Does a Mental Disorder Qualify For Social Security Disability?

August 23, 2022 by

You may wonder if a mental disorder also qualifies for Social Security disability assistance. Mental disorders can be just as disabling as a physical disability or handicap. A mental disorder can prevent you from working, having fulfilling relationships, and functioning in society.

 

elderly lady who have Alzheimer disease
                                                                                                                                           Mental Disorder affects 1 in 5 Adults

In 2020, about 21% of Americans experienced a mental disorder or about 1 in 5 adults. About 5%, or 1 in 20 adults, experienced a severe mental disorder. About 8% of Americans, or 21 million people, experienced a major depressive episode in the same year.

Suicide and other negative activity can result if the mental disorder is left untreated. Many people in jail have been found to have some kind of mental health challenge. Veterans are not immune from mental disorders and may qualify through the Social Security Disability program as well as veterans disability programs. As you see, if you are suffering from a mental disorder, you are not alone. Medical care is available and you may qualify for disability assistance as well.

Social Security Disability Insurance (SSDI)

This is a program that pays a person and certain family members if, while you were working, you earned enough credits through payment of Social Security taxes from your earnings, or those of a qualifying family member.

SSDI is for individuals who are no longer able to work due to a substantial illness or impairment. To qualify, a person must have worked in jobs that are covered by Social Security and deduct those taxes from earnings. The calculations are made on the number of earnings the disabled person earned prior to leaving work due to a disability.

SSDI is different than SSI, or Supplemental Security Income. SSI is a need-based program offering basic financial assistance to older persons and disabled individuals who have limited resources. SSI recipients qualify for Medicaid immediately, whereas SSDI recipients qualify after 24 months of receiving benefits.

Qualifying Criteria

Social Security uses the same basic requirements for any disability rating. The disability must be expected to last longer than 12 months or end in the death of the recipient. Mental disorders are also judged by the same standard. They are considered a disability and do qualify for disability through the Social Security Administration (SSA).

The SSA’s “blue book” contains the full listing of all conditions that they consider “disabling.” The book contains an entire section on mental disorders. Many of the disorders have multiple requirements that must be fulfilled to qualify for SSDI. Any mental illness that prevents you from having and maintaining gainful employment may be used as a qualifier.

But just having a mental disorder isn’t enough to begin receiving SSDI payments. You still must submit an application and include sufficient documentation that supports your claim of disability. This can include:

• Medical records from psychiatrists, psychologists, counselors, social workers, or therapists

• Any treatments, such as brain scans that show any abnormalities responsible or other organic cause for symptoms (if applicable)

• Medical records from emergency room treatments or hospitalizations resulting from your condition

• Pharmacy records related to the prescription treatment of your condition

A diagnosis isn’t enough to show disability. You’ll be required to demonstrate that the diagnosed illness also includes limitations that impair certain functions and this functioning impairment prevents or prohibit you from working. During medical visits, speak honestly with medical providers about how your disorder impairs you so that their medical records will give an accurate account of your condition.

Adding detailed descriptions of how your mental disorder disrupts your life can be a helpful first-person account that accompanies your medical records. It is not unusual to find many individuals applying for SSDI may have one or more disabling physical conditions in addition to their mental disorders.

It is a good idea for you to speak with an experienced disability attorney, like Bill Herren, before submitting letters and first-person documentation so that they are done correctly. Working with a disability attorney from the beginning can increase your chances of approval and ensure that the application is completed correctly. It also lets you focus on taking care of yourself while your attorney handles your claim application process.

Unfortunately, many claims are rejected because of insufficient documentation or errors. If you are considering applying for yourself or a loved one that has a mental disorder that qualifies for Social Security Disability, contact an attorney that specializes in this area of law. If the application is denied, you can have your attorney represent you in an appeal, which can increase your chance of being approved.

How Long Does it Take?

With rare exceptions, disability payments do not begin immediately. Once you submit your claim, it will be reviewed by a caseworker who will verify your information and medical documentation before rendering a decision. The decision is generally given within three to five months, on average, though sometimes it can take longer.

Once your application is approved by the SSA, you’ll have a yearly review of your condition since many mental disorders are treatable. If your condition remains the same and there is no improvement, you will likely continue to have your benefits.

Contact Herren Law Today

Mental disorders affect thousands of Texans and their families. Many should qualify for Social Security Disability Insurance (SSDI), but their applications are denied because of insufficient documentation or outright errors. Herren Law has helped over 4000 Houstonians receive the disability benefits they need. William Herren has an unsurpassed commitment to his disabled clients and is a proud member of the National Organization of Social Security Claimants Representatives. Licensed to practice law in Texas and in the Federal District Courts of the Southern District of Texas and the Eastern District of Texas, as well as the Fifth Circuit Court of Appeals, Mr. Herren is very experienced in Social Security disability type cases, including mental disorders that qualify for Social Security Disability.

When you call Herren Law, we’ll immediately begin working with you one-on-one, going through your records, and helping you to apply properly.

If you or someone you care about has a mental disorder and you are wondering if that mental disorder qualifies for Social Security disability assistance, start with William Herren and the Herren Law firm. Your first step is getting an experienced Social Security Disability lawyer on your side, so contact our Houston law office at (713) 682-8194. We offer free, no-obligation consultations, and there is no fee unless we win your case.

Filed Under: Social Security Disability Tagged With: , ,

Find an Experienced Disability Lawyer in Houston

July 14, 2022 by

It is important to find an experienced disability lawyer in Houston as the process of applying for and getting disability payments through Social Security can be a long and frustrating one. Veterans trying to get disability awarded run into similar frustrations and don’t get us started on the frustrations folks find dealing with insurance companies for their long term disability claims! For this reason, William Herren and the staff at Herren Law offer its services as a way to help navigate the process. Mr. Herren’s over 25 years of experience in this area of law in the Houston area makes him uniquely qualified to help clients. He and his staff help with applications, appeals and representation when it comes time for a hearing.

Our goal is to have every qualified applicant receive the benefits they deserve and need. Unfortunately, not everyone who applies on their own have a good experience. That’s when they need to find an experienced disability lawyer to help them.

How Can A Disability Lawyer Help?

If you decide to apply for disability on your own, without help, you’re often required to fill out tons of forms, and gather relevant evidence such as medical records, all while dealing with your medical condition. It can be overwhelming and confusing. You sometimes wonder if the difficulties are designed on purpose so you will give up.

For example when you hire a disability lawyer to help you with the social security disability process, you are required to fill out about 40 pages of forms. When you hire William Herren, you hire an advocate who understands the Social Security disability process and disability law. He can handle the paperwork and evidence gathering for you, and make sure you have what you need. Hiring the right lawyer at the outset can make sure your application is done correctly and that you’re well represented throughout the process.

Another good reason for getting help from a disability lawyer is that they can help you prepare for a Social Security Administration (SSA) examiner’s interview for your case. When you attend this hearing alone, you may say the wrong thing or give too much attention to the wrong things during questioning, because you simply wouldn’t know what is important or relevant or what the examiner is looking for. While you may be focused on the immediate effects of your disability, the examiner is more focused on how your disability impacts your everyday life. A physician or other healthcare provider focuses on your symptoms and treatment and most don’t necessarily understand how the SSA system works. Therefore, your doctor may not be the best person to adequately prepare you for the eventual in-person hearing.

But an experienced disability lawyer should have specific knowledge directly related to the process of filing, the in-person interview, and the appeals process. Therefore, they can prepare for the examiners’ review ahead of time. The attorney will help you with what to say, and more importantly, what not to say. This gives you a better chance of answering the questions correctly and ultimately getting your needed disability benefits.

Reasons to Hire a Disability Lawyer In Houston

The number one reason to hire an experienced disability lawyer in Houston is, of course, you reside in Houston or in Harris County so hiring a local attorney makes sense for personal convenience. William Herren and his staff are very familiar with the insurance companies, the SSA, and area doctors, hospitals etc – meaning he knows who to deal with. His experience brings resources and contacts a less experienced lawyer may not have. Having good professional, and in some cases, friendly relationships help to get things done more efficiently for his clients. While a good doctor and treatment regimen is important for any type of life-changing disability, sometimes a good disability lawyer can help in other ways, such as:

• Be informative and answer any questions along the way
• Help with the initial application process
• Gather all required evidence you need to support your claim of disability
• Present your case in the examiner’s interview
• Assist with appeals if your initial application is denied
• Act as a “coach” ahead of time so that you’ll be prepared to answer all questions correctly
• Taking the pressure off you to get everything correct
• Update the SSA with changes in your medical conditions
• Represent you in a hearing with an administrative law judge if needed

Without the help of an experienced Houston disability lawyer, you’re on your own against a process that can be full of stumbling blocks and “red tape.” For example one of the most important factors is submitting the right medical evidence. Your disability lawyer will communicate with your medical providers and review all medical records to ensure that you have what you need. They have the experience to eliminate anything irrelevant to your case.

Another issue you may run into is the doctor who is unwilling to assist you in getting categorized for your disability. They may believe that the patient isn’t disabled. Perhaps the physician doesn’t understand the process or is just simply not interested in dealing with paperwork. However, these type of doctors will often speak with an attorney representing a patient, especially, as with Mr. Herren, the attorney has more experience dealing with doctors and other healthcare professionals.

Also because a disability lawyer understands the process, they should also make sure that all deadlines are met and you are kept up to date on everything. While the attorney handles the legal side of your case, you can concentrate on taking care of yourself.

Houston Disability Lawyer William Herren

We at Herren Law know the process, know our city of Houston, and are proud of helping more than 4,000 people get the benefits they need. We are ready to help you with your initial application and ensure that your application or appeal is done correctly. We are experienced in helping people successfully navigate through the disability application and appeals process and we can help you too. Our contingency fee means you won’t have to pay until you start receiving benefits.
If you’ve been denied benefits, or don’t know where to start, please call the Herren Law Firm today at (713) 682-8194 or (800) 529-7707 to schedule your free consultation. We look forward to being of service.

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

Long Term Disability Exclusions

June 20, 2022 by

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

elderly man with long term disability

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

What Is An Exclusion?

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

Common exclusions include:

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

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

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

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

• A normal pregnancy and delivery

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

• Other criminal activities

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

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

Mental Health Conditions

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

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

Alcohol And Substance Abuse

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

Handling A Denial

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

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

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

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

Your Houston Long Term Disability Attorney

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

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

Filed Under: Long Term Disability Tagged With: , ,

Do I Need a Texas Disability Lawyer?

April 15, 2022 by

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

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

Do I Need a Texas Disability Lawyer?
Houston Statistics

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

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

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

Why A Texas Disability Lawyer Can Help You

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

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

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

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

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

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

If you haven’t spoken to a disability lawyer, go ahead and make an appointment now. Unless you’ve applied and are waiting for an answer from SSA, nearly anytime is a good time to make that call. Attorney William Herren has been helping Houston and Texas residents cut through red tape and get their disability benefits for more than 30 years.

Can I Afford A Texas Disability Lawyer?

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

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

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

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

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

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

Texas Disability Lawyer William Herren

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

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

Filed Under: Long Term Disability Tagged With: , ,

Is There an Age Limit for Long-Term Disability?

March 20, 2022 by

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

Is There an Age Limit for Long Term Disability?

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

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

How It Works

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

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

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

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

The End Of The Policy

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

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

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

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

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

Your Houston LTD Disability Attorney

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

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

Filed Under: Long Term Disability Tagged With: , ,

Do Disability Benefits Change If My Medical Condition Changes in Houston?

May 6, 2021 by

Applying for disability is a complex, long-term process with a considerable amount of documentation required. You’ll need to not only prove your disability but your work history and earnings that qualify you. Even after you’ve submitted everything requested, you may still find yourself denied benefits, requiring an appeal.

Once you’ve begun receiving benefits, you will still have to support your diagnosis during periodic reviews of your case. But if your condition changes, what’s next?

Do Disability Benefits Change If My Medical Condition Changes in Houston?

How It Works

SSDI is not awarded based on the degree of your disability, but your earnings history.

As a rule, you get awarded disability if you have a medical condition that is expected to prevent you from working for more than a year, or ends in death. Social Security Disability Insurance (SSDI) considers you fully disabled at the time you’re awarded benefits.

Therefore, if your condition worsens, you’re already at your maximum benefit amount, and the amount won’t change.

Regular Reviews

All SSDI recipients have periodic case reviews to determine if they still have a true disability. Depending on the circumstances, reviews can happen from every six months to every seven years. This will largely depend on the seriousness and type of your condition and if any improvement can be anticipated.

SSA will mail you a letter in advance of your upcoming medical review. You’ll be asked for patient and treatment records from doctors, clinics, and hospitals where you’ve received treatment since your last review, or since you were awarded benefits. If you’ve also been working, you’ll need to provide information on that such as dates, payments received, and the type of work you were doing.

The only way you might receive an increase is with a yearly cost-of-living adjustment (COLA) to take into account inflation.

Social Security also regularly conducts audits of accounts. Any previously uncounted earnings may require your monthly benefits to be recalculated. If any disparity is found, you’ll be notified of the recalculations and the increase in your monthly payments.

If Your Condition Improves

This will depend on what condition you are claiming disability with. Some may improve with time, such as certain types of cancers with treatment, while others may not.

Should your condition stay the same, or become worse, you will most likely continue receiving benefits. This is true even if you receive a separate, additional diagnosis for another condition.

However, if your condition significantly improves to the point where you can return to working and earning a living on your own, it’s highly likely that your cash benefits will come to an end.

You can earn some money while on disability. In 2021, that limit is $940 monthly before benefits are reduced. Additionally, you can also participate in a trial work program for up to nine months to see if you are ready to return to work. The nine months do not have to be consecutive.

The Social Security Administration has a booklet available online that explains some of the basics of SSDI.

Your Houston LTD Disability Attorney

Most attorneys aren’t familiar with the intricacies of disability filings, but we are. 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. We have the experience to help you through the process for a successful outcome.  The Herren Law Firm can help you with your application, any necessary appeals and help you get the 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.

Filed Under: Long Term Disability Tagged With: , ,

What Happens When An Employee Goes On LTD?

October 5, 2020 by

Long-term disability is a form of insurance that offers an employee a portion of his or her income, usually 50% to 75%, during a recovery period from an illness or accident that isn’t work-related. (Worker’s Compensation covers work-related accidents.)

What Happens When An Employee Goes On LTD?

Statistics from The Council For Disability Awareness indicate that:

  • About 1 in 4 individuals currently 30 years of age will become disabled and out of work about a year before they reach retirement age
  • Most disabling incidents leading to long-term disability are not accidents, but cancer, heart disease, pregnancies, back injuries, and the like
  • About 48% of Americans have enough savings for three months of not working due to disability
  • The average duration of an LTD claim is 34.6 months, nearly three years

Two laws also govern disability leave:

Many long-term disability claimants will fall under one or both of these acts.

An Employer’s Perspective

Even when an employee is out, a company still has work that needs to be done. Temporary and/or contract help may be hired to fill in if the employee has an estimated return date. If the employee is out longer than previously determined or asks for an extension, employers may take a person off the payroll entirely.

Depending on the company, an employer may attempt to hold your job open while you are recuperating, depending on the expected length of your convalescence. Others may have a set time frame by which they will list the job as vacant, and attempt to hire someone else to fill the position. Still, other companies may hold an employee’s position for a specific time, such as a year, before they consider the employee to not return.

Can You Be Fired?

You actually can be terminated, laid off, furloughed, or outright fired while on LTD.

Receiving benefits from an LTD policy does not offer any job security, and your employment job can end for any reason. Your job can be eliminated due to downsizing, or you can be terminated for other job-performance reasons unrelated to your disability.

However, employers must tread carefully when doing so, or risk expensive litigation.

An employee cannot be fired if:

  • He or she is able to do the job with requested reasonable accommodations, but the employer has failed to provide them, whether or not the employee is on FMLA
  • He or she is on FMLA leave, whether or not they can still perform the job under the ADA.

After the 12 weeks of FMLA leave ends, an employee can be terminated. Under the ADA, an employee can request reasonable accommodations. If these accommodations don’t cause hardship, the employer is required to provide them, whether it’s a change in work hours, desk adjustments, or other changes that allow an employee to continue in their job in spite of a disability.

What About Benefits?

What happens to your insurance payments if your employment ends? It depends.

If an insurance company is paying your benefits, chances are that won’t change. But if your company is paying your long-term disability, chances are your benefits will end when your employment does.

You must continue medical treatment in order to keep your LTD benefits but may lose your health insurance in the interim. It’s a conundrum, but continued treatment for your condition is vital for a number of reasons.

This is one of the many reasons to carefully review your policy before applying for long-term disability, especially if your policy is company-provided. You’ll need to know exactly what to expect if things change substantially, such as a downsizing or your company going out of business.

Your Houston LTD Disability Attorney

If you’re facing an absence from work due to a long-term disability, but are having trouble, we’re here to help.

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

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: , , ,

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: , , ,

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: , ,
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