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

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.

 

Hiring a Houston Attorney for Aetna Disability Claims

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.

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

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.

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

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.

Can You Get Long Term Disability for Anxiety in Houston, TX?

Nearly everybody goes through difficult times. Some may find themselves with depression and/or anxiety until things get better. But is your anxiety bad enough to warrant long-term disability? It can be, if it prevents you from working, and inhibits nearly every part of your life.

Can You Get Long Term Disability for Anxiety in Houston, TX?

Anxiety, like most mental illnesses, is difficult to positively diagnose, and therefore harder to claim. Unlike an injury, such as a broken leg, or a condition like cancer, anxiety doesn’t have symptoms that are readily obvious or detectable with a blood or other medical test. But living with a physical disability can also trigger concurrent mental disabilities, including anxiety.

What Is Anxiety?

Anxiety is usually defined as a chronic fear or worry about something that could happen, but hasn’t happened yet, and may never happen. There are many factors that can trigger this fear or worry, such as work-related issues, relationship problems, or other problematic situations (i.e., a car accident, chronic pain, etc.) A shortage of oxygen in some areas can contribute to anxiety, as well as brain chemistry. Certain medications can also cause anxiety, as well as withdrawal from some substances.

Mild cases may remedy themselves, but severe cases can be debilitating and prevent you from working and living your life. There are multiple variations of anxiety:

A mental health professional (i.e., psychiatrist) can identify the cause of the anxiety. A physical exam, including medical testing, can identify any physical symptoms that may be causing the anxiety.

A positive diagnosis includes consistent worry for more than six months, difficulty in controlling that worry, and that the symptoms severely impact everyday life, interfering with work and/or school, etc.

Check Your Policy First

The first thing you’ll need to review is your LTD policy. What does it consider a “disability?” Does it cover mental illnesses? More importantly, does it exclude mental illnesses?

Check to see how your policy defines “disability.” Many LTD policies put a two-year limit on mental illness benefits. Anxiety may develop for any number of reasons, but it’s important to note if it develops in someone who is living with a physical disability that prevents them from working. Your LTD policy will tell you if mental illnesses are limited, or outright excluded.

You’ll need to meet all the other requirements of your LTD policy to be able to file the claim. If your anxiety was caused by an underlying physical condition, you may be able to collect benefits beyond the two-year standard for mental illnesses. But in order to do that, you’ll need to curate enough medical evidence that demonstrates your physical illness qualifies you as disabled on its own. This is where an attorney can help you.

The Human Factor

Always remember that disability insurance claims processors aren’t medical professionals. They’re not trained to offer medical advice or opinions, only to examine claims to see if they’re properly supported and submitted. They’re looking for anything that positively proves your disability, be it mental or physical.

Don’t rely on the insurance company to get everything. The more documentation you can submit that supports your claim, the better your chances of approval. Providing copies of physician’s notes, additional medical records, prescription records, therapy notes, and anything else that might be relevant can be submitted to support your claim.

Also be careful of any questionnaires or other documentation the insurance companies send to you. Some of the questions may be carefully written to intentionally disqualify your claim when you believe you’re answering truthfully to better support your claim. Having a disability lawyer review documentation before it’s sent to the insurer will help prevent automatic disqualifications for these kinds of questions, and make sure your claim is thorough and complete.

Surveillance

It’s not uncommon for insurance companies of all kinds to conduct surveillance on someone filing a claim, whether it’s LTD, for a car accident or a personal injury claim. (This is also common in divorce cases.) You may be followed, or your social media may be examined for evidence that you’re not as disabled as you claim, so be cautious about your activities and postings. Be aware that any evidence that is gathered can be used to deny your claim, even if it’s misrepresenting.

Your Houston LTD Disability Attorney

Nobody wants to suffer from chronic anxiety, but applying for long-term disability can be difficult. It’s important not to give up. We’re ready to help you through the long process of getting long-term disability benefits.

Over 4,000 Houstonians have received the LTD benefits they need, and we can help you too. The Herren Law Firm can help you with your application, appeals and help you through the process so you can concentrate on getting better. 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.

 

Houston Long Term Disability Attorney

Houston is one of the most vibrant, exciting cities in the US, and keeps getting better every passing year. We have great food of all kinds, culture, festivals, industry, shopping and a world-class Medical Center. The Houston area has everything you could ever want in a city.

Fortunately, if you have a long-term disability, Houston is also a good place to be.

Houston Long Term Disability Attorney

Getting Long Term Disability

If you’ve developed a long term disability that prevents you from working, your life has changed considerably. You may have to make a number of adjustments to continue living a normal life. Home modifications like a wheelchair ramp, “grab bars,” or lift to get back up and down stairs may be in your future. (If you don’t have the means, there are a number of grant programs available to help.)

While it’s a lot of trouble to have to “prove” that you’re disabled and can’t work, once you’re done, you’ll have time to take care of other things you may need.

If you need help with the application or appeals process, a long term disability attorney may be your next call. Forms, deadlines and evidence that are part of the process can be easy to overlook. An experienced LTD attorney can give you the help and oversight you need to ensure that your claim is properly submitted for approval.

Long Term Disability In Texas

Census figures from 2014 indicate that about 3.4 million Texans classified as “disabled.” A disabled person is has a wide range of services available, including:

  • Rehabilitation
  • Medical equipment
  • Job and career assistance
  • Medical care
  • Personal assistance attendants

The services available in Houston can help people with a long term disability live independently and stay in their own home, help find suitable jobs, get medical assistance devices and other needed equipment, help family members care for them, and assist with applying for disability if needed.

Texas Health And Human Services Commission

The state of Texas has services available for those with long term disabilities. You can get help applying for Medicaid or Medicare, Social Security or Supplemental Security Insurance, and apply for SNAP benefits if you need them.

Houston is in Region 6 of the HHS service area. You can find out more of what HHS offers at this website, and more about independent living services. You can also call 211 to request help.

The Houston Mayor’s Office For People With Disabilities

Established in 1993, three years after the Americans with Disabilities Act (ADA), this division of the Mayor’s Office is an advocate for Houstonians with disabilities. Register with this office and you can receive free legal assistance through the South Texas College of Law Legal Clinic (STCL). If you’re deaf or hard of hearing, you can also register for a free visual fire alarm through the City Of Houston Fire Department. Free tax help is also available, as well as parking permits. Call the MOPD office at 832-394-0814, or email at mopdmail@houstontx.gov.

Your Houston LTD Disability Attorney

The Herren Law Firm can help you with your application, appeals and help you get the long-term disability benefits you need so you can live your life. 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.