Long Term Disability Exclusions

There are some long term disability exclusions because long-term disability doesn’t necessarily cover every possible disability condition. When you purchase long-term disability insurance, you may believe you understand the coverage and your policy will cover you for most disability scenarios.

elderly man with long term disability

In fact, nearly all long-term disability policies have specific exclusions for certain conditions. Before you go through the process of applying for long-term disability benefits, carefully review your policy and understand what is and is not covered. You will want to understand the long term disability exclusions in your policy. If you are not sure, then you may want to consult with the Herren Law office in Houston, Texas.

What Is An Exclusion?

This is a clause in your policy that you probably agreed to when you purchased it, or you accepted the policy from your employer. An exclusion details a specific situation where the insurance company does not pay you any monthly income. The idea is to exclude coverage for claims that result from or are related to a pre-existing medical condition, or exclude coverage of any claim that could result from any potentially hazardous activities that can lead to the increased risk of potential disability.

Common exclusions include:

Pre-existing conditions, which is a condition you already know you have prior to application. This may include some or all pre-existing conditions, depending on your policy.

Work-related conditions, especially if your occupational injury or illness would otherwise be covered by worker’s compensation benefits.

Specific health conditions such as cancer, heart disease, lung disease, or diabetes, are detailed in the policy.

Hazardous or high-risk activities, such as injuries and conditions related to things like bungee jumping and other extreme sports

A normal pregnancy and delivery

Acts of war and conflict, such as a riot, insurrection, or another incident of violence

Other criminal activities

• Self-inflicted injuries. Most policies do not cover any injuries that are self-inflicted or related to a suicide attempt.

Policies with more exclusions generally cost less. The more exclusions you reduce, the higher your premiums. Meaning if it covers more conditions, it will be more expensive as the chances of a claim will also increase.

Mental Health Conditions

Many long-term disability policies also limit or exclude mental health or nervous conditions. This means that if your disability is caused by or contributed to by a mental or nervous condition that’s in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), you may have no benefits or strict limitations on the benefits you can receive.

For policies that do allow for mental health condition claims for disability, the standard limitation is 24 months or two years. Depression, anxiety, stress, and even dementia have a strict 2-year limit in most policies for long-term disability benefits. If you are still disabled because of a mental or nervous condition following the two-year period after your benefit period ends, you will unfortunately no longer be eligible to receive benefit payments.

Alcohol And Substance Abuse

Similar to mental health conditions, many long-term disability insurance policies limit or exclude coverage for any disabilities related to alcohol and substance abuse. Some policies do not cover them at all, but other plans include limitations on how long you could receive benefits.

Handling A Denial

If you think your condition is not a long term disability exclusions, then you apply for benefits.  But even if you are confident your condition is covered under your long-term disability policy, you may be surprised to receive a denial letter from your insurance company. Unfortunately, this is a common occurrence with long-term disability applicants. The good news is you have the right to appeal, so take advantage of it.

Read the letter carefully, and make sure that you understand why your claim was denied. It may be that you did not submit enough medical evidence, or there was something else missing from your claim application. The denial letter will tell you why, and what you need for your claim. However this may also be time to consult an experienced long term disability attorney like Bill Herren. Herren Law Office is a Houston, Texas-based law firm serving clients throughout the greater Houston area. With almost 30 years of experience, they’ve helped over 4,000 people with their disability claims. If you are trying to obtain SSDLTD, or VA disability benefits, it is beneficial to get help as soon as possible from an experienced disability attorney.

The letter will also let you know about the deadlines for appealing the company’s decision. It is critical to make sure that you meet these deadlines or you’ll lose your right to appeal altogether.

If you believe your insurance company is acting in bad faith, this is also a reason to engage the services of an experienced disability attorney who can help you file your appeal. A good disability attorney understands how insurance companies work, particularly for claims where they will have to pay out money.

Your Houston Long Term Disability Attorney

If you need help filing a long-term disability claim, or are having trouble with the insurer paying your benefits, or need help preparing an appeal to a denial of benefits, we’re here to help.

We’ve helped over 4,000 Houstonians have received the LTD benefits they need. The Herren Law Firm can help you with your application, appeals and help you through the process, and give you one less thing to worry about. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation and no up-front fees. We only collect if we win your case.

Is Anxiety a Long-Term Disability?

Anxiety Can Be a Debilitating Condition That Can Cause Long-Term Disability

After an upsetting life event, such as losing a loved one, going through a divorce, or losing a job, it’s understandable that a person might find themselves feeling anxious or depressed. But if the anxiety continues long after the event, it becomes chronic and may lead to something more complex.

Anxiety Can Be a Debilitating Condition That Can Cause Long-Term Disability

Anxiety and anxiety disorders can be a crippling and disabling medical conditions for some. If you are experiencing anxiety symptoms that are preventing you from working and everyday life, long-term disability may give you a period in which to receive treatment and recover. But it’s not as easy as it sounds, and denials are common.

Generalized Anxiety Disorder (GAD)

While anxiety can visit most people at any time, individuals with chronic anxiety experience symptoms such as insomnia or hypersomnia, chronic fatigue, and cognitive issues such as lack of concentration. For many people, these impediments are temporary, or manageable to the point where they can work without a problem.

However, GAD may also include symptoms such as:

• Irritability and agitation
• Heart racing
• Restlessness
• Shortness of breath
• Muscle tension
• Grinding of teeth that leads to jaw pain
• Panic, fear, dread, and excessive worrying

These symptoms and others can lead to functional impairment that directly impacts your daily life and employment.

Proving Disability

As with any medical condition, you’ll first have to demonstrate to your insurer that you are, in fact, disabled. Mental conditions such as anxiety will require a more thorough degree of proof.

An evaluator will review all of your medical records, including treatments. This includes things such as weekly visits to a therapist, psychologist, psychotherapist, or psychiatrist, and any prescriptions for your condition.

It’s also important that the evaluator see that not only are you following through with treatment, but your provider is also offering the correct standard of care. This means that although they have prescribed treatment, they must also follow through with monitoring your progress, make adjustments, or even change medication as necessary. If you believe your current provider isn’t offering the correct standard of care, you should seek out another provider, or at least a second opinion.

A strong indicator of disability would be if your doctor suggested you would benefit from hospitalization or intensive outpatient treatment. For that period, you would be unavailable for work which shows that your condition is incompatible with regular employment.

Documentation and letters from your treating physician that describe and support your diagnosis should also be included in your case file. This would include medical records and notes from therapy that describe your ability and limitations on employment-related activities. Your doctor should include specific and distinct restrictions and limitations on your abilities that detail your limitations, rather than generalized statements such as “inability to tolerate stress.”

Mental Illness Limitations

Many LTD policies have strict limits on anxiety and other mental illnesses, which are typically 24 months, or two years. After the period ends, your benefits run out. Some policies may specifically exclude mental illnesses entirely. However, some conditions may have an exemption; that’s why it’s important to read your policy carefully to find out.

A disability attorney can help you with record gathering and make sure your application and claim file has everything you need for a successful LTD claim.

Houston’s LTD Disability Attorney

Over 4,000 Houstonians have come to us for help with LTD claims. The Herren Law Firm can help you with your application, appeals, and through the process. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, no up-front fees, and we only collect if we win your case.

Do I Need a Texas Disability Lawyer?

You may wonder if you need a Texas disability lawyer to apply for disability benefits. Unfortunately, applying for disability is a difficult process that is time-consuming and complex. You may seek the advice of friends or family who may already have a disability But when you apply, you may only to be frustrated by administrative delays—or even a denial. But you don’t have to have the this experience.

One option to consider is to find a well experienced Texas disability lawyer like Bill Herren who can help guide you through this complicated process and make things easier.

Do I Need a Texas Disability Lawyer?
Houston Statistics

Whether you grew up  here in the Bayou City or just in the Lone Star State, you know that everything is “bigger in Texas.” Houston is the largest city in Texas and keeps getting bigger.

Our city is home to about 2.3 million people, just in the city, making it the 4th most populated city in the US. (Harris County is the third-largest county in the country.) Houston saw an increase of over 11% in population from 2010 through the 2020 census. It’s expected that Houston will become the 3rd largest population in the US by 2030.

More than 145 languages are spoken here, with people visiting and moving in from nearly every country in the world. Both domestic and international inbound migration shows no signs of slowing down.

Why A Texas Disability Lawyer Can Help You

You aren’t required to have a lawyer file an application for disability, but it really helps. Dealing with a disability application can be frustrating if you decide to undertake it by yourself.

Something else to consider is that with more Houston and Texas residents, there are more people applying for disability here than ever before. What this also means for you is waiting longer for processing and a greater possibility of a denial of application.

The earlier you begin speaking with a disability lawyer, the better. Look for one that offers a free consultation like Herren Law does! Your case should be evaluated and then you should be told if you have a case upon which you can move to apply.  At Herren, we tell you what the procedure will be to apply.

Getting legal help increases your chances of approval in two ways:

• A  good disability lawyer will make sure that your application is done correctly and has everything you need to meet the criteria, (i.e., medical records) and

• You’re more likely to be approved by Social Security if you are represented by a disability lawyer.

If you haven’t spoken to a disability lawyer, go ahead and make an appointment now. Unless you’ve applied and are waiting for an answer from SSA, nearly anytime is a good time to make that call. Attorney William Herren has been helping Houston and Texas residents cut through red tape and get their disability benefits for more than 20 years.

Can I Afford A Texas Disability Lawyer?

If cost is what’s holding you back from considering legal counsel, don’t let it. Most charge little or no fees upfront, and the benefits of having representation will likely outweigh the costs.

That being said, fees for disability lawyers are set by federal law. A Texas disability lawyer can only charge a maximum of 25% of any back pay you receive, up to $6,000. This figure may be a little higher for an appeal, but the fees are capped at $6,000. You’re only charged fees if the attorney wins your case.

If you’re wondering, “where am I going to get $6,000?,”  we’ll explain. The lawyer’s payment comes from something called “back pay.” That’s the lump sum you’ll receive when your benefits begin. The amount will vary based on your monthly payments and the amount you would have received from the date of your application to the date that your monthly benefit payments begin.

For instance: If you apply for disability on January 1, but you aren’t approved to receive benefits until September 1, that’s nine months of benefits. Let’s say your benefits will amount to $700 a month. When you begin receiving your $700 per month benefits, you’ll also receive a lump-sum “backpay” of $6,300, or nine months of $700 monthly benefits from the day you applied.

Your attorney’s fee will be 25% of that back pay, or $1,575 for assistance with the application. You’ll still have $4,725 in backpay and then receive your $700 per month benefits every month.

If your backpay amount is higher, your fee will be higher, but generally not more than $6,000. Your lawyer should  explain this payment process in greater detail during your consultation.

Texas Disability Lawyer William Herren

Applying for a disability is not easy and, given the large population in Houston and Texas, getting it is even more difficult. At Herren Law, we’ve helped more than 4,000 people get the benefits they need. Mr. Herren and his staff are ready to help you with your initial application and ensure that your application is done correctly. If you have already been denied, discuss with us the appeal process.

Remember, call the Herren Law Firm today at (713) 682-8194 or (800) 529-7707 to schedule your free consultation. We are very experienced in helping people successfully navigate through the disability application and appeals process, and we can help you too. Our contingency fee means you won’t have to pay until you start receiving benefits.

Is There an Age Limit for Long-Term Disability?

People wonder is there an age limit for long-term disability? Long-term disability is an insurance policy designed to replace your income so that you can pay your living expenses while you’re unable to work. Generally, the payments are about 60% of your income. They provide cash directly to you to pay your bills as you would if you were still working. You may also use it to cover new occupational training or other assistance you may need if you believe you will return to work later.

Is There an Age Limit for Long Term Disability?

This means that you can avoid burning through your savings for your retirement, your children’s education funds, or other future goals.

But is there an age limit for long-term disability? Will it last year, two years, or longer, or will you age out of your policy? There are several factors involved in any LTD policy, including an age limit.

How It Works

Most people have a long-term disability policy through their employer. Others, such as self-employed individuals, may purchase a policy on their own. In many cases, they are accompanied by short-term disability policies. Generally, when the short-term disability policy ends, usually within three to six months, or as long as twelve months, the long-term disability policy begins.

Long-term disability policies usually have a six-month waiting period before payments begin. This is because most people have a short-term disability policy already in place. Long-term disability policies are written to accommodate short-term policies.

Once the waiting period is over, your long-term disability benefits should begin. The benefits are supposed to be paid for as long as you are disabled. Of course, the length of your benefits will also depend on the type of disability you have, how long it’s expected to last, and how disabled you are. A policy that’s written so that you could perform any type of work is different from one that only pays when you are unable to work in your own occupation.

For someone who has a much longer disability, that either keeps them out long term or prevents them from returning to work permanently, the long-term disability policy generally pays for the rest of your disability.

The End Of The Policy

For the person who is disabled for the rest of their working life, a long-term disability policy will continue to pay until the individual is eligible for retirement. Once the individual reaches the point at which they would normally retire, the policy will end, and the status changes to “retired.” The now-former policyholder then begins receiving Social Security and other retirement funds. This can include a pension, a 401K, or other retirement supplements.

However, the age limit for the long-term disability policy will also depend on the policy itself. Some policies end at age 65 or 67 when most people are expected to retire. However, it is possible to purchase a long-term disability policy with an age limit of 70.

Some policies may change their benefit payment schedule if you are disabled after the age of 62. Benefits may be reduced, or given a limited number of months until you are eligible to retire. You can also voluntarily retire before you reach the end of your long-term disability benefits.

Other policies will indicate the number of months for which benefits are payable if you become disabled at or after the age of 65, such as 18 months. Again, this all depends on the individual policy. It’s important to review your policy to see if the insurer will consider your age when determining if you meet their definition of “disability.”

Your age may impact your ability to learn a new occupation or skills, especially if you have only worked in one field for most of your professional career. This may limit the alternative occupations that you may be able to perform after becoming disabled.

Your Houston LTD Disability Attorney

If you’re facing an absence from work due to a long-term disability but are having trouble with the insurer paying your benefits, we’re here to help. We can help with all facets including questions about  the age limit for long-term disability.

We’ve helped over 4,000 Houstonians have received the LTD benefits they need. The Herren Law Firm can help you with your application, appeals and help you through the process, and give you one less thing to worry about. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation and no up-front fees. We only collect if we win your case.

Am I Able To Get Veteran Disability Back Pay?

Can you get veteran disability back pay? Because the VA is notorious for taking a long time to award disability benefits to veterans, you’ll be happy to know that there is a silver lining. And the longer you must wait, the better your chances of getting back pay.

Am I Able To Get Veteran Disability Back Pay?

Veterans who apply and have trouble getting their benefits may wait months and even years before receiving their monthly VA disability payments. This can lead to a one-time lump sum.

What Is Veterans Disability Back Pay?

There is usually a substantial wait between the time veteran applies for disability benefits and the time they begin to receive these benefits. Therefore, the VA generally pays benefits in full that the veteran is due. This can lead to a substantial payment to make up for the months (or years) waiting for the payments to begin.

Commonly called “back pay,” it’s the difference between the effective date and the date of the benefit award. This means that you may receive a lump sum that’s the total amount of money you would have received monthly if you’d been awarded benefits from your effective date.

Defining The Effective Date

The VA pays benefits from what it calls your “effective date,” which is the latter of two dates. These are the date of your application or the date that your service-connected disability either shows up or increases in severity.

For example: If you apply for VA disability benefits on May 1st, and your benefits are approved on December 1, your monthly benefit payments may not start until the following May. This means that you would receive a lump sum equal to the amount you would have been paid from your application date, which was the original May 1st when you applied. This original May 1st is the effective date.

For most claims, the date of your application is the effective date. However, the second date is usually when a veteran decides to file for the first time or to request an increase in their ratings. That’s why the second effective date would not be the original date of the claim filing.

Sometimes, an earlier effective date may be used. These would be for recently discharged veterans, claims for increased ratings, or Agent Orange exposure claims. The reason for that is because Agent Orange exposure is known as a presumptive service-connected condition.

The VA begins the claims process once the effective date is established for the veteran.

How Much Will I Receive?

As with any legal case, it’s impossible to give an exact dollar amount for a veteran’s disability back pay. Every veteran’s case is different, their benefit amounts are different, and they’re based on each individual’s disability rating.

The eventual back pay award will be based on:

• The amount that the veteran will receive monthly once benefits are awarded
• The number of months and/or years that the veteran has been waiting since his or her effective date.
• The differences in the benefit amount for the months or years that the veteran has been waiting, taking into account factors like cost-of-living adjustments.
• Any other special considerations, such as additional monies for aid & attendance, or other allowances.
The longer you have been waiting, the larger your possible back pay will be. As always, veterans’ benefits are tax-free. This includes anything you receive as back pay.

Appeal If You’ve Been Denied

For a handful of reasons, many VA claims are denied at the outset. If this has happened to you, don’t re-apply for VA benefits—file an appeal instead.

If you submit another application, your effective date will change. This means you could lose hundreds and even thousands of dollars in back pay. Using the above example, if your claim is denied in December, and you reapply at that time, your new effective date will be December 1st, not the original May 1st. You will in this example lose six months of potential back pay, if not more.

After a successful review or an appeal, you may also receive back pay.

It’s important to note that all applications for VA disability benefits must be made in writing. If you have had discussions with an attorney, a veterans service officer (VSO), or a VA representative about filing a claim, don’t assume that it has been done for you.

The VA has considerable discrepancies in notifying veterans about the possibility of having a claim. Therefore, it’s up to you to begin the process. The effective date of your award is always on the date of your written claim, and not before. Working with a disability law attorney can make the process easier and make sure that your application is done correctly the first time and that any appeals are handled well.

Herren Law Helps Houston Veterans

Getting veteran’s disability back pay and benefits is a long, arduous process that takes patience as well as understanding the law. William Herren is a disability attorney who has helped more than 4,000 Houstonians get the benefits they deserve, including veterans. Call The Herren Law Firm today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and we’ll take your case on a contingency fee basis, with no up-front charges. You don’t owe a fee until we win your case.

Is A Mental Health Disorder Eligible For Disability?

Most people think that disability is strictly for individuals who are physically disabled. But a mental health disorder can be equally disabling, especially if not properly treated. If you have a mental health disorder that prevents you from working or inhibits your everyday functioning, you may also be eligible for disability payments.

Is A Mental Health Disorder Eligible For Disability?

Adults who are living with a mental health disorder may not have the funds to take care of themselves or to be able to seek treatment. Millions of people with disabilities are unable to get proper treatment because they do not have the means to obtain care. But it’s vital to get a diagnosis before pursuing a claim for disability.

The Blue Book

Social Security has an organized listed list of impairments, commonly called the “Blue Book.” Mental disorders are contained in Section 12 and are arranged into 11 categories. These are the impairments that are serious enough to prevent a person from working. It also lists the medical requirements that determine if a person can receive benefits for a disability.

Conditions in the Blue Book already meet the Social Security Administration’s definition of disability. However, children who are applying for SSI will not be based on an occupation, but whether a condition will cause “marked and severe functional limitations”

Just being diagnosed with an illicit condition does not automatically qualify you for disability benefits. The Blue Book details the symptoms, test results, and other data that show that your condition is serious enough to be actually disabling according to SSA guidelines. It also lists the records you need to prove to the SSA that you are disabled.

Social Security Requirements for a Mental Health Disorder

Social Security’s requirements for mental disorders are much the same as physical disorders. It must be a condition that will keep you disabled and unable to work for at least 12 months.

To show that you are disabled, you will also need medical evidence that documents your disability and shows how it prevents you from working and disrupts your everyday life. This will include things such as psychiatrist’s notes, lists of medications, treatment records, any associated diagnostics, and documented impacts of your symptoms on your “activities of daily living,” or ADL.

You must have these documents available and in order before attempting to file your claim application. While SSDI can be done online, SSI requires an in-person interview and cannot be completed online.

There are two disability programs available:

• For Social Security Disability Insurance, or SSDI, you will need to have previously worked and paid into the Social Security system for five of the last ten years. Monthly benefits are based on your lifetime earnings, known as your “average indexed monthly earnings,” or AIME. You will qualify for Medicaid after 24 months.

Supplemental Security Income (SSI) is designed for those who have not paid into Social Security in the last ten years or have never worked. Both adults and children can qualify for SSI. If you qualify for SSI, you also qualify for Medicaid benefits.

If you are unable to work but don’t meet the bluebook’s criteria to qualify on a medical basis, you can still be approved with a medical-vocational allowance. It will take your age, work history, educational background, transferable skills, and medical condition into consideration. Your physician can fill out a residual functional capacity form, or RFC, to add to your disability claim.

The RFC will indicate if you have difficulty focusing, cannot work with others, have difficulties with communications, are unable to complete a task, etc. It lists these indicators and symptoms so that the examiner can understand whether or not you can work, and what type of work you are able to do. Including an RFC from your psychiatrist or psychologist can be key to approval for your claim.

Get Help With A Mental Health Disability Application From Herren Law

Having a mental health disorder can prevent you from working and impact your daily life. We also understand how important it is for you to receive your benefits in a timely fashion. Herren Law has helped over 4000 Houstonians receive the disability benefits they need.

When you call us, we’ll immediately begin going through your records, working with you one-on-one, and representing you during your hearings. The first step in getting an experienced SSD attorney on your side is to contact our Houston law office at (713) 682-8194. We offer free, no-obligation consultations, and there is no fee unless we win your case.

Get A Disability Lawyer Before Applying For Benefits

As anyone who’s ever done this will tell you, applying for disability benefits is a long, arduous process that is complicated as well as confusing.  You should consider getting a disability lawyer from the get go!  Many applicants don’t understand how to fill out the required paperwork or submit the correct medical documentation. It’s the main reason why more than 65% of disability claims are denied at the first application.

Get A Disability Lawyer Before Applying For Benefits

Another reason is that most people don’t normally deal with Social Security and so are unfamiliar with the process.  A good disability attorney understands the claim, the process, the laws surrounding disability claims, and what’s needed for a successful claim.

You do have the right to legal counsel, but it’s not a requirement. But there are reasons why you should consider working with a disability lawyer before you apply for benefits. You undoubtedly need financial help and messing around with this process may end up a waste of time, especially if you eventually need a disability lawyer to help anyway.

Consultation with a Disability Lawyer

While it’s true that an attorney is not required, the truth is that their knowledge and expertise go a long way in making it easier on you and increasing your chances of success.

You will want to look for a disability lawyer offering a free consultation to discuss your situation. You can use that consultation to discuss your reason for filing a claim and they can tell you what you need to know going forward.

You’ll also have a better idea of what you need to get started. They can tell you about the medical records, test results, and other medical documentation you’ll need for your application. They can also advise you on specific situations that you are experiencing and how to approach them before you start.

If it make sense after the consultation, you can hire the lawyer to handle this on your behalf. At Herren Law, all work is done on contingency meaning you will not be charged a fee unless we win your case.

Your Claim

After speaking with an attorney, starting the process will be easier. You’ll know what you need and where to get it. If you decide to hire a disability attorney, you’ll have expert advice every step of the way and minimize any guesswork. You’ll know that your application is correct before filing and you have everything you need.

Should your application for some reason lack any information or documentation, you can consult with your attorney to find out what you need to do to remedy this situation.

If your initial application is denied, even with expert help, you’ll already have legal counsel that  can guide you through the appeals process. You won’t have to worry that the attorney doesn’t understand your case because he or she should already be familiar with your situation. This makes it easier to work your appeal. Your attorney can advise you on your application, your appeal, and represent you if you are required to go to a hearing.

How Much Does It Cost?

That’s always the biggest question–money. Disability attorneys don’t work for free but may work on a contingency fee basis, like Herren Law Firm does. This means that they get paid when you receive a settlement because they receive a portion of it. If the attorney is unsuccessful, they will not be allowed to be paid. Therefore, most attorneys are motivated in successful outcomes.

The Social Security Administration has rules that limit the amount of money a lawyer can charge you and they also approve your fee agreement with an attorney.  The attorney cannot charge more than $6000, or 25% of your back pay, whichever is less. Their payment is taken from your past-due benefits and sent directly to the attorney. The SSA does this to avoid any extra charges. The attorney is paid directly so you won’t have to deal with that part.

Be aware that your attorney may bill you for some out-of-pocket expenses, such as obtaining medical reports. These are not subject to approval by Social Security.

The amount that they are paid will also depend on where you are in your application process. If you are beginning your application, the attorney will likely be awarded 25% of any back pay you receive. But since there isn’t much in the way of backpay from an initial application, their portion of the settlement will be much less. But if you are in an appeal situation, chances are your back pay will be a higher amount. In this case, attorney fees are capped at $6000, even if the 25% figure would be higher.

Social Security has more information on your right to representation by legal counsel.

Let Herren Law Help

Applying for disability is difficult and dealing with a large government agency like Social Security can be intimidating. But we can help you at the beginning and ensure that the process is as smooth as possible. If you have been denied benefits, we can help you file an appeal if appropriate.

If you believe you have a claim or have already been denied,  call the Herren Law Firm today at (713) 682-8194 or (800) 529-7707 to schedule your free consultation.  We are experienced in helping people successfully navigate through the application and appeals process, and we can help you too.

What to Do if Insurance Denies My Long-Term Disability Claim?

If you have received the dreaded denial letter from your insurance company, you may believe that your claim for long-term disability is over. However, that is not the case. Many applications are denied based on the initial application for multiple reasons. But you do have the right to file an appeal.

What to Do if Insurance Denies My Long Term Disability Claim?

We have discussed the possible reasons for LTD denial in a previous blog post. If you have yet to file your initial LTD application, read the previous blog post to make sure that your application and any follow-up meet the criteria.

Appealing The Denial

If you have already received a denial letter, the first thing to do is to prepare to file an appeal.

All LTD policies allow for one, and sometimes two appeals before a person begin receiving long-term disability benefit payments. In fact, most people receive their benefits after the exhausting appeals process.

First, examine the letter that details why the company denied your application. This letter will also tell you the period you have for filing any type of appeal. You must pay attention to this deadline, or you’ll miss your opportunity for appeal, and winning your claim will be over.

Next, contact the insurance company and request a copy of your claim file in writing. If your policy is through your employer’s Human Resources department, contact them for a copy of your claim file. This will show you what they used to determine your claim denial, and how you can prepare for your appeal.

What You Need to Reverse Their Decision

One thing we do know about insurance companies is that they are in business to make money, not to provide you with benefits. Many engage in what’s known as “bad faith practices” to ensure that you don’t get your benefits and that you eventually give up trying. If you haven’t already, this is the time to consider working with an experienced disability attorney to represent you and your long-term disability claim.

It does take considerable effort to file a successful appeal. This includes gathering additional evidence and documentation, such as:

• Supplementary medical records and information to support your claim
• A letter from your treating physician that describes your condition and how it directly impacts your everyday life
• Personal statements, which are from you as well as from a coworker. This information should describe your life with a disability and detail the reasons why employment is not a possibility. Family members and/or former coworkers can also submit statements that describe your limitations and how the disability affects your ability to do your job.
• Your appeal letter that details why you are entitled to disability benefits under the terms of the policy. This letter must clearly detail the facts of your case so that anyone who reviews your appeal will clearly understand that you are unable to work full time.

One thing to focus on at this stage is the addition of relevant medical records for your file. If your claim file doesn’t have sufficient medical documentation, now is the time to add what’s missing and make sure it’s there. Add as much as you can, and a little more—because it’s your last opportunity to “stack the deck” in your favor. Should a lawsuit become necessary, you will not be able to add anything else. The lawsuit is based on everything in the claim file through the end of the final appeal.

Filing A Lawsuit

It is possible to sue an insurance company over a denied long-term disability policy. However, ERISA requires that you pursue all administrative avenues, and all other opportunities for resolution are exhausted.

Prior to filing a lawsuit, your disability attorney can request that the insurers provide another appeal. This will give your attorney the opportunity to buy additional time to reverse the decision. However, in the process of reviewing your claim for the second time, the insurer may file a complaint with the Texas Department of Insurance (or another state’s regulatory agency.) The good news is that this will be part of the lawsuit detailing how the insurer worked to deny your claim.

Hopefully, your case will resolve in appeals, and you will begin receiving LTD benefits soon after. But if that’s not a possibility, your disability attorney can then file a lawsuit in federal court. While this is a longer process, a lawsuit may be necessary to get the company to pay your claim.

Call Herren Law for Help With Your Long-Term Disability Appeal

If you’ve been denied long-term disability benefits, don’t try to manage your appeal on your own—get help today. The Herren Law Firm can help you with your initial application, any appeals, and a potential lawsuit. We can make sure you have one less thing to worry about while you take care of yourself. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation and no up-front fees. We only collect if we win your case.

What If My PTSD Gets Worse?

Post-Traumatic Stress Disorder or PTSD affects more than 6% of the US population. Of this demographic, PTSD affects more than 12% of veterans. While PTSD can happen to anyone, veterans are particularly susceptible to PTSD even if they were not in combat. As a veteran, you can seek treatment through the Veterans Administration, or through a private physician.

Houston VA Disability Attorney

With treatment and time, many veterans with PTSD improve and are better able to handle the symptoms. However, this is not always the case, and some veterans find themselves with worsening symptoms. Aging veterans may face this problem after retirement when their situations change.

If your condition improves, it is possible that the VA may reduce your rating, and your monthly disability payment could decrease. But if you find that PTSD is getting worse, and improvement is unlikely, you can request that your rating be updated.

Changing Your Disability Rating

The VA assigns ratings based on how the disability affects a veteran’s life, health, and ability to function.
The VA could change your rating for PTSD, either up or down, and you’ll be notified when it happens. Your initial rating may have been too low, or your claim didn’t include enough information to justify a higher rating.

The ratings are assigned incrementally from 0% to 100%, based on the severity of the disability. The higher the rating, the more monthly compensation the veteran receives.

However, the VA’s ratings are not set in stone. As a veteran, you may ask the VA to reevaluate your disability rating if you believe the original decision was incorrect. You can also request a rating reevaluation if you are disabled by PTSD, and the condition has increased in severity.

However, if you make a request for re-evaluation within a year of receiving your disability rating, it is not considered a re-rating, but an appeal of the original decision.

Re-evaluation Requests

A veteran has three options for appeals to increase a disability rating. The type of review will depend on your individual circumstances.

Higher-level review—a veteran can request this review with a senior rating specialist at a VA regional office. The veteran is required to submit VA Form 20-0996. A specialist will review the claim and determine if the original decision was correct or needs an update. The decision generally takes four to five months, but if you disagree, you can request a board appeal for your case for review by a Veteran Law Judge. This appeal must go through the Boards of Veterans Appeals. You could also file a supplemental claim if you have new evidence to submit.

Supplemental claim—you will need to submit VA Form 20-0995. As the most common form of appeal by veterans, it takes four to five months for a decision. The reviewer decides whether the evidence will support an increase in your disability rating. Should you disagree with the decision, you can file another supplemental claim, or request a higher-level review, or a board appeal.

Board appeal—if you disagree with either of the above or your initial claim decision, you can also file a notice of disagreement with the VA and request a Board Appeal. You will need to file VA Form101082 to request this appeal. Your case will be decided and reviewed by a Veterans Law Judge at the VA Board of Veterans Appeals in Washington DC.

A supplemental claim is an option if you have had the same disability for more than a year, but believe your current rating is no longer accurate. Filing this type will reopen your claim to request a rating increase. You will need to submit additional medical records that demonstrate your service-connected disability is worsening, you have a new service-related condition, or if you have additional and relevant evidence not previously used in the initial rating decision.

Because veterans’ appeals are complicated, we strongly suggest working with an experienced VA disability attorney to avoid having your appeal denied.

Houston VA Disability Attorney For PTSD

Whether you’re suffering from PTSD or other service-connected disability, we can help you apply, appeal, and make your case to get you the VA disability benefits you worked for.

When you’re ready to start your application, need help with an appeal, call The Herren Law Firm at 713-682-8194 (or use our online contact form) to schedule your free consultation. Our contingency fee basis means you won’t owe a fee until we win your case, and there’s no obligation.

What is the VA’s Aid and Attendance Benefits?

Veterans who need assistance with everyday living may not realize that they can get additional financial support from the VA to cope.  The VA’s Aid and Attendance benefits program may be worth checking out. Wartime veterans who already received a VA pension may qualify. This assistance is not as well-known but is available for veterans who are in a nursing home or are spend all their time at home because of one or more disabling conditions.

What is the VA’s Aid and Attendance Benefits?

Because living assistance may increase a veteran’s expenses, this stipend can help offset the extra cost of that help.

Aid and Attendance Benefits

This is a benefit available to low-income veterans and their spouses who qualify for the VA pension. Whether they need in-home care assistance with everyday tasks like bathing, dressing, eating, etc., or if they live full time in a nursing home, Aid and Attendance can help make it easier to pay for their care.

A VA pension is not the same thing as military retirement pay. The VA pension is for veterans who have a financial need and a discharge that is not classified as dishonorable.

Aid and Attendance is not an automatic benefit. The veteran must apply for it separately.

The VA also has limits on income and assets, including a cap on the net worth at $129,094 for both. The veteran’s home is excluded up to a lot of two acres, even if the veteran resides in a nursing home. Medical expenses can be deducted from that limit. However, qualification is somewhat similar to Medicaid’s requirements. The VA has a three-year “lookback period” that examines whether any assets were gifted or sold below market value to lower the asset limit.

Qualifications

A veteran who served on active duty for at least 90 consecutive days which includes at least one full day during a time of war can be eligible for Aid and Attendance if they also qualify for the basic veterans’ pension and meet the financial and medical requirements. The veteran’s service does not have to include time in a combat zone.

For the veteran who went into active duty on or about September 7th, 1980, they must have at least 24 months of service with at least one day during a time of war, or other hostilities.  A widowed spouse of an eligible veteran may also qualify if they meet the same medical and income requirements and never remarried.

The Wartime Veteran

To qualify for the VA’s aid and attendance benefits, the veteran is required to be a veteran of wartime service. Those dates include:

World War II—December 7, 1941, through December 31, 1946
Korean Conflict—June 27, 1950, through January 31, 1955
Vietnam Era

o February 28, 1961, through May 7, 1975, for veterans who served in the Republic of Vietnam during the period
o August 5, 1964, through May 7, 1975, for those who did not

Gulf War—August 2, 1990, through a future end date set by law or Presidential proclamation or law (the VA considers this war to be still in effect)

The veteran must also meet one of the following requirements to qualify for a basic pension:

• Age 65 or older with no little to no income
• Be permanently and totally disabled
• Receive Supplemental Security Insurance (SSI)
• Receive Social Security disability insurance (SSDI)
• Live in a nursing home

Surviving spouses may also be able to apply under the same criteria.

Need Help? Work With A Houston VA Disability Attorney

Call The Herren Law Firm in Houston at 713-682-8194 (or use our online contact form) to schedule your free consultation for VA disability and other benefits. Our contingency fee basis means you won’t owe a fee until we win your case, and there’s no obligation.