Reasons For Long Term Disability Denial Of Claim

March 3, 2020 by

After paying premiums for several years, you expect that when you have to file a claim for long-term disability your insurance company will take care of you. But as many policyholders have discovered, that’s not always the case. You’ve had doctor visits, testing, treatments, therapy, and filled out a ream of paperwork that they’ve asked for, only to see your claim denied. So what’s going on here?

Reasons For Long Term Disability Denial Of Claim

Insurance companies are in business to make money and will deny your claims any way they can. These are some of the reasons your claim may have been denied.

They’re Watching You

Insurance companies regularly conduct video surveillance of individuals who file an LTD claim when they say they’re disabled and can’t work. Why? To prevent obvious insurance fraud, particularly by individuals who claim they can’t work because of an injury, but they’re publicly engaged in activities that they shouldn’t be.

Surveillance can be both long-range video and social media investigation. Even with your account set to “private,” it’s highly possible your vacation pictures and other “action shots” can be visible to people who you never intended. It’s always advisable to set your posts to “friends only,” but you should also be aware of who is following you and who you accept friend/follow requests from. Additionally, investigators may be able to access your account by demanding your passwords.

For instance, if you’ve filed a claim for a back injury that prevents you from working, and you post pictures of yourself surfing in Maui, that’s a clear indication that you’re not injured. Of course, if that picture is five years old, an investigator may not realize that, even if you date it.

Best bet: limit your social media postings, or deactivate or delete them until your case is decided.

Not Enough Medical Evidence

Any kind of insurance claim needs sufficient medical evidence to support it. Evidence is key to supporting your claim and showing that you are, indeed, disabled.

  • Consistent medical treatment for your condition(s). Your insurer expects that you are receiving consistent and regular medical care for the condition you are claiming. If you aren’t receiving regular medical care, the insurer will interpret this as your condition isn’t serious. Physical illnesses will include physician visits, as well as any required testing such as X-Rays and MRIs. If your claim includes mental illness such as depression, you should be seeing a mental health provider (such as a psychologist or psychiatrist) on a monthly basis or better.
  • A doctor’s statement detailing your medical condition and how your disability limits your ability to work. Don’t rely on the insurance company’s forms—they are designed for you to respond in a way that will ensure your claim is denied. Should your doctor deny you support for your disability, find another one who will help.
  • Absent medical records that are essential to proving your claim. If the insurance company hasn’t requested all relevant records, request a list of all the records they have already requested an a list of what they’ve received. Then insist that the insurer request all the records on the list. You may have to be persistent until they have all of your medical records.

Missed Deadlines

Insurance companies are notorious for deadlines, and even one day can end your claim. Make sure you understand their deadlines for both applications and appeals.

You Don’t Meet Their Definition Of “Disabled”

As ridiculous as this may sound, most policies have strict definitions of what “disabled” actually means.

One of the biggest sticking points is “own occupation” and “any occupation” clauses in the policy.

“Own occupation” indicates that your disability prevents you from fulfilling the requirements of your current occupation. “Any occupation” means that you are unable to fulfill the requirements of any occupations. Some policies begin as “own occupation” but transition to “any occupation” after 24 months.

Additionally, pre-existing conditions and medical conditions related to current or prior substance abuse tend to be excluded. Mental conditions and those that are based primarily on self-reported symptoms, such as fibromyalgia and chronic fatigue syndrome, may be limited to 24 months of benefits after approval.

Your Houston LTD Disability Attorney

When applying for long-term disability it’s important to follow your insurer’s instructions to the letter. They’re not interested in helping you and your claim, but there’s someone who can help.  The Herren Law Firm can help you with your application, appeals and help you through the process so you can get the benefits you need. 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, because we will only collect if we win your case.

Filed Under: Long Term Disability Tagged With: , ,

Can I Receive Both SSDI And VA Benefits?

February 3, 2020 by

The short answer: yes, it is possible to have both. Neither SSDI nor VA disability is need-based, so you may be able to receive both. But there are a few things you need to know before you begin your application, and before you begin receiving benefits.

Can I Receive Both SSDI And VA Benefits?

Social Security Disability Insurance

This is a program that provides monthly disability payments to workers under 65 who have sufficient work credits and qualifying disabilities that prevent you from working.

Additionally, you can’t receive retirement and/or SSI benefits at the same time as SSDI. Once you reach retirement age and begin collecting Social Security, your SSDI will be discontinued.

However, SSDI is not affected by VA or DoD disability benefits.

VA Benefits

There is a difference between VA benefits and VA disability benefits.

VA disability benefits are based on the VA’s schedule of ratings that determine your amount of disability. You do not have to be totally disabled, you can also be partially disabled. Even a 0% rating acknowledges the presence of a service-connected condition that could later manifest and cause you to be at least partially disabled.

If you receive a VA pension, which is income and needs based, it can affect the amount you receive from SSDI, and vice-versa.

The Difference

One thing to remember is that Social Security and the VA are two separate governmental entities. Qualifying for VA disability benefits is not an automatic qualification for SSDI—you must apply for it separately.

Receiving VA disability benefits has no effect on an application for SSDI, and the SSA does not give weight to VA approvals for consideration of its own decisions. But since the SSA shares the medical database with both the VA and the DoD, they will have access to military and veteran medical records. These records may be used to expedite claims processing for vets with a 100% disability rating or “Wounded Warriors,” those who were injured on active duty after October 1, 2001.

However, if you are on SSDI, the VA is required to consider records that are used for approval of SSDA, and those medical records can provide valuable information for your VA claim.

You can apply for SSDI whenever your disability prevents you from working. You must be totally disabled in order to receive SSDI benefits.

However, for VA disability, you should apply as soon as you begin dealing with a service-connected disability condition. The VA awards benefits based on either partial or total disability.

The VA’s “Fast Track” Application Program

The unfortunate part of applying for any kind of governmental benefits is the time it takes before you begin receiving them. The VA has taken notice, and introduced the Fully Developed Claims (FDC) program, commonly called the “Fast Track.” The VA developed this program to help cut down on the backlog of applications that take years to complete.

The difference is that submitting an FDC will require you to do more of the preparation and “legwork” than you would if you were submitting a standard application. But submitting an FDC also qualifies you for retroactive benefits if you were disabled for a year before you submitted the application, and if it’s your first application.

The new application forms are all available at the VA’s website. You’ll need the VA Form 21-526EZ, Fully Developed Claim (Compensation) for disability compensation claims, which is a simpler, shorter application.

Legal Representation And Help For Disability Claims

If you’re applying for either SSDI or VA disability benefits, the process can be confusing. An incorrectly prepared claim for either or both can result in a denial. The time to get help is at the outset, to ensure that the application process is done correctly.

The Herren Law Firm has helped over 4,000 Houstonians get the benefits they deserve. Call us at (713) 682-8194 or (800) 529-7707 for a free consultation (or use our online contact form.) We’ll talk with you about your case and let you know how we can help. Our contingency fee arrangement means you won’t owe us anything unless we win your case.

Filed Under: Long Term Disability Tagged With: , ,

Can You Get Disability For Glaucoma In Houston?

January 3, 2020 by

At your last eye exam, your doctor may have noticed something you didn’t—your vision is slowly being affected. You haven’t realized that your vision has been receding just a little, because it’s a slow change. But your doctor knows, and now you’re concerned about going blind.

Can You Get Disability For Glaucoma In Houston?

Regular eye exams are important in the early detection and treatment of glaucoma. When caught early enough, the symptoms are treatable, and you may be just fine.

But if you’ve lost a significant amount of sight, and you’re finding yourself unable to see as well as you used to, is disability in your future?

Glaucoma Basics

Although most people believe glaucoma is a disease in and of itself, it’s actually a series of eye problems that could, without treatment, eventually lead to blindness. That’s why regular eye exams are important for the health of your eyes. While there is no cure, available treatments and surgeries can preserve your vision so that you can continue to see. About 5% of patients do go blind despite treatments.

Glaucoma can affect people of all ages, but is more common in middle-aged and elderly patients and is also hereditary. It’s a very slow-progressing condition, affecting the peripheral (side) vision first before it breaches into the central vision.

The most common type is primary open-angle glaucoma, where the eye’s canals are is clogged and fluid can’t properly drain from the eyes. This increases the inner eye pressure, affecting vision over time. POAG responds well to medication, particularly if it is caught early and treated.

The less common form is angle closure glaucoma, which develops quickly and needs immediate medical attention. It is also caused by clogged drainage canals, and occurs when the iris and the cornea closes. Angle closure glaucoma can also increase the pressure inside the eyes.

The SSA, Glaucoma, And Disability

The Social Security Administration recognizes that glaucoma can eventually cause problems for people who work. If it progresses far enough, it is possible that you may be unable to work.

Note that evidence of glaucoma is not enough to rate and receive disability payments. It’s only when the condition interferes with your ability to work that you’ll be considered for disability, and possibly rated for benefits.

The SSA has a specific section in its Listing Of Impairments just for Special Senses And Speech for adults, which describes “statutory blindness.” If your glaucoma progresses to statutory blindness, you may be eligible for an increased amount of benefit, which

However, the SSA also gauges the degree to which a disability prevents someone from working by establishing if they are engaging in what’s called Substantial Gainful Activity (SGA). That is, the amount of monthly income you earn and whether it’s enough to support yourself without monthly disability benefit payments. In other words, if you’re working and making enough to live on.

An individual who is not engaged in SGA and is statutorily blind will receive a larger amount of money due to the “adverse economic consequences” of blindness. However, the SSA encourages blind individuals to continue working, because the increased monthly amount due to blindness will not be affected by working.

Working With Glaucoma

If your current occupation is undoable with glaucoma, you may only need to change careers. Available technology can open up a world of opportunities for visually impaired individuals.

The Chicago Lighthouse For The Blind lists these occupations as just some of the ways people with partial blindness can continue to work, with our without SSA benefits:

  • Teachers, college professors and guidance counselors
  • Social workers and psychologists
  • Doctors, nurses and occupational and physical therapists
  • Masseuses and chiropractors
  • Rehabilitation teachers and counselors
  • Customer service representatives
  • Restaurant and store workers
  • Factory workers
  • Freelance writers, journalists and TV and radio broadcasters
  • DJs and musicians

The American Printing House For The Blind also has a website called CareerConnect, which offers resources for those with sight impairment to find suitable jobs.

Disability For Glaucoma

If you’ve been diagnosed with glaucoma, you may be able to receive disability benefits. Not sure where to start? The Herren Law Firm in Houston, TX can assist with your application, appeals and records gathering to prove your case, and win your claim.

We’ve helped over 4,000 Houstonians get their disability benefits, and are ready to help you. Contact us today at 713-682-8194 (or user our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, and we only collect a fee if we win your case.

 

Filed Under: Long Term Disability Tagged With: , ,

Organic Mental Disorders and Disability Benefits

December 20, 2019 by

You may be under the impression that if you have a mental disorder, you won’t be qualified for disability benefits. However, in many cases, you can. We’ve previously discussed disability for mental disorders. Most people think of mental disorders as depression, anxiety, bipolar, PTSD, OCD, and other mood disorders.

But an organic brain disorder is different, and unless you’ve been diagnosed with one, you might not understand what that means. Here, we’ll offer some understanding on the subject.

Organic Mental Disorders and Disability Benefits

What Is An Organic Mental Disorder?

This is a condition that’s differentiated from other mental health conditions due to the causes. While other mental disorders are considered to be chemical in nature, or a result of a person’s circumstances (such as the loss of a spouse or a job), organic mental disorders have a direct, physical cause. These can include:

  • Heredity
  • Traumatic brain injury
    • Concussion
    • Bleeding in the brain or into the space around the brain
    • Blood clot inside the skull that puts pressure on the brain
  • Strokes that cause dementia
  • Hypertension that causes a brain injury
  • Low oxygen or high carbon dioxide levels in the body
  • Withdrawal from alcohol and/or drugs
  • Effects from drugs and/or alcohol inebriation (however, not from the use of alcohol and/or drugs)
  • Infections, such as blood poisoning, encephalitis, meningitis
  • Other medical conditions such as cancer, kidney/liver disease, hypo or hyperthyroidism
  • Vitamin B deficiency (B1, B12, or folate)

Symptoms include:

  • Difficulty understanding spoken language, such as the inability to speak
  • Behavioral changes
  • Cognitive impairment
  • Confusion/disorientation
  • Dementia
  • Delirium
  • Amnesia
  • Personality changes
  • Hallucinations

Filing For Disability Benefits

It is possible to receive disability for organic mental disorders (also called Organic Brain Dysfunction) by submitting a complete listing of medical records, evidence, test results, and the date of the diagnosis. Additional testing that shows the rate of cognitive decline may also be required, such as an IQ test. While a low IQ doesn’t necessarily mean the patient has it, a drop in IQ from one test to the next is usually an indicator of an organic mental disorder.

Individuals with severe neurocognitive impairments may require assistance from a spouse or other family members who care for the individual. They should inform the patient’s attending physician about their problems and conditions so that everything is added to the medical records. The SSA may request information from the spouse or other family members about the patient’s condition.

The “Blue Book”

The SSA’s Disability Evaluation Schedule considers organic mental disorders to be neurocognitive disorders, and the criteria can be found under Section 12.02.

To prove your claim, you will need to satisfy the SSA requirements in A and B, or A and C:

    1. Provide medical documentation of a significant cognitive decline from a prior level of functioning in one or more of the cognitive areas:
      • Complex attention
      • Executive function
      • Learning and memory
      • Language
      • Perceptual-motor or
      • Social cognition

And:

    1. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:
      • Understand remember or apply information
      • Interact with others
      • Concentrate persist or maintain pace
      • Adapt or manage oneself

OR

    1. Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:
      • Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder and
      • Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life

If you need help filling out your application and compiling the records, get help from a Houston disability attorney with the knowledge and experience in disability law. Early assistance can save you time, money, and frustration in the long run.

Houston’s Disability Attorney For Mental Illness And Disorders

If you or a loved one have been denied disability payments for an organic mental disorder, we’re ready to help. Don’t give up on your claim—call us today.

The Herren Law Firm in Houston, TX can assist with your application, appeals and records gathering to prove your case, and win your claim. Contact us today at 713-682-8194 (or user our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, and we only collect a fee if we win your case.

Filed Under: Long Term Disability Tagged With: , ,

Can I Get VA Benefits For Hearing Loss In Houston, TX?

October 15, 2019 by

You may have noticed that you’re not hearing as well as you did before, or you keep asking people to repeat something. Did this happen during your time on active duty?

Doctor talking to an older female patient about Houston, TX VA disability benefits for hearing loss.

 

Hearing Loss Can Affect Anyone

Most people think of age-related hearing loss (the loss of the hair-like cells in your inner ear), or people who were born without hearing. But losing your hearing can happen to anyone anytime without an explanation. Even excessive earwax can cause hearing loss, but more common causes include:

  • Exposure to loud noises, including construction equipment, power tools, concerts, movies, and other high-decibel sounds without protection.
  • Listening to music too loud in earphones
  • Tinnitus (ringing in the ear, especially after loud concerts and movies)
  • Traumatic brain and other injuries to the head
  • Tumors and other growths in the ear area
  • Medications for conditions such as cancer and infections (antibiotics)
  • Sudden altitude and pressure changes during flying (or even driving)
  • Diseases in children such as:
    • Chickenpox
    • Smallpox
    • Meningitis
    • Measles
    • Mumps
  • Other chronic illnesses such as:
    • Heart disease and hypertension
    • Autoimmune diseases (such as Hashimoto’s thyroiditis and lupus)
    • Diabetes
    • Strokes

Veterans may have some of these causes, but their hearing losses are more commonly caused by experiences in the military, such as gunfire, transport, airplane and helicopter engines, and other artillery explosions (i.e., hand grenades.)

Like any VA disability claim, you’ll be required to establish a service connection for your hearing loss.

Three Steps

Just filling out an application will not help you get rated. In order to apply, you’ll need:

  • A current diagnosis of hearing loss from a licensed audiologist, who will administer two different diagnostic tests to be submitted to the VA:
    • Maryland CNC Test, which uses a 50-word list to determine how well you can recognize speech
    • Puretone Audiometric Test, which measures the lightest sounds you can pick up on and hear
    • Note: when you’re being tested, remove any hearing aids and let the audiologist know you’re taking this test to satisfy the VA’s requirement for establishing a service connection.
  • Establishment of a service connection, which may include examining your service records for evidence of any types of activity that could have contributed to or caused your hearing loss. Wartime service can be used to make that connection as well.
  • A corroborating medical opinion, one that can effectively link your hearing loss to your time in service

It’s not uncommon for hearing problems to develop some years after your discharge—but that doesn’t mean it isn’t service related. If you can demonstrate that you were exposed to loud noises during your time in the service, you still may be able to establish a service connection for your hearing loss.

Meniere’s Disease

This inner-ear disorder causes a number of symptoms, including hearing loss, vertigo, tinnitus, and pressure or “fullness” in the affected ear. It normally affects only one ear, and can also include fluid in the ear. While there are treatments for Meniere’s Disease, there is no cure.

The VA does rate on Meniere’s Disease, as much as 100% if you’re experiencing weekly bouts of vertigo and its related symptoms. Other inner ear disorders rate between 10% and 30%.

Hearing Loss Ratings

As with all disability ratings, the VA draws from the VA Schedule of Ratings Disabilities. Auditory (hearing) disorders are found under Section 4.87, in diagnostic codes 6200 to 6260. While tinnitus and hearing loss are common for veterans, there are other types of disorders that the VA will rate, including:

  • Cancer in the ear area. The VA gives a 100% rating for the six months following the end of treatments.
  • An inner ear problem called “peripheral vestibular disorder” rates at 10% if it causes you dizziness on occasion, and 30% if your dizziness is accompanied by staggering
  • The loss of one ear (external) is a 30% rating, whereas the loss of both ears rate at 50%, assuming that you have at least some hearing despite the loss of the ear itself.
  • The VA rates all cases of perforated eardrums at 0%.

If you have total hearing loss in both ears, you may also be eligible for a special monthly compensation.

Herren Law Can Help With Your VA Disability Benefits Claim

The VA does award disability benefits for hearing loss, but you have to apply, as you would for any type of disability. We can help make sure that your application is done correctly, and can also help with an appeal if your claim is denied.

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.

Filed Under: Long Term Disability, Veterans Disability Tagged With: , ,

Long Term Disability Death Benefits In Houston, TX

September 16, 2019 by

It’s difficult enough when you or a family member has to apply for long-term disability, especially if there is a terminal or progressive, degenerative illness, such as ALS, or an injury that will never heal. What’s even more difficult to think about is when the time comes that you or your loved one passes away.

But when the day comes, will you receive any death benefits from the LTD policy? This will depend on the terms of the policy, which should be reviewed completely before attempting to apply for LTD disability benefits.

Long Term Disability Death Benefits In Houston, TX

What Is A Death Benefit?

This is a lump sum paid to an insured’s family when the individual dies, and is most commonly associated with life insurance. In fact, life insurance is just that—insurance on someone’s life, which pays out to whomever the insured assigns as a beneficiary.

But with long-term disability, there may or may not be a “death benefit.” Some policies do offer a “survivor benefit” that pays a lump sum of LTD death benefits to survivors for a specific time period, usually one to three months. But as a rule, if the individual has passed away, there is no more need for the insurer to make payments, so they will stop.

If your LTD policy comes through your employer, it may or may not include a death benefit—check your policy. You may have been offered a rider for an additional charge to have that would provide your family or other selected beneficiaries a death benefit.

You may have selected this option for your own LTD policy as well. Again, read and check your policy to be sure, or contact your agent to clarify. You may have the option of adding this type of LTD death benefits, even if you’ve had your policy for some time.

An Alternative LTD: Accelerated Death Benefit

If your LTD insurance is not sufficient, or you are terminally ill and need help immediately, one possibility would be to request an accelerated death benefit on your life insurance policy. There are restrictions on requesting this benefit, and it will reduce the death benefit (total sum of money) paid to your survivors after you die.

You may also use this coverage if you are confined to a nursing home, or are deemed terminally ill. Some policies automatically pay this in circumstances of an imminent death. To qualify, you will have to be certified by a doctor or other medical professional that you are terminally ill, and that death is expected in 12 to 24 months. Some providers set the threshold at six months.

Critical illnesses that can also trigger this benefit include:

  • Stroke
  • Cancer
  • Heart attack
  • Kidney failure
  • Organ transplants
  • ALS

Chronic illnesses are not the same as critical illnesses. To determine if your policy allows an accelerated death benefit for your illness, as always, review your policy and speak with your insurance agent to be sure.

Your Houston LTD Disability Attorney

Long term disability can be an annoying process before you begin receiving benefits. The Herren Law Firm can help you with your application, appeals and help you through the process, and give you and your family peace of mind. 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, because we will only collect if we win your case.

Filed Under: Long Term Disability Tagged With: , ,

Taxation of Disability Benefits in Houston, TX

August 26, 2019 by

One of the less-discussed parts of getting disability benefits is what happens when it becomes tax time. Do you pay taxes on these benefits? The answer depends on what type of benefits you receive, and how you receive them.

Long Term Disability Insurance

Taxes on LTD insurance comes down to one question: who paid for it?

If your disability benefits come from a policy you paid for with after-tax dollars, as a rule, your benefits are tax-free.

However, if your employer paid for the policy, and does not include the cost of the policy in your gross income, the benefits are taxable, as it would be if you were earning an income.

Taxation of Disability Benefits in Houston, TX

If you shared the cost of the premium with your employer, you will share the tax benefits as well. The part that you paid (with after tax dollars) for will be tax free, but the portion your employer paid for will be taxable.

Should you retire from your job on disability, lump-sum payments for accrued time (such as vacation) are not part of a disability package. It is taxable, and should be listed as income.

The IRS also offers additional information on their website.

Disability Benefits From Social Security—SSDI And SSI

SSDI can be subjected to income tax, depending on what other income you may have (such as a spouse’s income.) However, many recipients don’t have much in the way of income, and do not end up paying taxes.

Under Social Security, you would receive one of two types of income:

  • Social Security Disability Insurance, or SSDI, which is based on your working history and funded through payroll taxes
  • Supplemental Security Income, or SSI, a need-based program which is awarded to low-income individuals, or individuals who haven’t earned enough work credits to qualify for SSDI. SSI benefits are not taxed.

They are both separate and distinct programs administered by the Social Security Administration.

As an individual, if your annual income is less than $25,000, you would not pay any income tax. If your annual income is from $25,000 to $34,000, your SSDI benefits would be taxed at 50%. If your monthly income exceeds $2,834, and your annual income exceeds $25,000, your SSDI would be taxed at 85%.

Married couples have a similar taxation schema, with up to 32,000 untaxed, up to $44,000 at 50%, and over $44,000 at 85%.

  • “Back pay” of benefits—if you receive a lump sum of money for the previous months of benefits since your application date, you may be taxed at a higher rate because of it. However, with the help of a CPA or other tax professional, you can amend your previous tax returns to include the back pay money so that you are not taxed as heavily on your current year’s tax return.

Some states tax SSDI benefits, but Texas does not.

VA Disability Benefits

While military retirement pay may considered taxable income (if it’s based on age or length of service), military and/or VA disability benefit payment resulting from service-connected illness or injury is not.

Other veterans benefits paid to you or your family are also not taxable (from Military.com):

  • Education, training, and subsistence allowances
  • Disability compensation and pension payments for disabilities paid either to veterans or their families
  • Grants for homes designed for wheelchair living
  • Grants for motor vehicles for veterans who lose their sight or use of their limbs
  • Veterans’ insurance proceeds and dividends paid either to veterans or their beneficiaries, including the proceeds of a veteran’s endowment policy paid before death
  • Interest on insurance dividends left on deposit with the VA
  • Benefits under a dependent-care assistance program
  • The death gratuitypaid to a survivor of a member of the Armed Forces who died after Sep. 10, 2001
  • Payments made under the compensated work therapy program
  • Any bonus payment by a state or political subdivision because of service in a combat zone

The IRS publishes a guide specifically for military members to help with tax preparation, as well as one on taxable and nontaxable income. Additionally, the IRS can assist you with tax preparation if you need it.

Other Nontaxable Benefits

These types of benefits are also non-taxable:

  • Payments for blindness and other benefit payments from a public welfare fund
  • Workers’ compensation for occupational injury or illness if it’s paid under a workers’ compensation act or similar law
  • Compensatory damages for physical injury or physical sickness (punitive damages are taxable, however)
  • Disability benefits under a “no-fault” auto insurance policy for income loss or earning capacity as a result of injuries
  • Compensation for permanent disfigurement or the permanent loss or loss of use of a part or function of your body

If you have any questions about what is taxable or nontaxable, consult with your tax professional, or with a disability attorney.

Have Questions On Disability? Herren Law Can Help

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.

Filed Under: Long Term Disability Tagged With: , ,

Disability Claims for Mental Disorders in Houston, TX

August 15, 2019 by

Applying for disability benefits for a physical condition is a time-consuming task long before you begin receiving monthly payments. But filing disability claims for mental disorders can be considerably more difficult in Texas, where more than 70% of initial claims are denied.

Girl in bed showing why disability claims for mental disorders in Houston, TX are so important. with her mother holding her hand

Although the Social Security Administration does recognize mental illness as something that can cause long-term disability, you must be diagnosed by a physician, and meet the same criteria as any other injury or illness. The SSA awards benefits for a physical and/or mental disorder that prevents you from working, but only after a long process of medical treatments, documentation, applications, and a lot of waiting.

Mental Disorders

There are a wide range of mental disorders for which you may be able to receive disability, including:

  • Autism spectrum disorders
  • Affective disorders, such as depression and bipolar disorder, and aren’t considered brain injuries
  • Anxiety related disorders, if you can show that they prevent you from working
  • Psychotic disorders
  • Substance abuse disorders
  • Mental retardation
  • Somatoform disorders, for which there is no obvious or discernable cause
  • Organic disorders that affect the nervous system, such as dementia, Alzheimer’s, delirium

The SSA’s guidelines for mental disorder are contained in its book of policies known as the “Blue Book.”

Qualifying For A Mental Disorder Disability

Proving disability claims for mental disorders requires providing more than adequate documentation in your claim application. In it, you must provide:

  • All sources of treatments, including names and contact information of doctors, hospitals, and other providers where you have sought and received treatments.
  • The types of treatments you’ve received, as far back as you have evidence for. While the SSA considers “current treatment” to be within the last 90 days, “back pay” will require information dating as far back as you can provide to show how long you have been dealing with your condition. Without current treatments, there is no way for the SSA to understand that you are currently unable to perform substantial gainful activity (work.)
  • Detailed work history, including companies, dates, job title and job duties, just as you would if you were filling out a job application.

You must have one severe impairment with considerable medical evidence (documentation) to support your claim for an approval. This impairment must affect you so severely that you are unable to return to any job you performed in the prior 15 years, and makes it impossible for you to do any other kind of “suitable work” at a level that brings in “substantial gainful activity” (SGA.)

Currently, that monthly dollar amount is $1,220, adjusted for inflation and before taxes. In other words, Social Security considers a “disability” to be the inability to work and earn at least that much for at least one year. If you’re earning more, your claim will likely be denied regardless of your condition.

Why You Need A Disability Attorney

Getting disability claims for mental disorders approved can be more difficult than a physical one. So it’s even more critical to not only have all your documentation for your claim, but to ensure that everything is done exactly right.

You may only be doing this once in your life, and will spend a considerable amount of time on it. A Houston disability attorney can not only help your chances of winning, he or she can also save you a considerable amount of time.

A disability attorney helps people every day get the benefits they need, and understands the laws, policies and procedures that govern the application and awards process. Instead of going into the claims process blindly, a Houston disability attorney will be your advocate through the claim process, and if necessary, appeals process. Claimants who are represented by an attorney have a much better chance of approval, either in the application process or in the appeals process.

Houston’s Disability Attorney

If you’ve been denied disability payments for mental illness, call us immediately. We’re ready to help.

We’ve helped over 4,000 Houstonians get their disability benefits. The Herren Law Firm in Houston, TX can assist with your application, appeals and records gathering to prove your case, and win your claim. Contact us today at 713-682-8194 (or user our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, and we only collect a fee if we win your case.

 

Filed Under: Long Term Disability Tagged With: , ,

What Is ERISA And What’s The Connection To Houston Disability Benefits

July 15, 2019 by

If your employer covers your benefits package, it’s likely governed by ERISA. Most employer-sponsored plans are ERISA-regulated, except for privately-purchased policies or those provided by governmental agencies, churches or church-owned hospitals.

What Is ERISA And What's The Connection To Disability Benefits In Houston, TX

Despite the title and description, getting disability benefits isn’t always as simple as filling out forms and waiting for a check. Although ERISA was created to protect employees’ benefits and rights, its complex requirements can sink your claim right after you file it. If you file a claim and don’t follow the ERISA guidelines exactly, you claim may be denied without the right to appeal. Missing a deadline for appeal can prohibit you from filing a future claim.

ERISA Basics

Employer-sponsored benefits plans are regulated by ERISA, or Employee Retirement Income Security Act, established in 1974.This federal law under the US Department of Labor that “sets the minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in the plans.”  If you apply for disability and are denied, ERISA gives you the right to sue the insurer in federal court.

ERISA requires that employers provide their employees with basic information that includes:

  • Details of what’s covered and not covered under the plan
  • Instructions on filing a claim if an employee becomes disabled
  • Details of the company’s appeal process if the company denies an employee’s claim

ERISA sets a limit on the insurer’s timeframe to accept or deny a claim once it’s filed. The insurer has 45 days to render a decision, but can add an additional 30 days, and must notify the employee in writing.

If the insurer denies the claim, it must provide the reasons in writing within 45 days. ERISA controls not only the employee’s time frame for appeal, it also controls the deadlines for insurers to approve or deny the appeal.

Providing Documentation

It’s important to have a wealth of documentation in your claim file at the outset. This includes medical records, test results, doctor’s notes, and other instruments that will prove your claim for disability. Your attorney can advise you on the ERISA requirements, what information you need, and what you’ll need to request.

Note that if your claim is denied on appeal and you decide to move forward with a lawsuit, you will not be able to add additional evidence or information as you would with a civil or criminal trial or appeal. Everything that is already in your file is all that the judge will see. That’s why it’s important to have as much documentation to support your claim as you can obtain as soon as you can.

Discretionary Clauses In Texas Are Denied

You may have heard the term “discretionary clause” when discussing your policy with your employer or with the insurer. This is language written into the policy and allows the insurer plenty of “wiggle room” to limit or deny their claims. The clauses also prevent a court decision from reversing the insurer’s claim decisions.

In 2012, the state of Texas passed a law prohibiting any insurance company from using “discretionary clauses.” That is, any policy written or renewed after January 1, 2012 in Texas cannot contain a discretionary clause.

Deadlines Count

Insurers have specific deadlines for filing claims for disability benefits as well as appeals. Don’t miss a deadline, and make sure your claim adheres to ERISA’s very complicated rules. Let an experienced Houston disability benefits attorney take care of your claim and make sure everything is taken care of.

The Herren Law Firm can help you with your ERISA application, appeals and help you get the long-term disability benefits you need. Contact us in Houston today at 713-682-8194 to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

 

Filed Under: Long Term Disability Tagged With: , ,

Selecting A Houston Long Term Disability Attorney After Receiving A Claim Denial

June 27, 2019 by

Dealing with the rules of the long-term disability process can be confusing, at best, and downright frustrating, at worst. At a time when you likely need to rest and take care of yourself, you may find yourself facing a denial of coverage and knee-deep in paperwork, some of which you may not understand completely.

Disappointed man in wheelchair with arm on wheel after a claim denial.

But a denial isn’t the end of everything. Your letter should detail the reason your claim was denied, and how to go about filing an appeal. Pay close attention to the part about appeals—you have a very limited time in which to file that appeal. Once that deadline is passed, you’ll lose your right to appeal, and you may not be able to file again.

This is when you need help. An appeal is the time to select a long term disability attorney.

The Appeals Process

From the day you receive your denial letter, you will have a specific period of time to file an appeal. This period is usually 180 days, but it may not be—read your letter carefully. Once that deadline passes, your claim will be over.

During the appeal period, you will have the opportunity to gather additional evidence to support your claim. This can include medical records, test results, letters from a treating physician, functional capacity evaluation and vocational expert reports, and other relevant information. Your attorney can help you through the appeals process, and advise you on what information to obtain in order to go forward.

What’s In Your Insurance File?

The only way to find out is to request copies of your insurance file and find out for yourself. The insurer won’t hand it over unless you ask them to.

Once you see what’s there, you’ll be able to offer additional evidence and documentation to not only support your claim, but correct any factual mistakes that may negatively impact your claim. Your attorney can advise you on what kind of information you’ll need to add to the file in order to support your claim.

Getting An Attorney Who Knows And Understands Disability Law

When you’re dealing with a disability and with an insurance company, you’re already under a large amount of stress. Many companies are known to deny benefits to people who need them without explanation. Without help, you run a higher risk of making a mistake that could see your appeal denied as well. Don’t take that chance.

You need an attorney, but not just any one will do. Just like finding a physician who can help you with a specific medical issue, you’ll need to find an attorney who understands how the disability application and appeals process works.

Remember: the insurance company already has a team of lawyers to defend itself against paying claims, and especially against any lawsuits. Hiring your own will level the playing field and increase your chances of winning on appeal. Besides—claims appeals are probably not your forte. But an attorney who works with disability law understands all the ins and outs of applications and appeals, and does it every day. Shouldn’t you have that kind of help on your side?

Long Term Disability Appeal? Call Herren Law For Help!

If you’ve been denied long term disability benefits, don’t try to handle your appeal on your own—get help today. 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.

Filed Under: Long Term Disability Tagged With: , ,
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