls, emails, and written letters. Take detailed notes in which you indicate who you spoke to, their phone number, and what you talked about. Your insurance company is sure to keep detailed information, so ensure you are not left out of the loop.

Speak Clearly and Politely

While you may not be very happy with your insurance company, avoid writing or communicating you would not want the judge to see. Insurance companies may record their phone calls, which could be used in court to haunt you. A phone call could undermine your credibility, which ultimately impacts your case. Always be polite – insurance adjusters do not respond well to threats or anger.

Hire a Disability Attorney

Remember that your insurance company will have their own attorneys to manage their case. Insurance companies have the power to hire large teams of attorneys who are experts at fighting disability claims.

You are wise to hire an attorney to make it a fair fight. Not just any attorney will do; you need one who understands how to square off against high-profile insurance companies and their lawyers.

Scott Shaffman Attorney At Law is knowledgeable and skilled with disability claims. If you have been disabled and the insurance company refuses to pay, you cannot wait. Call us today to discuss your case.

Understanding Group Long Term Disability Policies: an Employee's Guide

Fri, 23 Aug 2019 02:02:23 GMT

One important benefit that many employers offer their workers is group long-term disability insurance. If an illness or injury prevents you from working for an extended period, long-term disability insurance can help you replace some of your lost income. Read on for a guide to understanding long-term disability policies offered by employers.

What You Can Receive

A typical policy will provide you with 50 to 75 percent of your salary at the time the disability occurred. The length of time you will receive payments varies depending on the specific conditions of the policy. In some cases, the time is as short as 2 to 10 years, in others, you will receive payments until age 65.

Your payments are not tied to the inflation rate unless the policy has relevant language to this effect. If your policy does adjust your benefits for inflation, the insurer will typically tie the adjustment to the government's cost of living index (COLA).

Conditions

Most policies require that you are a full-time employee who works at least 30 hours a week. Also, you need to learn if your group policy pays out when your disability does not prevent you from doing other work. Some policies pay out as long as you can't perform your current job. Other insurers may require you to take any type of work your disability allows you to perform.

For instance, if you are not able to continue doing a strenuous job such as a warehouse worker, the group insurer may demand that you take a less physically demanding job, depending on the language of the policy.

What Is Excluded

Not every condition that leads to a disability is covered by all long-term disability policies. An inability to work due to mental illness, alcoholism or drug use is not necessarily covered, or may be covered only for a limited time. Some insurers may also exclude injuries that occur in the workplace.

Another point to note is that if a pre-existing condition leads to your disability, the policy might not cover you. As a rule, a pre-existing condition is defined as a health issue that was diagnosed or treated within a specified period before your coverage started. A common time-frame for excluding a pre-existing condition is 90 days before coverage.

When to File for Disability

As soon as you become disabled, obtain a copy of your group policy from your employer Read the policy carefully to determine if your disability is covered. Long-term disability policies are quite complex, so it's a good idea to have an experienced attorney help you understand the language and advise you on how to proceed.

Contact

When you have read and understood the terms of the policy, contact the insurer and ask them about the proper procedure for filing your claim. Follow their procedure to the letter. You do not want to make any mistakes when filing that the insurer could use against you later.

What Happens if You are Denied

Many long-term disability claims are initially denied. Fortunately, you have the right to appeal a denial to an administrator at the insurance company. When you have exhausted all of your appeals and are still denied, you may then take your case to federal court.

A key point to remember is that you cannot enter new evidence at a court trial. Make certain that you present all of your evidence at the administrative appeal.

Naturally, you will want a qualified long-term disability attorney with a strong track record of success helping you at all steps of the process. Having experienced counsel at your side can definitely make the difference between a positive and a negative outcome.

To learn more about this issue, contact the team at Scott E. Shaffman Attorney at Law.

How Social Media Use Affects Your Long-Term Disability Claim

Fri, 02 Aug 2019 07:57:14 GMT

An unfortunate truth is that one of your major social outlets could be working against you. Increasingly, insurers look at social media to collect evidence against and dismiss long-term disability claims. Here's what you need to know.

Photos Can Be Used as Evidence

Many disabilities are erratic in nature. If you have a knee injury, you might feel fantastic one day, but horrible the next. Unfortunately, though, if you posted pictures of yourself on a hike, they can easily be used as evidence that your knee is fine. Photos can be used as evidence against long-term disability claims related to physical disability.

Not only should you be careful about posting your own pictures, but you need to be careful about being tagged in pictures. Other people can "tag" you in photos on Facebook or Instagram doing things that may make it appear as though you don't have the disability that you have.

Even old pictures can be confused as evidence. Someone might post an old picture of you and your family on an old vacation, which appears to be new. If you post any old photos, make sure they're clearly marked and timestamped.

Your Emotional Status Could Be Monitored

Some disabilities are invisible, such as anxiety and depression. An insurance company can take a look at social media accounts to try to create a pattern of positive mental health. This is, of course, unfounded: many people present their best face on their social media.

Unfortunately, those who have long-term disability coverage for mental illnesses and other invisible disabilities need to be particularly cautious about what they post on social media, if they use social media at all. Notably, someone with a mental health disorder should not post that they are feeling better or that they are recovering.

Your Ability to Work May Be Questioned

Today, many social media platforms also ask you about your occupation. If you indicate that you're presently looking for work (even gig work), it could be an indicator to your insurance company that you are able to work. This is especially true for platforms such as LinkedIn, which are geared towards professional appearances.

Many people on long-term disability still want to pick up some amount of work. But if it's proven that you have the capacity to work regularly, then your long-term insurance claim could be denied.

Additionally, you should make sure that any work history that's displayed on LinkedIn or on any online resumes is correct. Something as simple as entering in the wrong years for a job that you did previously could be enough to call your long-term disability into question.

Some people are inclined to "fudge" their resumes a little to reduce gaps or lengthen the amount of time they worked. This could overlap with your disability period.

You Can Lock Down Your Privacy Settings

Most social media platforms make it possible to make your profile private. You can "lock it down" so that only your family and friends can see it. But that alone isn't always enough to protect you, especially if some of your content is posted by other people, or photos are shared by others.

You can also consider opening social media accounts under a fictitious name, but you need to be careful: some social media accounts do not allow this. Those with disabilities need to be very conscientious about their social media use today.

Do you suspect that your disability insurance claim could have been rejected because of your social media? Do you need help clearing your social media before your claim? Contact the experts at Scott E. Shaffman Attorney at Law.

3 Types of Conditions That Can Qualify for Long-Term Disability

Fri, 14 Jun 2019 22:07:39 GMT

An injury or illness can happen at any moment that leaves you permanently disabled and unable to work. However, which conditions commonly fall under this category? Discover three types of injuries or illnesses that you may have that can qualify you for long-term disability benefits.

1. Car Accident Injuries

Car accident injuries can range from minor cuts and bruises to major traumatic brain injuries or amputations. Car accident injuries that often qualify for long-term disability claims include the following.

Traumatic Brain Injuries

If your head or brain has suffered severe trauma, this can cause additional, long-lasting conditions such as memory loss, loss of feeling or balance, or even paralysis.

Spinal Cord Injuries

If your spinal cord received an injury from a car accident, this can cause severe damage that can leave the person partially or completely unable to function or move.

For example, some people with spinal cord injuries might have partial or complete paralysis, often on their right or left side, from the waist down, or even from the neck down. These injuries may require the injured person to use a wheelchair or a respirator.

Amputations

A car accident can cause any part of your body to require amputation. Those who require a major amputation, such as an arm or leg, can find themselves requiring long-term therapy and facing lifelong disability. An amputation may also leave them unable to work in their formal capacity, especially if they worked in physically challenging occupations.

Soft Tissue Injuries

Soft tissue injuries are injuries to your muscles, ligaments, and tendons. While many soft tissue injuries are recoverable, many can cause long-term injuries that can result in continual pain, as well as impaired mobility and function.

Emotional or Mental Injuries

If a car accident has left you with long-lasting emotional trauma, such as PTSD or depression, this can redefine your entire life. If the symptoms of PTSD, depression, or other emotional or mental injuries have left you emotionally or mentally unable to work, then you may be able to qualify for long-term disability.

If you are unsure of the differences between short-term and long-term injuries or want to know if your car accident injuries are applicable for long-term disability, a disability lawyer can help.

2. Musculoskeletal Disorders

Musculoskeletal disorders are any conditions that affect bones, muscles, tendons, ligaments, and joints. Some disorders include:

Muscular dystrophy
Scoliosis
Tendonitis

Many musculoskeletal disorders that worsen over time and leave you unable to perform normal working tasks can be eligible for long-term disability. These musculoskeletal disorders can come from various causes, such as car accidents or work injuries.

If you want to know if your musculoskeletal disorder or condition is eligible for long-term disability, an attorney experienced in long-term disability can help.

3. Cancer

If you have cancer that leaves you unable to work and function normally, you may be eligible for long-term disability. Long-term disability for cancer often relates to the severity of your illness and the side effects of the cancer treatment you receive.

The side effects that can qualify you for long-term disability are long-term side effects such as nerve damage, fatigue, or heart issues. These side effects must result from the treatment you take, such as chemotherapy or radiation.

Call a Long-Term Disability Expert Today

Whether you have questions of whether you qualify for long-term disability or your long-term disability claim has been denied, rely on the professional legal services of long-term disability attorney Scott Shaffman Attorney at Law . He can help you understand why your claim might have been denied and what you need to do to file a successful long-term disability claim.

Tips for Filing Your ERISA Claim

Thu, 09 May 2019 14:21:59 GMT

ERISA refers to the Employee Retirement Income Security Act of 1974. Under this act, any time a participant is denied plan benefits, that denial must be thoroughly reviewed. Thus, if you have been denied the benefits to which you think you are entitled, you may have a valid ERISA claim on your hands.

The best way to handle this claim- and to be granted a favorable outcome- is to have an attorney experienced with ERISA claims assist you. In addition to hiring an attorney, however, keep a few tips in mind as you go through the claims process.

Get a Claims Form From Your Employer

When you need to file an ERISA claim, you have many ways in which to get your hands on a claim form. However, your employer should provide these forms to you without protest.

If they do protest, or if the employer fails to provide the form to you, document this information. An employer who is non-compliant in anyway, or who tries to keep you from what you are entitled to, is not following the law. Having a record of this behavior can work on your side and help you build a case if necessary.

No matter what the outcome,asking for the form directly from your employer gives you a chance to see if your employer does things appropriately and by the book. If they are, that's great. If not, however, it can actually work to your benefit to show that your employer chose to use unfair practices.

Be Aware of Time Limitations

In terms of federal law, there is no time limit or statute of limitations on when you can recover plan benefits via an ERISA claim. However, this fact does not stop courts and outside attorneys from using state laws to ward off your claims.

Make yourself aware of any state laws that may be used against you and your claim,and prepare to argue against them. Obviously, this is a lot of work and requires much legal know-how. For this reason, instead of trying to follow this tip yourself, choose a competent attorney who is aware of this oft-used tactic as well as howto combat it.

Work Closely With Your Insurance Company

Outside of your attorney, the other important entity involved in your claim is your insurance company. Work as closely and cooperatively as possible with your insurance company to increases the chance of a favorable outcome.

Provide your insurer with anything that it might want to know, including information on your doctors, any medications you may be using,and any other information that may be requested of you. Not providing required information can sometimes keep your claim from getting approved, which is the last thing that you want.

However, keep in mind that your insurance company, first and foremost, looks out for itself, not for you. For this reason, work with a lawyer when you provide any information to your insurer. You should not submit something that could later be used against you and that could keep you from getting your claim approved.

Seek Help with Your Claim

Filing an ERISA claim and getting a favorable outcome is tricky. There are so many rules and laws to know,and sometimes, it can seem like everything and everyone works against you.

Your attorney, however, is the one person you can truly trust,as long as you choose a qualified one who is experienced with ERISA claims. To this end, work with the professionals at Scott Shaffman. Our firm has qualified,experienced lawyers who have handled many ERISA claims successfully. With us, you will be in the best possible hands.

3 Reasons Why Your Long-Term Disability Claim Might Be Denied

Wed, 03 Apr 2019 15:50:39 GMT

Suffering a long-term disability is obviously traumatizing. But it can be almost as demoralizing to receive a rejection letter stating that your long-term disability claim is being denied. After you’ve lost this form of recourse, now what?

The first thing you should know is that this initial rejection is not the end of the line. You can probably go through an appeals process or attempt further legal action. But if you want to come out on top in the end, you'll have to understand the reasons why your first claim was rejected and do what you can to correct the problem.

Here are some of the most common reasons why your claim could be denied and what you should do about it.

Your Medical Evidence Is Not Convincing

Medical paperwork and documentation is the backbone of any successful long-term disability claim. If your evidence isn’t convincing or complete, your claim is not going to have a chance.

First, you need to make sure your medical records are complete. If the insurer has incomplete records that don’t show the extent of your medical history or problems, this could lead to a rejection. Make sure you send in the documents yourself to avoid having something fall through the cracks.

Does your claim also include a doctor's statement? If not, have your physician write a letter on their own stationery explaining your condition in detail.

Finally, make sure you show that your condition is ongoing and requires regular medical treatment. Some people send in evidence of the initial injury that led to the disability, but they don't make it clear that medical treatment will continue for a long time to come.

You Were Caught Doing Something You Aren't Supposed to Do

In some cases, insurance companies might send out private investigators to document the person making the claim. If the policy holder is not supposed to bend over or be able to run, but the investigator has video evidence or photographs of you doing so, this could lead to a denial.

When filing a disability claim, make sure you follow all doctor instructions and don't push yourself to do something that could put your claim at risk. However, if you are denied because of photographic or video evidence, you still might be able to win on appeal.

Some disabilities cause pain that comes and goes, meaning you will have days when you can do more and days when you are bedridden. If you were photographed doing something on a good day that you can’t always do, make sure your doctor makes the nature of your disability clear to the insurance company.

You Made a Paperwork Error

Long-term disability claim forms can be confusing to fill out. The paperwork will likely include lots of complex questions, and you may need to meet strict requirements or deadlines. Make one mistake, and the insurance company may throw out the entire claim.

If your claim was denied due to a paperwork technicality, you will need to make sure you use more care during the appeals process. Work with a professional experienced with these matters to ensure that your paperwork is correct, which will give you the best chance of succeeding in your appeal.

Regardless of the reason why your initial claim was denied, you need to make sure you do everything right if you are going to win your appeal. Having a seasoned lawyer review your medical records and other paperwork before filing your appeal could be the difference between success and failure. Scott Shaffman Attorney at Law has years of experience helping clients just like you. Contact Scott Shaffman today for more information.

Important Long-Term Disability Insurance Terms You Should Know

Wed, 27 Feb 2019 03:48:56 GMT

When most people think about disabilities, they might think of different maladies, such as paralysis, loss of limbs, or blindness. However, you may have a less traumatic disability that still qualifies you under the terms of your disability insurance policy. This can include illnesses such as asthma, arthritis, issues with pregnancy, and depression, or injuries such as broken bones.

When you enter a long-term disability plan, you should fully understand exactly the language within your policy so you know your rights. The following are some terms you should know regarding legal definitions in most ERISA long-term disability policies, both individual and employer-sponsored.

What Is a Disability?

A disability is any qualified illness or injury that occurs that leaves a person or employee unable to perform his or her job. A disability also applies to an individual who is unable to earn a specific percentage of income while employed at his or her normal job.

What Is a Preexisting Condition?

A preexisting condition is a type of injury or illness where you received treatment or should have received treatment during a time before your insurance became effective. The amount of time will be different based on your insurance plan's policy.

What Is an Injury?

An injury is any accidental hurt or sickness that is a direct result from a qualifying accident under your policy. If you were hurt and not insured, then you were hurt again in the same part of the body, your long-term disability insurance may not cover you. This is dependent on individual policy language. Be sure to check your policy to see if this the case for you.

What Is a Physician?

A physician is a licensed doctor who provides treatment for your illness or injury in his or her licensed area of practice. A physician cannot be your husband or wife, in your immediate family, or someone living in your home.

Additionally, if you have to provide a physician statement to validate your disability claim, the statement will not be considered if the statement is from a relative or member of your household.

What Is a Regular Occupation?

A regular occupation is a job where you worked at the time of your disability. ERISA group policies typically define an occupation by the work done on a national level rather than the tasks you specifically perform in your occupation. However, some insurance policies define regular occupation by the tasks you specifically perform for your employer.

The definition of regular occupation can be crucial when you fight for your long-term disability benefits. For instance, if you are a banker and your firm provides special courier services to different clients, the scope of that job is different from what bankers normally do.

If you drive to a client carrying heavy boxes of documents and you fall and break your back in the course of your job and you can no longer do this portion of your occupation, whether or not you will get long-term disability benefits will highly depend on your insurance company's definition of regular occupation.

Specific examples of terms in a long-term disability policy are important to know and are often different than you would normally use in your normal life. Before you file a claim for your disability insurance, understand these definitions to make sure you protect your rights.

If you have any questions about long-term ERISA disability insurance or if you are having trouble making a claim on your policy, please contact us at Scott E. Shaffman Attorney At Law . We can help you understand the definitions and coverage of your insurance and take up your case for your disability claim.