How Will the Change to Social Security Judicial Reviews Impact ERISA Disability Claims?

A change took effect in March to how Social Security disability claims are processed, which is raising concerns for those of us who help people to get benefits that have been denied or terminated.

Please note that our firm does NOT handle Social Security claims, but we believe that the rule change may have an impact on Long Term Disability Insurance claims when policies are part of an employee benefits package.

These policies, known as ERISA policies, are subject to extremely strict rules and an administrative judge makes the determination of coverage when claims are denied or terminated.

The change allows the administrator law judges to weigh evidence in an applicant’s file as they wish, rather than requiring them to make their decision based on the opinion of the claimant’s treating physician. The idea was to simplify the judge’s deliberation and put the power of decision making in the judge’s hands. But that lessens the impact and importance of the physician, who is in the best possible position to make an evaluation about their patient’s health, well-being and inability to perform the tasks that are necessary to the claimant’s occupation.

We are concerned that the change will cause people to be wrongly denied.

This could completely undermine the role of the treating physician in the administrative appeals process.

Disability insurance attorneys are very concerned that an administrative judge who has spent little or no time with a claimant is making a huge decision on their behalf based on a paper file. This is similar to the paper review conducted by a claims manager who doesn’t always see the entire claims file and makes a life-changing decision based all too often on incomplete information.

If your disability claim has been denied, your next step is an appeal. Doing an appeal without the assistance of an experienced long term disability insurance lawyer could lead to a denied appeal. If your claim has been denied or you tried to appeal the claim on your own and it was denied, or if your benefits have been terminated, please call our office at 877-LTD-CLAIM (877-583-2524) to learn how we can help. Be aware that there are strict time limits on these claims, so call today.

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