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

January 24, 2022 by

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

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

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

Appealing The Denial

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

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

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

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

What You Need to Reverse Their Decision

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

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

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

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

Filing A Lawsuit

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

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

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

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

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

Filed Under: Long Term Disability Tagged With: , ,

Getting Benefits For Somatic Symptom Disorder In Houston, TX

July 31, 2020 by

When you have a condition that’s obvious, it’s easy to show and discuss your symptoms with your physician or other healthcare providers. But when you have physical symptoms that don’t seem to be caused by anything specific, things can get complicated.

Somatic Symptom Disorder, also called SSD, is one that is considered mental in nature but causes physical symptoms, which can include pain. The symptoms can cause considerable distress that can disrupt a patient’s daily life.

Getting Benefits For Somatic Symptom Disorder In Houston, TX

The Basics Of SSD

An individual who wakes up with a headache one morning, or develops one during the day, may believe they have a serious illness such as encephalitis. The headache may have any number of causes, from caffeine withdrawal to work-related stress, both of which are treatable and manageable. But instead of determining where the headache is coming from, the person focuses solely on the headache and seeks medical care.

When one doctor doesn’t provide a suitable diagnosis, the person visits multiple physicians seeking answers, convinced that the headache is something more serious. Medical tests don’t indicate any particular problem, leading to an obsession with more doctor visits and additional testing. Seeking the correct answer may lead to debilitating anxiety and distress that makes normal functioning difficult, including:

  • Chronic worry over a serious illness
  • Concern over serious medical conditions when testing shows there isn’t
  • Fear of damage or injury with physical activity
  • Believing that your medical exam and treatment were inadequate
  • Frequent doctor visits that don’t supply answers and increases anxieties
  • Having symptoms that aren’t consistent with the normal effects of a particular medical condition

Note that symptoms such as pain are real, even though there is no detectable cause. Some cases may involve issues with nerve impulses that send signals involving pressure, pain, and other sensations to the brain. These symptoms may be difficult to diagnose, and a physician may or may not prescribe medications for the symptoms.

If no underlying cause is detected, a physician may refer a patient to a mental health provider for additional evaluation. Cognitive-behavioral therapy (CBT) and psychiatric medications may be prescribed to address anxiety related to the physical symptoms.

Applying For Disability

When a condition prevents you from working and living normally, you may decide to apply for disability. Because a somatoform disorder isn’t readily visible and not detectable by normal medical testing, positively proving the condition can be much more difficult. However, it’s not impossible.

The Social Security Administration (SSA) does recognize somatoform disorder as a disabling condition in its blue book under Section 12.07, along with a list of requirements.

Working with one physician for treatment instead of visiting many doctors shows that you are actively seeking treatment and not “doctor shopping.” While the search for answers may lead to multiple doctors, developing a strong relationship with a single psychiatrist and/or physician and regular treatment goes a long way in proving your case for disability.

The SSA will also consider what types of jobs you can continue to do, whether your own or another type, with the help of a mental residual functional capacity (MRFC). While the SSA’s examining physicians will create an MRFC report from your records, you should also have one created by the psychiatrist who is currently treating you. The SSA will favor a psychiatrist who specializes in somatoform disorders over any type of physician who doesn’t.

Get Help With Somatic Symptom Disorder Disability From Herren Law

Applying for disability benefits from the SSA brings increasing challenges to prove your case. With the help of an experienced disability attorney, you can make sure you have the evidence you need, your application is properly executed, and stand a better chance at getting the benefits you need.

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: , ,

Reasons For Long Term Disability Denial Of Claim

March 3, 2020 by

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

Reasons For Long Term Disability Denial Of Claim

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

They’re Watching You

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

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

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

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

Not Enough Medical Evidence

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

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

Missed Deadlines

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

You Don’t Meet Their Definition Of “Disabled”

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

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

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

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

Your Houston LTD Disability Attorney

When applying for long-term disability it’s important to follow your insurer’s instructions to the letter. They’re not interested in helping you and your claim, but there’s someone who can help.  The Herren Law Firm can help you with your application, appeals and help you through the process so you can get the benefits you need. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, because we will only collect if we win your case.

Filed Under: Long Term Disability Tagged With: , ,

Long Term Disability Death Benefits In Houston, TX

September 16, 2019 by

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

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

Long Term Disability Death Benefits In Houston, TX

What Is A Death Benefit?

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

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

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

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

An Alternative LTD: Accelerated Death Benefit

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

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

Critical illnesses that can also trigger this benefit include:

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

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

Your Houston LTD Disability Attorney

Long term disability can be an annoying process before you begin receiving benefits. The Herren Law Firm can help you with your application, appeals and help you through the process, and give you and your family peace of mind. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and no up-front fees, because we will only collect if we win your case.

Filed Under: Long Term Disability Tagged With: , ,

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: , ,

Houston Attorney for CIGNA Disability Claims

July 15, 2018 by

Most people don’t expect to become disabled. But in the US, one in five individuals is considered disabled, enough not to work. Some need time to recover from an illness or injury. Some may never return to work, and will be on disability for the rest of their lives. But in many cases, part of their journey to disability involves long-term disability insurance. And for many, that insurance company is CIGNA.

Houston Attorney for CIGNA Disability Claims

Who Is CIGNA?

It’s one of the largest healthcare insurance companies in the world, for both companies and individuals. Whether you’re buying on your own or through your company, CIGNA offers health and dental insurance, Medicare, and supplemental coverage to augment your regular insurance policies. These include accident insurance, two types of cancer insurance, heart attack/stroke insurance and “whole life insurance” for final expenses.  Companies can also choose from supplemental group plans, wellness programs, cost control options and benefit technology solutions.

If your company offers short- and long-term disability insurance, there’s a good chance it’s also through CIGNA.

CIGNA is also one of the world’s largest group disability insurance companies. Calling itself a “global health services company,” CIGNA was ranked #97 on the Fortune 500 list in 2014. The company has more than 37,000 employees worldwide, has over $35 billion in revenue and $10.8 billion in shareholder’s equity.

While CIGNA offers a wide range of related services worldwide, they are also in business to make money. Denying claims is part of their business.

What CIGNA Is Really Like

Company literature touts their slogan, “Together, all the way.”  But policy holders who have CIGNA will tell you that once you file a disability claim, it’s not always like that. For a vulnerable person who needs help, CIGNA turns their back on many of their policyholders.

The company has a reputation for denying claims immediately, with little or no investigation, and only minimal documentation is used to deny claims. They also have a reputation for ignoring policyholders, not responding to phone calls and emails, and issuing multiple requests for the same information.

The company is governed by ERISA guidelines, but uses them to its advantage. CIGNA’s deadline for deciding your claim is 45 days, but the company routinely asks for 30-day extensions to delay that decision. They also continually ask for additional bits of information to further delay decisions—every request stops the time, and then starts it over. When you receive these requests, answer them immediately. The initial claim decision generally takes about 105 days with the extensions.

If your claim is denied, you’ll have 180 days to appeal. Don’t wait—begin your appeal immediately (and if you have a disability attorney, he or she will know what to do.) Your appeal will take time to prepare—don’t wait. CIGNA will take 45 days to respond to your appeal, but may also request a 45-day extension, making it 90 days.

Another tactic CIGNA uses is to continually ask for information and stalling their decision. You may also be told by one of the many “case workers” you speak to that if you’ll just write a simple letter, your claim will be approved and your checks will begin right away. This is another stalling technique, and can be used to deny your claim. Talk to your attorney if you’re being ignored or treated badly.

Don’t Ignore Appeals

Appeals are essential to getting your claim approved if you’re denied the first time. Pay attention to the deadlines given—if you miss it, you’ll lose your ability to appeal, and possibly your entire claim to long-term disability.

CIGNA allows two appeals before either approving your claim. If you’re still denied, you may opt for a lawsuit. If you don’t have an attorney at this point, you’ll need one now.

Are You Fighting With CIGNA?

Fighting with your insurance company can be worse than having a disability. It doesn’t have to be that way. A thorough and complete application is the best way to start, and we can help.

We understand the process of applying for disability and dealing with appeals—we do it every day. The Herren Law Firm in Houston, TX can assist with your application, appeals and all documentation. Contact us today at 713-682-8194 to schedule your free consultation. We’ve helped over 4,000 Houstonians get their disability benefits, and we only collect a fee if we win your case. Don’t fight alone—call us today.

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

Houston Long Term Disability Attorney

June 20, 2018 by

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.

Filed Under: Long Term Disability Tagged With: , ,
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