Supporting You Through the Disability Claims Process

As experienced long term disability claims lawyers, we know that you need help throughout your battle with the disability insurance company. We know that the steady stream of letters that arrive, requesting more information or asking you to come to a doctor’s office for an exam and other requests and demands, can be unsettling. We’re here with you – every step of the way.

Disability Claims Process

Here’s how the Disability Claims process works:

We hope you’ll contact us before you file a claim for long term disability insurance benefits, or even short term benefits. The earlier in the process we get involved, the smoother it will be. That’s because your doctor’s reports and exam results all need to demonstrate not just that you are disabled, but why you are unable to perform the tasks that your job requires. You may have a badly ruptured disc in your back and suffer from great pain, but unless your medical records clearly indicate that you can’t stand in the operating room to perform surgery, the disability insurance company may deny your claim.

Frankel & Newfield also works with your treating physician to help them understand how important their medical records are, and what they can do to have the medical records properly documenting the deficits to support your claim.

Once you file a claim for disability insurance benefits, you may receive some correspondence from the disability insurance company advising you that your claim is being reviewed and asking for some additional information. Or they might try to conduct a phone interview with you.

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We can help here also. The insurance company is only entitled to the information that is detailed in your disability insurance contract. A business owner, for example, may be asked to provide a decade’s worth of financial reports – when your policy may not require that information to be shared at all. The interview is potentially where a claimant may trip up their claim unwittingly.

The disability insurance company may also ask for extensive medical records, some of which may seem unrelated to your claim. Your medical records from ten years ago may have nothing to do with your current condition. But unless you are in the disability insurance legal field, it’s not likely that you can read through the policy to find the exact language that defines what medical records you are required to share, and what you are not. You will likely feel intimidated by the insurance company.

The disability insurance policy is a legally binding contract. It is at the heart of your claim – we often say it is the roadmap for the claim. But like many legal documents, it is complex, and has a lot of complicated language, often written in the insurance company’s favor. That’s why an experienced disability insurance attorney can figure out what you must provide to the insurance company when they ask for it, and what you don’t have to provide, while still satisfying your claimant obligations under the policy.

After the insurance company or their third party reviewing company gets a thorough review of your paperwork, and often utilize biased medical reviewers, they decide to pay or deny your claim. When your claim is denied or terminated, it’s time to call Frankel & Newfield.

Clients Choose Us Because We:

• Have recovered $200M+ for our clients.
• Have seen your situation before.
• Are aggressive in our approach.
• Know the tactics used by the insurance companies.
• Hold high AV Ratings & received the Super Lawyers designation each year.

Your Short Term Disability Claim Matters

Think of your short-term disability insurance claim as the entrance ramp to disability insurance benefits. If your short-term disability claim is denied, you may never qualify for disability. In most cases, short-term disability claims are paid by your employer, but it’s the disability company that often administers the short-term claims. They have an incentive to keep you from completing the short term claim process.

The disability insurance company benefits in a number of ways: they get an advance notice on your claim and have the opportunity to review your claim, medical records and work records. They can red flag your claim especially if you are relatively young and/or have a high benefit amount.

Learn more about short term disability claims here.

How ERISA Factors into the Claim Process

If your disability insurance policy is paid for through payroll deductions and you received it as part of your employee benefits, then you need to know about ERISA – Employee Retirement Income Security Act of 1974. ERISA was created to protect employee benefit plans from unscrupulous employers, originally to protect pensions. But disability insurance companies discovered that they could use ERISA to take control of coverage disputes. ERISA creates problems for claimants who try to tackle denials on their own because under ERISA:

• Time limits to respond to the denial are short and inflexible.
• There is no jury trial.
• An administrative judge oversees a review of the claimant’s file.
• Only materials in the claimant’s file may be considered by the administrative judge.
• Once the appeal is denied, the next step is a federal court case.

Learn more about ERISA and your disability insurance claim here.

Awards

We Have an Excellent Track Record with Our ERISA Cases

Every disability policy and every fact pattern is different, but our experience and aggressive representation of our clients has led to many successful outcomes. We have overturned denials for clients at all stages of their claims, and even won back benefits after terminations. While past performance is no guarantee of future success, these short descriptions are provided to demonstrate our effectiveness:

• A relatively young – 42 – law professor was unable to teach, publish or work on committees because of several related conditions, including Lyme Disease, Post Lyme Disease Syndrome, POTS (Postural Orthostatic Tachycardia Syndrome) and the restrictions that her illnesses created. The Standard denied her claim, and we fought back and got her a lump sum of past benefits and she was paid her claims for several months. At that time, The Standard tried to terminate her claim. Once again, we fought back, and she continues to be on claim.
• A 62 year old man who had been the Director of Finance for one of New York’s best nonprofit workforce development organizations underwent radiation treatment for lymphoma and experienced severe side effects. Afterwards, he was diagnosed with a neurocognitive disorder and a number of co-morbid conditions that left him unable to work. Guardian began an in-depth review of his claim, which we saw was actively seeking information to support a predetermined position of a denial. Despite paying him benefits for two years and there being no change to his medical status, Guardian terminated his claim. We fought back with an aggressive ERISA appeal and his benefits have now been reinstated.
• After three years of receiving disability insurance benefits from CIGNA, a 55 year old man’s claim was terminated. Nothing in the man’s condition had changed, and there was no advance warning that CIGNA was even considering terminating him. Frankel & Newfield fought for him with an ERISA appeal to reinstate his disability claim. We did so with a detailed vocational and medical analysis. We were able to have his termination reversed and he continues to receive benefits.

Recognize What’s at Stake When Your Disability Claim is Denied

Disability insurance is meant to replace income when you are unable to work due to an illness or an injury. You count on that insurance, but often the disability insurance company has another thing in mind: protecting its shareholders and profits.

Disability Insurance Claims FAQ

How can I manage my disability and fight the insurance company at the same time?

Short answer –you can’t. Long answer – you don’t have to. This is the question that everyone asks in their minds, but are reluctant to ask out loud. Our position is that you and your family need to focus on your health and adapting to your new circumstances. The last thing you need is the frustration, aggravation and anxiety created by a faceless corporation. We work with our clients every step of the way, so they don’t have to go it alone.

Here’s how one client described his experience:
“Jason Newfield, Esq., is a very knowledgeable, professional, and kind lawyer. He is thorough, helpful, and responsive. He is quick in returning e-mails and prompt with paperwork. He shows perseverance and helped me greatly. I highly recommend him.” RM

If you have any questions or would like to learn more, please call us at 1-877-LTD-CLAIM (1-877-583-2524) or click here to send an email.

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications