In Houston TX, Can I Get Veterans Disability Benefits For Sleep Apnea?

May 20, 2019 by

Good sleep equals good health. An individual needs as many hours as they need to get a good night’s rest. But for many, a good night’s sleep isn’t something that happens like it should.

Sleep problems affect as much as 70% of the population at one time or another. Among veterans, the rate is about 20%, with the rate increasing to 87% of veterans between the ages of 55 and 89. These numbers are irrespective of socio-economic class or other demographic.

In Houston TX, can I get Veteran Disability Benefits for Sleep Apnea?"

The American Academy of Sleep Medicine reports that sleep disorders have seen a dramatic rise in the veteran population. The article from the journal Sleep reports that sleep apnea was the most commonly diagnosed condition at 47% of the 9.7 million veterans studied. (Insomnia was second, at 26%.) Veterans with pre-existing PTSD are associated with a higher risk of sleep apnea and other disorders. The Department of Veterans Affairs reports that claims for sleep apnea have increased fourfold in the last several years, with more veterans requesting tests and applying for benefits.

What Is Sleep Apnea?

Sleep apnea is a condition in which your breathing is repeatedly obstructed while you’re asleep, forcing you to start breathing again. (The Mayo Clinic has more information.) Because you don’t always wake up, you might not be aware. But snoring and drowsy fatigue upon rising are signs that you might be experiencing sleep apnea.

Sleep apnea has three different causes, but all lead to the same outcome. Lack of sleep can lead to other conditions, such as heart disease, high blood pressure, weight gain, headaches, memory problems, stroke, diabetes, and depression. Drowsiness can lead to things like car crashes and other accidents if left untreated.

Although anyone of any age can find themselves with sleep apnea, it’s most common in men over 40, particularly if they are overweight. Diagnosis requires a sleep study to confirm apnea.

After a diagnosis, the usual treatment involves a CPAP (continuous positive airway pressure) machine. This device forces air into nasal passages that’s strong enough to bypass any obstruction and promote more normal breathing. Because it’s a treatment and not a cure, a CPAP must be worn nightly, or the patient experiences a return of apnea symptoms.

Getting Benefits For Sleep Apnea

Because sleep apnea may develop after your discharge, there may be no reason to have a sleep study done. Veterans in line-of-fire combat situations are not likely to request a sleep study while deployed, and sleep problems are usually tied to the occupation.

Like any condition, the VA is looking for one thing: a service connection.

The first step is to actually get a diagnosis, although that doesn’t guarantee a rating and benefits. Either your sleep apnea was caused by or aggravated by your time in the service.

The next step is to gather the medical evidence you need to establish a connection between your time in the service and your sleep apnea diagnosis.

If you have other conditions that are already service-connected, such as PTSD, your sleep apnea could be what’s called a “secondary service connected” issue. Sleep apnea could also be the cause of another condition.

The South Texas Veterans Health Care System in San Antonio  at the Audie L. Murphy VA Medical Center has a full diagnostic testing lab for veterans. The website also includes printable PDFs with information on better sleep.

But if you are experiencing severe sleeping problems, it’s important to get started on a sleep study and getting treatment (including a CPAP, if possible), even if it’s not service connected, so that you can start sleeping better. There are organizations that can help you get a CPAP if you’re unable to afford one on your own. Your doctor can work with you to determine if it is, in fact, service connected, and write a prescription for the CPAP.

If your claim for sleep apnea has been denied, it’s time to enlist the help of an attorney who understands the VA disability claim system.

Helping Houston’s Veterans With Sleep Apnea Claims

William Herren has worked with veterans in the Houston area for more than 30 years to help them get their VA disability benefits.  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 with our contingency fee arrangement, we don’t charge a fee until we win your case.

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

Overview of Long Term Disability Policy Age Limits

May 6, 2019 by

The average length of a disability that keeps people from working is about three years, and depends on the type of disability they have and their age. As recoveries go, a person in their mid-twenties usually recovers from a disabling illness or injury faster than a person in their mid-fifties or sixties. But depending on the type of policy you have, long-term disability (LTD) may last six months, a year, or longer. Will it last long enough?

houston disability lawyer

What Type Of Policy Do You Have?

There are two types of policy coverages.

  • Your policy may cover you for “any occupation,” meaning that you’re covered as long as you can’t work any job doing anything, whether or not it’s related to your current job and/or vocation, for the same or less money.
  • Your policy covers you for “own occupation,” meaning that you’re covered as long as you can’t perform your current occupation. Whether you can perform another occupation for which you’re qualified isn’t a determining factor.

Some policies combine the two, with “own occupation” for the first two years, and “any occupation” after that. Other policies offer a cost of living increase as an optional benefit that may cost more.

How Long Do LTD Benefits Last?

Most group LTD policies last until age 65, or until your actual retirement age. The presumption is that once you’re retired, you no longer need the income from your employment.

Most people assume they will retire at 65, but SSA has changed retirement ages for different individuals. Currently, individuals born in 1955 or later can retire at age 66 and 2 months. If you were born after 1960, your retirement age is 67.

Look for LTD benefits to end, with some exceptions, at your time and age of retirement.

Benefits Beyond 65

Purchasing a long-term disability policy with a benefit period longer than five years is more expensive, but comes with an additional benefit. You can choose a “lifetime” benefit period that will pay you as long as your disabled, even after retirement age, as long as you were disabled before the age of 60. This will be especially helpful if your disability is expected to last for many years, or is considered permanent.

These kinds of policies tend to be much more expensive, and could be harder to find. If you’re unable to get one, at least purchase a policy that will pay you until your legal retirement age. With an employer’s policy, your status will automatically change to “retired” once you reach that retirement age bracket.

Most LTD policies pay 60% to 70% of your regular salary and none will pay 100%. Different policies have different exclusions and restrictions.

Some policies have “level premiums,” which stay the same for the life of the policy. This is useful

Additional information, and a checklist for buying a policy, is available at the Consumer Federation of America’s website.

Houston Disability Lawyer Can Help With Your LTD Claims

Our Houston disability lawyer William Herren is experienced in handling all types of disability applications and claims including LTD claims, and our law office has helped more than 4,000 Houstonians, too. Call The Herren Law Firm today at 713-682-8194 (or use our online contact form) to schedule your free consultation with one of our disability attorneys. There’s no obligation. There are no up-front charges, because we’ll take your case on a contingency fee basis. You only owe us a fee when we win your case.

 

Filed Under: Long Term Disability Tagged With: , ,

Long Term Disability Exclusions To Watch For In Houston, TX Insurance Policies

April 25, 2019 by

Applying for long term disability to protect you when you’re not working is a long, difficult process. After the doctor visits, test results and treatment plans, you’ll wait for a decision, sometimes for a while. You may also receive a denial letter, based on your condition.

Long Term Disability Exclusions Houston Texas

“Exclusions,” as they are called, are one of the many intricacies of long term disability policies—the things the policy and/or carrier doesn’t cover. The first step is to review your policy and find the Long Term Disability exclusions so you’ll have a better understanding. Here we’ll discuss the different types of exclusions.

What A Policy Won’t Cover

The most common LTD exclusions include:

  • Car accidents when you are driving under the influence
  • Self-inflicted injuries, whether sane or insane
  • Normal pregnancy
  • Suicide attempts

Some policies may also exclude:

  • Injuries caused by aircraft (exception: passengers on regularly scheduled flights)
  • Injuries on the job (these are covered by worker’s compensation)
  • Criminal actions you commit (or attempt to)
  • Civil disobedience actions, including riots, rebellions and insurrection
  • Other intentional acts that cause disability.

Some insurance policies also have a 2-year limitation on disabilities partly caused by substance abuse.

Pre-Existing Conditions

These are conditions that are currently diagnosed and you are currently being treated for when acquiring your policy. A pre-existing condition will require you to wait a designated period of time before you can be covered for it.

If you have a pre-existing condition, there are two periods: a “lookback period,” which can be anywhere from 90 days to as long as a year, and a “waiting period” before you can be covered.

Your insurance company will look back through your medical records for that period to see if you’ve been tested, treated, or otherwise knew that you had the condition.

Once that’s established, you’ll have a period where you must be covered before that condition can be covered. With some conditions, it could be as long as one to two years.

Getting LTD With A Pre-Existing Condition

You can, of course, get long-term disability with the pre-existing condition—you just won’t be covered for it. Anything in your medical  records is findable and fair game. Even if you don’t tell them, there’s a good chance they will find out eventually, and will use that as a Long Term Disability exclusion to deny you payments.

Different companies handle them in their own way, and some simply won’t cover you. Coverage will also depend on the severity of the condition, and you will likely pay higher premiums. But insurers also distinguish between recoverable conditions and non-recoverable conditions like cancer.

Mental/Nervous Disorders

One sticking point for a number of policyholders is the limit or exclusion of mental and nervous disorders, such as anxiety, depression, stress, and dementia. While some policies don’t exclude them, many do. Other policies have limits on these disorders, typically for 24 months or less.

However, if your disorder that is the result of a different physical condition or injury, (such as a back injury) there may be no limit or exclusion.

Alcohol/Substance Abuse

While this is classified in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), coverage may only extend for 24 months. Many policies don’t cover alcohol or substance abuse at all, so review your policy for this potential Long Term Disability exclusion.

Houston’s LTD Claims Attorney

Over 4,000 Houstonians have come to us for help with Long Term Disability exclusions, applications, claims, and appeals. With this experience The Herren Law Firm can help you with your LTD legal issues as well. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation with our Houston Long Term Disability attorney. There’s no obligation, no up-front fees, and we only collect if we win your case.

 

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

Can I Claim Disability Benefits For Hearing Loss In Houston, TX?

March 18, 2019 by

Most people think that losing your hearing part of “getting older.” But it can happen to anyone at any age for different reasons. Age-related hearing loss comes from the gradual loss of hair cells in the inner-ear.

While some individuals are born deaf, hearing loss happens with certain medical conditions, such as Meniere’s disease, an inner-ear disorder. Musician Huey Lewis suddenly found himself unable to hear onstage in 2018, and was diagnosed with possible Meniere’s disease. As a result of his inability to hear during concerts, Huey Lewis and The News canceled their tour schedule.

Can I Claim Disability Benefits For Hearing Loss In Houston, TX?

 

Causes Of Hearing Loss

Meniere’s Disease is just one of a number of possible causes for hearing loss. Other causes include:

  • On-the-job exposure to loud noises, or other exposures to sudden loud noises (power tools, etc.)
  • Tinnitus, ringing in the ears after loud noises (especially loud concerts)
  • Loud music with earphones or earbuds
  • Injuries, such as severe head trauma
  • Childhood illnesses such as measles, mumps, meningitis and chickenpox
  • Abrupt pressure changes from activities like flying or diving
  • Certain medications, such as antibiotics and cancer drugs
  • Chronic disease, such as heart disease, hypertension, stroke, diabetes, and some autoimmune diseases
  • Growths and/or tumor in the ear system
  • Ear wax buildup

If hearing loss prevents you from full-time work, or you are disabled and can no longer work, it may be time to apply for disability.

Qualifying For Disability With Hearing Loss

Like any other type of disability, you will have to meet the qualifications for disability with hearing loss. In this case, you’ll have to verify your hearing loss to medically qualify for benefits.

Although it’s covered by the Americans with Disabilities Act (ADA), you’ll still have to prove that your condition is serious enough that reasonable accommodations by your employer are not enough to enable you to continue working in any job that you might be qualified for. You’ll need to document the essential functions of your job, previous jobs, and how hearing loss prevents you from performing your job even with reasonable accommodations available.

SSA will also require you to have hearing testing using the “Blue Book” disability listing, conducted by an otolaryngologist or an audiologist certified by The American Board of Audiology or The American Speech-Language-Hearing Association. The testing must be done without any hearing appliances, such as hearing aids.

Inform your doctor that you will be applying for disability benefits for hearing loss, and request that he or she review the Blue Book requirements beforehand so your tests are conducted according to SSA’s rules.

First the doctor must conduct a physical exam of your ears, including the internal and external ear, middle ear and the tympanic membranes.

Secondary testing includes:

  • Pure tone and bone conduction audiometry—an average hearing threshold of 60 to 90 decibels or greater in the better ear, dependent upon the testing method, or
  • Word recognition test—a score of 40% or lower in the better ear

If you have hearing loss with a cochlear implant, you will automatically qualify medically for disability benefits for hearing loss at least one year after surgery. If your word recognition score is still 60% or below on a “hearing in noise” test more than one year after the surgery, your benefits will be extended until your hearing improves, if it does.

Translations: Communicating With SSA

If you need an interpreter to properly communicate with SSA, ask for one. SSA will provide a free sign language interpreter for anyone who needs help communicating with them. An interpreter will ensure that the applicant will have an accurate and complete translation of all related communications between them and SSA. Sign language interpreters are bound by confidentiality rules, and cannot repeat what they translated. This offers the same privacy as a person who can hear. A hearing-impaired person won’t have to rely on family members, or be embarrassed trying to communicate with a case worker because they can’t hear or understand the questions.

Let Herren Law Help With Disability Benefits for Hearing Loss

You may be able to collect disability after severe hearing loss, but you won’t know unless you apply. 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 Tagged With: , ,

Hiring a Houston Attorney for Aetna Disability Claims

February 28, 2019 by

Hiring an attorney is more than getting legal counsel—it’s about finding an advocate for yourself in a difficult situation. Whether it’s an accident, a divorce, or a disability claim, an attorney works with you to get through the process, protect your interests and your rights.

Aetna Disability Claims attorney Houston

You may have purchased an Aetna policy through your employer; many policyholders do. But most people don’t have the resources to fight a large, multinational company with a team of attorneys on its side without some help of their own. The company may deny your Aetna disability claims outright, hoping you’ll give up and go away. If you’re having trouble with a short-term or long-term disability claim through Aetna, an attorney will make sure that your application and claim are done correctly.

Bad Faith Practices

Despite the advertisements, insurance companies are in business to make money. Paying claims is not conducive to being profitable, so claims adjusters are eager to deny claims. This is known as “bad faith insurance practices.” They can include:

  • Denying valid claims and refusing to explain why
  • Underpaying or delaying a claim
  • Misrepresenting facts or provisions of a policy
  • Refusing settlement for a valid claim

The “Paper Review”

If you’ve received a determination that you are able to go back to work, and your benefits have been terminated, it may be due to a “medical review” by one of Aetna’s doctors. The review is simply an “examination” based on paperwork, and no physical examination by a company doctor. The company uses a “paper review” of a client’s files, and makes a decision about their Aetna disability claim from there.

Because Aetna’s physicians conduct this “paper review,” there is a conflict of interest. This is especially obvious in Mendez v. FedEx Express and Aetna, a case where Aetna blatantly denied a client benefits even after he received SSDI benefits and Aetna began offsetting his Long Term Disability benefits as the policy dictates. At no time did any of the physicians actually meet with the plaintiff in person, and disregarded complaints of severe pain and disablement noted by his own treating physicians. Two physicians decided based on his file that he could work 25 hours a week or more, without consulting with the plaintiff’s own treating physicians. The court found in favor of Mr. Mendez.

This is just one of many cases where Aetna (and companies like them) work to deny your benefits.

How An Aetna Disability Claims Attorney Can Help

If you’ve been scrambling through Aetna’s hoops trying to make sure you meet their deadlines and answer all their questions, only to be denied, you’re already at a disadvantage. You have 180 days to appeal the denial, so the time to contact an attorney is now. If you miss the 180-day deadline, you’ll lose your rights under the claim and may have to re-file. Contact an attorney who works with Aetna disability claims immediately.

How much might this cost? An Aetna disability claims attorney generally receives about 25% of any back pay you receive, up to $6,000. You won’t owe any money until we win your case.

If you didn’t have legal help with your original disability application, don’t leave things to chance. The process can take many months, and in some cases, years. Get started now.

Herren Law Fights Aetna For Your Benefits

Let us help you with your Aetna disability claims appeal and help you get the benefits you deserve. Request a copy of your claim file from Aetna, and bring it with your denial letter to Herren Law to begin your appeal right away.

We’ve worked with Aetna customers before, and are ready to help you with your claim. 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 Tagged With: , , ,

Is Long Term Disability Income Taxable in Houston TX?

January 22, 2019 by

One of the things you’ll deal with as you begin receiving long term disability income is the difference when you file your tax return. Is it considered taxable income, or not? You may have heard conflicting or confusing advice on the subject. The basic answer is, it depends. We’ll explain the difference.

Is Long Term Disability Income Taxable in Houston TX?

How Did You Pay Your Premiums?

You may have paid your premiums out of your paycheck, separately from your employer, or your employer may have paid it. Or you may have paid part of the premiums, while your employer paid the rest of it. How the premiums were paid makes a big difference.

If you have an individual policy and used after-tax dollars to pay for your LTD premiums, you’ve already paid taxes on the money, so your long term disability income payments are tax-free. However, you can’t deduct the payments as a medical expense like you would with health insurance.

Using pre-tax dollars to pay your individual LTD premiums reduces your taxable income until you begin receiving payments. Once you do, your LTD payment becomes a “taxable income,” because you saved taxes earlier. Therefore, you’ll have to pay taxes on the payments.

If you purchase a group policy through an association, the policies are similar to individual policies, but you can’t deduct the premiums. The tax ramifications are generally the same as the individual policies, and the benefits are tax-free.

Employer-Sponsored/Paid Premiums

The rules are a little different when you are under an employer-paid policy.

When your employer pays all of your premiums but doesn’t include it in your gross income, your long term disability income payments will be taxable.

If you pay part of your premiums, the tax liability will be shared. The same rules apply for pre-tax and after-tax dollars for the portion that you pay for yourself.

If your employer offers a so-called “cafeteria plan,” where you can choose disability as well as other insurance benefits, they’re normally paid on a pre-tax basis. In some cases, the employer for some benefits up to a certain limit. After that, you pay for additional benefits you choose over and above the set limit. These additional benefits can be paid pre-tax or after-tax.

Should you chose to pay with after-tax dollars, that part of your income will be considered tax-free, but you will be taxed on the employer-paid portion. If you pay with pre-tax dollars, you’ll be taxed on both your portion and the employer-paid portion.

Should You Use Pre-Tax Or After-Tax Dollars?

There are benefits to both methods. One way or the other, you still pay taxes on LTD income.

If you never need to file an LTD claim for benefits, you’ll save money on taxes by paying with pre-tax dollars. But if there’s a chance you’ll be filing a claim for disability, you may be better off using after-tax dollars. You’ve already paid taxes on the money you used, so your benefits will be tax-free.

How you pay for your LTD policy is a personal decision. The IRS offers some information on its website. Discussing your options with a tax professional can help you decide which method is right for you.

Your Houston Long Term Disability Attorney

We’ve helped over 4,000 Houstonians have received their LTD benefits. Need 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: , ,

As A Veteran That Was Exposed To Agent Orange Can I Qualify For Long Term Disability In Houston, TX?

January 10, 2019 by

If you’re one of the many veterans who was exposed to Agent Orange during military service, you may have also experienced chronic health problems. Skin rashes, chronic pain, Type 2 Diabetes, respiratory issues, and peripheral neuropathy are just some of the identified disorders that are known side effects of Agent Orange and other powerful herbicides deployed during the Vietnam War.

As A Veteran That Was Exposed To Agent Orange Can I Qualify For Long Term Disability In Houston, TX?

The VA presumes that an individual who Veterans who served anywhere in Vietnam from 01/09/1962 to 05/07/1975 are presumed to be exposed to these harsh chemicals.

Were You Exposed?

The VA lists on its website where exposure could have occurred during your service tenure. You’re presumed to have exposure if you served:

  • On C-123 Airplanes, between 1/9/1962 and 05/07/1975
  • On Thailand Military Bases, between 01/09/1962 and 05/07/1975
  • In Vietnam or Korea, between 01/09/1962 and 05/07/1975
  • Outside of Vietnam or Korea, between 01/09/1962 and 05/07/1975
  • In Testing and Storage Areas Outside of Vietnam, between 1944 and a yet-to-be-determined date
  • On U.S. Navy and Coast Guard Ships in Vietnam, between 01/09/1962 and 05/07/1975
  • In waters in or near Vietnam, between 01/09/1962 and 05/07/1975

Long Term Disability

You may have already applied to the VA for benefits due to AO exposure. But if you’re now working in a civilian occupation and are having issues with a service-related medical condition, long-term disability may be a possibility.

If you are facing disability, the first thing to do is request and review your LTD policy. Your coverage specifically depends on what your policy says. Some policies may specifically exclude military service-connected conditions, or call them “injuries or illnesses sustained due to an act of war.” It’s important to know before applying if your policy will cover you or not. Illnesses after AO exposure may also be considered “pre-existing conditions,” excluding them from LTD.

But if your service-related exposure did not manifest, such as cancer, until long after your service career ended, you may need a re-evaluation by a medical professional. Many conditions may occur during the service, but don’t exhibit symptoms until much later, interfering with your ability to work now.

You should also find out if your LTD policy contains an “offset” clause. That is, if you are receiving VA benefits for a disability related to AO exposure, your insurance company may reduce your LTD payments by the amount you receive from the VA or other sources (such as SSDI.)

You should also anticipate that your insurance company will work hard to deny your claim any way it can. This is where an experienced disability attorney can help defend you against an insurance company’s “bad faith” actions.

Resources For AO Veterans

The website for the Vietnam Veterans Of America offers information and resources for veterans, including an entire section on Agent Orange. Included are brochures on veterans health, including a self-help guide to Agent Orange exposure.

The VA also offers additional information about Agent Orange exposure on its website.

We Help Houston Veterans

Long-term disability can be a difficult process. 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.

Filed Under: Long Term Disability Tagged With: , ,

How Often Do I Have To Prove That I’m Disabled To Receive Benefits In Houston, TX?

December 11, 2018 by

Getting a determination of disability isn’t the end of your journey. Once you’re declared disabled, you’ll be subject to periodic reviews, depending on your condition. But reviews are part of the process and part of continuing to receive disability payments.

How Often Do I Have To Prove That I'm Disabled To Receive Benefits In Houston, TX?

What Type Of Disability Do You Have?

When you’re approved for disability, your caseworker will set dates for future disability reviews. Generally, these reviews are every three to seven years. However, it also depends on the severity of your disability.

There are three categories of disability conditions:

·         Medical Improvement Expected—if your disability is one that you’ll recover from, you can expect to have a review within six to eighteen months of your original determination

·         Medical Improvement Possible—for conditions from which you are reasonably expected to improve (such as mental illness), reviews are generally conducted every three years

·         Medical Improvement Not Expected—if you’re rated for a condition for which a recovery is not expected, reviews are conducted about every seven years. These conditions can include:

  • Autism
  • Blindness
  • Multiple Sclerosis
  • Deafness
  • Parkinson’s Disease
  • Some Cancers
  • Cerebral palsy

Children who receive SSI will have a review every 3 years. Children approved for low birth weight will be reviewed around their first birthday, and all children will be reviewed at the age of 18 regardless of what type of disability they have.

Navigating the CDR

Social Security is required by law to perform periodic reviews of individuals who receive disability benefits. This includes gathering medical records for review. The CDR, or Continuing Disability Review, is the process for determining your continuing disability.

When the time comes, Social Security will send you one of two forms to fill out and return:

·         If the likelihood of your recovery is low, you will be sent Disability Update Report (SSA-455-OCR-SM, or “the short form”

·         If your recovery probability is higher, you’ll be sent Continuing Disability Review Report (SSA-454-BK, or “the long form.”

From there, they will examine your medical records, any treatments, improvements in your medical condition and any other determining factors, such as vocational training that allows you to begin doing “substantial gainful work.”

Without any improvements, and the inability to return to “substantial gainful work,” your disability payments will likely continue. However, if they are changed, you do have the right to appeal any decisions.

What Can Affect Disability Benefits

Any major change in your medical condition, income, resources, living arrangements and other circumstances (such as marriage or divorce) can change your eligibility. Disability is need-based with limits on assets and income, so periodic “re-determinations” are regularly conducted. If you’re found to exceed the “allowable limits,” your benefits will be suspended or terminated.

Scheduled For A Review? We Can Help

Regular reviews for disability cases are common, they occur every three to five years, and don’t always mean your benefits will end. 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 Tagged With: , ,

If I’m Partially Disabled In Houston, TX, Do I Have To Accept Any Job I’m Able To Do To Collect Benefits?

November 1, 2018 by

You may have a sense of relief when you finally get your long-term disability benefits. But now that the initial trial is over, there is still the matter of complying with the policy’s rules. One of those rules may be working to keep your benefits.

Disability insurance is intended to protect you from financial risk if you become disabled or sick to the point where you are unable to work. The policy itself contains the definition of “disability”, and whether you qualify depends on what your policy terms as “disabled.” You will have to be “disabled enough” according to the policy’s definition in order to receive benefits. But everything comes down to the type of LTD policy you have.

If I'm Partially Disabled In Houston, TX, Do I Have To Accept Any Job I’m Able To Do To Collect Benefits?

Own Occupation Vs. Any Occupation

There are two basic types of LTD policies:

  • Own Occupation, in which you receive benefits when you are no longer able to work in your current vocation (more expensive)
  • Any Occupation, where you are able to work in a different occupation, but can no longer work in your current vocation (less expensive)

For instance, if you are a firefighter, and are injured on the job, you can no longer work in that occupation. Under an “own occupation” policy, you would receive benefits because you were totally disabled and could no longer perform “material and substantial duties” for that job. It would not matter that you could have a second career that was related to your work as a firefighter.

However, under the “any occupation” policy, the same firefighter who was injured on the job may be able to perform “material and substantial duties” for another occupation, i.e., a “desk job,” and will not be considered “disabled.” Only if the firefighter was unable to work in any occupation would the individual be considered “disabled” enough for the policy. “Any occupation” work may also mean workplace accommodations, which can also be used to deny benefits.

Most courts hold to the standard that if an individual is capable of any kind of work, even part-time, the individual is not truly disabled, and can be gainfully employed in any occupation, not just their own. This means that you would not meet the standard of disability.

Unfortunately, there are no standards for income disparity. This means that if you were working in a profession that paid $100,000 per year before your disability, you might still be able to work at a job that paid $15,000 or less, and therefore not be considered disabled. Under an “any occupation” policy, you would be required to work any job you could get, regardless of the salary.

Many LTD group policies provide benefits under the “own occupation” clause for the first two years of disability. After that, the benefits are under an “any occupation” clause.

Contact Houston’s Premier Disability Law Firm

Not many attorneys understand disability filings and appeals, but we specialize in it. With over 4,000 successful cases, we focus on helping disabled people receive the benefits they need. We’ve handled multiple situations that are similar to yours, and have the experience to help you through the process for a successful outcome.  The Herren Law Firm can help you with your application, appeals and legal action to help you get the disability benefits you need. Contact us 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: , ,

What Are My Options If My Disability Insurance Policy Denies My Claim In Houston, TX?

October 18, 2018 by

After paying your premiums for many years, now you need to use your disability insurance. You’ve done what you needed to do. Saw your doctor, got testing and treatments, filled out all the forms, and did everything they asked. But your claim was still denied. Now what?

What Are My Options If My Disability Insurance Policy Denies My Claim In Houston, TX?

Denial Is Not Final

The denial letter you receive is not the end of your claim, only an obstacle. You have options and can appeal the denial. Review your policy’s documents to understand what your next steps are.

A claim denial can happen for a number of reasons:

  • Inadequate or incomplete medical records
  • Written opinions from your treating physicians (this can be added during an appeal)
  • Incomplete medical testing and/or treatments

Your application should contain as much favorable information as possible for a positive decision. Adding as much as you can in the claim application ensures that if during an appeal, no additional evidence can be added, you have more than enough evidence to begin with.

If your insurer has wrongfully denied you benefits based on an individual disability policy, you (or your family) may be able to recover lost benefits, wages, pain and suffering and other, similar damages.

Bad Faith

Insurance companies are in the business of making money, not paying it out. Disability insurers use a number of notorious tactics they use to prevent the payment of a claim, including:

  • Policy termination without notice
  • Long delays in their review process
  • Mis-classifying injuries in order to deny a claim
  • Hiding benefits from policyholders
  • Excessive requests for documentation
  • Complicated forms with badly defined terms
  • Delaying your claim
  • Changing due dates

The idea is that you will, after the first denial, simply give up your claim and leave them alone, or at least settle for less than you thought you would receive.

Options

If you’ve received a denial letter after applying for the first time, you are entitled to an appeal. This should be described in your denial letter. Pay attention to any dates or time period mentioned in the letter, because if you miss them, your appeal will be dismissed.

You have the right to ask for any and all documentation and expert advice that was used to decide your claim, without charge. You’ll be able to determine what information might have been missed, and hiring an experienced disability law attorney can give you the best chance of winning on appeal. Working with an attorney who understands the application and appeals processes will make sure that your application and any appeals will be completed, giving you the best chance of a successful outcome.

It’s never too early to contact a disability attorney for help. Whether you’ve just become disabled and are wondering about your options, have been denied benefits, are appealing, or just don’t have the stamina to deal with an insurer while you take care of yourself, contact a disability law attorney to help you stand a better chance of winning.

Let Herren Law Increase Your Chances Of A Win

If you’ve become disabled and unable to work, the last thing you need is to worry about how to pay your bills and keep your household going. 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.

Filed Under: Long Term Disability Tagged With: , ,
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