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.

 

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.

How Do They Decide If I’m Totally Disabled Or Partially Disabled In Houston, TX?

If you’re unable to work due to a disability, “hurry up and wait” is probably a term you’ve heard at least once. Determining disability can be confusing. Are you completely disabled, or only partly disabled? There are a number of questions to answer before you receive an answer.

How Do They Decide If I'm Totally Disabled Or Partially Disabled In Houston, TX?

Qualifying For Disability

In order to receive Social Security disability, you must have worked long enough and recent enough to earn work credits, up to four per year. Once you’ve earned $5,290, you’ve earned the four towards your total of credits.
Social Security only pays for total disability, not partial. You are considered disabled if:

• You cannot do the same work you did before
• You cannot adjust to other work because of your medical condition(s); and
• Your disability has lasted or is expected to last for at least one year, or will result in death

How Disabled Are You?

This question is answered by Social Security’s five-step process that determines how much work you can do, as well as if and when you can be expected to return to work. There are a number of things that are considered the process.
Social Security will ask about your education and work experience. They will also ask about your current job—how did you do it? Can you still do some of it? Can you adjust to doing a previous job, or change professions to perform a new vocation?

One way to determine your abilities is to review your Residual Functional Capacity (RFC.) With the help of their Listing Of Impairments, SS will determine what abilities you have in spite of the conditions of your disability (standing, sitting, interacting, taking directions, etc.)

The determining questions asked involve:

• If you are currently working, and if you earn more than $1,180 per month
• If your condition severely limits your basic work abilities for more than 12 months (lifting, standing, walking, sitting, and remembering)
• If your condition is found in the List Of Medical Conditions that are severe enough to prevent you from doing “substantial gainful activity”
• If your medical condition or impairment prevents you from doing the work you did previously
• If you can do any other type of work. Your age, education, medical condition, experience, transferable skills, and other factors are taken into consideration

One determining factor is whether or not you can do “light or sedentary work.” If you are under age 50 and can do light, sedentary work, you will not be considered “disabled.” However, if you are over the age of 55 with an RFC of “light or sedentary work” and don’t have transferable skills, you will likely be granted disability under the medical-vocational allowance. However, if you can do light work, the SSA will assume that you can learn and perform a new job or vocation.

Need Help With A Disability Claim?

If you’re assembling your application, you may be overwhelmed. There are numerous forms to fill out, doctor visits and conversations to handle correctly. One wrong item can sink your claim.

Let us help. We’re experienced in handling all types of disability claims and have helped more than 4,000 Houstonians get the disability benefits they 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.

Is It Worth Hiring A Houston Attorney For Long-Term Disability?

Filing for long-term disability is a long and challenging process. It’s more than filling out a few forms and checking items on a list. Medical evidence, information from your employer and other documents are part of what will win or deny your case. Insurance companies have strict deadlines, and one small mistake can see your entire claim denied.

Is It Worth Hiring A Houston Attorney For Long Term Disability?

They Don’t Want To Pay You

Insurance companies would rather you didn’t realize that even though you’ve paid into their policy, they’re not interested in helping you. Paying claims is not a good business model, so insurers make sure that there are multiple ways to deny your claim. Short deadlines, excessive or duplicate paperwork, delaying claims or payments or giving lower payments than indicated in the policy are all ways insurers stall. Legitimate claims for disability are increasingly denied for the slightest reason. Knowing that most people don’t have the means to fight back, these “bad faith” practices continue with little pushback.

ERISA

The Employee Retirement Income Security Act of 1974 was enacted to protect employees, but ends up protecting insurance companies. Instead of protecting you, ERISA gives insurance companies greater freedom to deny your claim. Although the Department of Labor says that it “protects retirement savings from mismanagement and abuse,” insurers are free from many state-level restrictions on bad-faith insurance practices. Insurers are then are free to decide who is approved for LTD benefits, and who isn’t.

The deck is actually stacked against you as an applicant, and it’s up to you to be able to make sure your claim is completely correct. This is where an attorney can help make sure your application is not only correct, but more than sufficient to prove your claim and make it harder to deny.

If you decide to handle your ERISA appeal without an attorney, you’ll more than likely be denied, and you could lose any additional opportunities to appeal or file a suit. You may only have one chance at an appeal.

Hiring An LTD Attorney

Of course, you want to find an attorney in Houston who has experience with both LTD claims and with ERISA appeals. He or she will understand the process and know exactly how to follow the rules.

If you hire an attorney at the beginning of your application process, he or she knows that ample evidence in your administrative claim will help meet and exceed the insurer’s requirements. If you just fill out the paperwork on your own, and depend on the insurer to find all the evidence it needs, there’s a strong chance your claim will be denied because of insufficient information, or even a mistake.

Once a decision has been made, no new evidence is allowed. An experienced LTD attorney will know exactly what to add to the claim to increase your chances of approval. Should your claim be denied, having an attorney will increase your chance of winning an appeal, and you’ll have a good stack of evidence available to better prove your claim.

Your Houston LTD Disability Attorney

ERISA claims are a complex area of the law, and there aren’t many attorneys in Houston—or Texas—that handle it. The Herren Law Firm can help you with your application as well as any appeals to help you get the long-term disability benefits you need to take care of yourself. 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.

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

Long-term disability can be a difficult journey, from an illness that keeps you from working to the extensive medical appointments and paperwork involved before you start receiving benefit payments. But if that disability is PTSD, it can be even more difficult.

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

What is PTSD?

PTSD, or Post Traumatic Stress Disorder, is a condition seen in individuals who have witnessed or lived through a traumatic event. It’s a type of anxiety disorder that’s triggered by a traumatic event.

While PTSD is commonly associated with combat veterans who have spent time in war zones, PTSD can also occur in civilians. Natural disasters (like last year’s Hurricane Harvey), becoming a crime victim, receiving a diagnosis for a serious medical condition, car crashes, domestic violence, and other unexpected traumas can give someone this disorder.

Post-traumatic stress is commonly grouped into three types:

  • Intrusive memories—i.e., “flashbacks,” re-living the event or having recurrent nightmares
  • Avoidance/numbing—or avoiding thinking about it, as well as hopelessness, memory and concentration problems, difficulty with close relationships and no longer enjoying previous activities
  • Hyperarousal (or increased anxiety or emotional arousal), increased irritability or anger, shame or guilt, insomnia, self-destructive behavior (alcoholism, drug use, etc.) and being easily startled.

PTSD can cause problems in your job, your relationships, your marriage, as well as everyday activities. It also put you at risk for additional mental conditions, such as depression, eating disorders, suicidal thoughts, and other anxieties. The side effects of PTSD have also been shown to be linked to physical illnesses such as cardiovascular disease, autoimmune diseases, and chronic pain.

Treatments for PTSD can include various forms of psychotherapy, and psychiatric medications, short-term or long-term.

Policy Limits On Mental Illness

Because it isn’t something that can be detected with an X-ray or a blood test, insurance companies have additional restrictions on claims for mental conditions. The first step is to review your LTD policy, find out what they do cover, and see if there is a specific exclusion for PTSD or other mental illnesses.

Many LTD policies put a two-year limit on claims for mental illnesses, so it’s important to know what you need and what you can get before you start your application.

Review your policy to find out exactly what requirements you need to meet to file your claim. If your PTSD is the result of another medical condition, such as injuries after an accident or a disease diagnosis, you may be able to qualify.  In order to do that, you’ll need to collect enough evidence to prove that your physical condition that caused PTSD could render you disabled on its own. This is where an attorney can guide you through the process and increase your chances of proving your claim and having it accepted.

Your Houston LTD Disability Attorney

PTSD is a particularly difficult illness, but applying for LTD can make things even worse. We can 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 begin healing. 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 Attorney for CIGNA Disability Claims

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.

Are Long Term Disability Benefits in Houston Worth a Legal Fight?

Chances are that if you’re filing for long-term disability benefits, you know you’re in for a long haul, and possibly a fight (especially if you live in Houston.) Insurance companies would rather not pay you benefits as they’re supposed to, and seem to enjoy making you jump through hoops, dragging out your claim longer than it should take. When they move the hoops again, it may be time to call for help.

Are Long Term Disability Benefits in Houston Worth a Legal Fight?

Bad Faith LTD Claims

Long-term disability is intended to replace some of your income when you are unable to work while you recuperate from an illness or injury.

When an insurance company denies your benefits, drags out the process or uses other unethical tactics to deny your claim or pay you less than they’re supposed to, it’s called “bad faith.” Rightfully so, because you acquired your policy for the day you need it, and now they’re stalling. Don’t give up when they first deny your claim. That’s the time you’ll need to find an attorney—immediately—who is experienced with ERISA law and bad faith insurance company claims. If you wait, you could miss a deadline, and you could lose your right to appeal. (More information on bad faith LTD is available here on our website.)

Companies use a variety of tactics, including:

  • Requiring excessive, duplicate paperwork
  • Denying your claim for invalid reasons
  • Delaying your claim for an excessive amount of time (possibly causing you to miss a deadline you weren’t informed about)
  • Under-paying benefits

Additionally, the Unfair Claim Settlement Practices Act in Texas (Insurance Code Sec. 542.002), states that “an insurer engaging in business in this state may not engage in an unfair claim settlement practice.”  Should you discover that your insurance company is engaging in an unfair practice, it’s time to file a complaint.

ERISA

Short for the Employee Retirement Income Security Act of 1974, ERISA is the federal law that governs employee benefit plans. It’s a set of federal guidelines and minimum standards that explain to private employers how to administer employee benefit plans. (Governmental and church-related employers are exempt.)

Insurance companies are in business to make money, not lose it. So any way they can save money by not paying out to policyholders, they will. While ERISA was intended to help employees, it actually ends up having the opposite effect.

Standard Exclusions

There are some claims for which a denial is standard, and is spelled out in every short-term and long-term policy:

  • Injuries obtained during the commission of a crime of which you were convicted
  • Mental or nervous disorder (some allow these for up to 24 months)
  • A normal pregnancy
  • Pre-existing conditions
  • Alcohol/substance abuse
  • War/act of war
  • Injuries caused by an aircraft (except scheduled airline passengers)
  • Job-related injuries
  • Suicide attempts
  • Other acts done with the intent to cause disability

There may be others, depending on your policy. Some may be hidden in the fine print; some may even be outright illegal. The wording is deliberately complicated to make filing even more difficult.

Insurance companies have been known to request claimants to fill out forms that ask for purposefully damning information that will help a denial. An attorney who knows and understands disability claims can offer oversight to make sure you don’t accidentally sink your claim.

Be aware that whenever you speak with your insurance company, you’re probably being recorded. If you mention that you are considering hiring an attorney, be prepared for scare tactics or be offered a quick settlement. Don’t accept or sign anything until your attorney has a chance to review it first.

Can You Fight Back?

Yes, you can, even with a denial. But preparation for the fight is the key to winning.

  • Start collecting all of your medical records, doctor’s reports and other related documentation. Include evidence of any additional injuries or illnesses that prevent you from working.
  • If you’ve already filed a claim and have a denial letter, include that in your file.
  • Keep a record of every call and correspondence with your insurance company, including names, phone numbers, emails, dates and times.

If you haven’t filed your LTD claim yet, it may be a good idea to hire an attorney before you file your claim. He or she can guide you through the process and make sure you’ve done all you can for a positive outcome.

Talk To Us First

If you’ve realized your insurance company has participated in bad faith practices, call us immediately. The Herren Law Firm in Houston, TX can assist with your application, appeals and documentation to prove your case and win your claim. 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’ve helped over 4,000 Houstonians get their disability benefits, and we only collect a fee if we win your case.

What’s the Difference Between Long-Term Disability and Short-Term Disability?

Have you just started a new job, and heard a lot of different terms in orientation about “disability?” Are you faced with the possibility of being on disability, and don’t understand everything? At the Herren Law Firm, we understand the process of disability insurance and filings, and can help when the time comes.

know the difference between long and short term disability

What is Disability Insurance?

There are two types of disabilities, and disability insurance. It’s important to know the difference between the two. Both long-term disability (LTD) and short-term disability (STD) are separate insurance policies that serve as a replacement for your regular income in the event you are disabled. Disability insurance pays you when you are unable to work due to an illness or injury, regardless of the cause. It also covers gaps when your sick/vacation time are used up, and may keep you from having to dip into savings and retirement funds to pay your bills.

Both types of insurance are separate from health insurance, which only covers medical expenses. Disability insurance is also not the same as Worker’s Compensation, which is issued through your employer and only for work-related or workplace injuries suffered on the job.

Short Term Disability

The term means just that—usually 30 to 120 days, and starts paying within a few weeks. Short term is for things like a broken leg, maternity leave, or other limited convalescence.  If you’ll be going back to work in a few weeks or a few months, this policy pays you for the time that you’re unable to work. STD is only available through your employer. If your employer doesn’t offer it, you will have to use your sick time, vacation time and savings/line of credit to cover your expenses until you return to work. (California, Hawaii, New Jersey, New York and Rhode Island may require your employer to offer this coverage.)

Long-Term Disability

Long-term disability is used when you will be out of work for a longer period. LTD starts after you’ve exhausted sick/vacation time and your short-term disability policy ends, and takes longer to start paying. An emergency fund can bridge the gap between the end of the short-term policy and the beginning of the long-term policy, although, ideally, it should start where the STD ends.

Long-term” doesn’t always mean a permanent disability. It just indicates a medical condition that prevents you from working. The average LTD claim is for 3 years, although some do go on longer. If you don’t have three or more years of savings to cover the loss of income, long-term disability covers some of your income so you can pay your regular bills.

If you’re considering applying for disability through Social Security (SSDI), know that getting it can take a year or more, is difficult to get and approval is not guaranteed. The Herren Law Firm has helped over 4,000 people file claims and suits they needed for disabilities.

What LTD Covers

An LTD policy pays about 60% of your regular income. If you buy your own long-term disability policy and pay your premiums with after-tax dollars, the income from the policy is tax-free. That means with a $100,000 yearly salary, you’ll be paid $60,000 year, tax free.

Employer Or Self Pay?

Most people have long-term disability insurance through their employer, but you can also purchase a policy individually. It is more expensive, but an LTD also pays more, and longer, depending on the policy you chose. When considering cost and affordability, it may be time to do a financial housecleaning and see what you can eliminate from your budget in order to cover an LTD policy. What’s more important—something that doesn’t create value, or something that can save you from bankruptcy if you’re unable to work for a long time?

The length of the payments depends on your LTD policy. Since the average disability is three years, you can purchase a policy that pays as long as five years—or until you retire. Some policies will cover you until age 67, when you can start receiving Social Security. Doctors, nurses and others that use their fine motor skills benefit from this kind of policy, since it guarantees income if they are disabled by an illness.

Need help?

Having trouble with an insurer? Call the Herren Law Office today at (713) 682-8194. We’ll give you a free consultation, and work on a contingency fee basis to help you get what you paid for. We’ve been helping people for over 20 years, and would be happy to help you too.

How to Establish a Service Connection to Your Disability

Filing a claim with the Veterans Affairs (VA) for disability compensation for an illness or disability that resulted from your military service? In an ideal world, Houston area Veterans would be able to receive benefits from the VA simply and painlessly; unfortunately, VA disability benefits are quite complicated, the process can take a fair amount of time, and there is a lot of preparation involved.

Establish a Service Connection to Your Disability | Houston VA Attorney

Nevertheless, when filing a claim, one of the cornerstone pieces of evidence that you need is a connection between your disability or illness and your time in the military. In other words, you need to show the VA that your disability resulted from an incident during your service with a branch of the U.S. military, whether Air Force, Marines, Army, Coast Guard, Navy, or others. By calling Houston veterans disability benefits attorney William Herren, we’ll diligently investigate the details of your claim and build evidence to support that claim. Furthermore, we’ll vigorously fight on your behalf to ensure timely and fair benefits. For a free consultation with our law firm, call our Houston office today at (800) 529-7707.

Five Ways to Establish a Service Connection for Disability, Disease, or Illness

The VA has fairly stringent regulations regarding the establishment of a service connection for disabilities, diseases, and illnesses. To be clear, however, it’s important to note that “service connection” means that the disability was either developed or aggravated during active duty. In general, there are five ways that you can establish a service connection for your VA disability benefits claim. These methods include:

  1. Direct Service Connection — A direct service connection occurs when there is clear evidence that the incident occurred while the veteran was in service. For instance, a Veteran is paralyzed from a back-breaking fall that occurred while he/she was in military parachute training. The Veteran’s disability is clearly connected to his/her military service. Sometimes, if your symptoms manifested before you were discharged, you may not need a medical opinion to establish a link between your service and your disability.
  2. Presumed Service Connection — There are some disabilities, illnesses, and diseases that are “presumed” to be service connected, and the VA has compiled a long list of conditions that are presumed to be service connected during a certain date range. For instance, Veterans who were exposed to Agent Orange during the Vietnam War, and who now have Parkinson’s Disease, are presumed to have a service connection. Some other presumptive conditions include chronic illnesses, tropical illnesses, tuberculosis, multiple sclerosis, and Hansen’s disease, among others. Certain forms of cancer are also presumed to be service-connected in cases where the Veteran was subjected to radiation.
  3. Pre-Existing Injury Aggravated by Military Service — For this service connection, the Veteran had a pre-existing injury that was made worse (aggravated) due to an event that occurred during his/her military service. The condition must have been reported in the Veteran’s entrance medical exam records, and there needs to be evidence that the condition worsened during his/her service connection.
  4. Secondary Service Connection — When one service-connected disability is the cause of another disability, you may have a secondary service connection. The secondary disability doesn’t have to be service-connected, but you do need to show that it wouldn’t have occurred without the service-connected disability. For example, the famous case regards a WWII Veteran who had tuberculosis and was treated with a medicine known for causing hearing loss. The hearing loss occurred because of the service-connected tuberculosis, and so the hearing loss may be considered as a secondary service connection.
  5. Service Connection due to Injury Caused by Treatment in the VA Health Care System — If your disability arose out of VA hospitalization, treatment, rehab, or therapy, then that disability is considered to be service connected.

Establishing a Service Connection for Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder can manifest after your service, and this condition isn’t so black-and-white when it comes to a singular event that occurred during service. For these reasons, the VA has special rules for disability benefit claims involving PTSD. To establish a service connection for PTSD, you’ll need to:

  • Provide a statement regarding the traumatic event(s) that occurred during service
  • Have a diagnosis of PTSD
  • Get an opinion from a VA psychologist or psychiatrist that the stressor (traumatic event) was sufficient to cause PTSD

Call Veterans Disability Lawyer William Herren Today

The disability benefits application process can be time-consuming and it requires a keen attention to detail, especially with regards to documentation and deadlines. By calling Houston VA disability benefits attorney William Herren of Herren Law, we can provide expert legal counsel, guidance, and representation regarding every stage of the application process and, if necessary, the appeal. We also work on a contingent basis, meaning you won’t pay a penny until you get your benefits.

For a free consultation with Herren Law in Houston, call us today at (800) 529-7707.

What is the Pre-Existing Condition Exclusion in Disability Insurance Claims?

All disability claims have limits in what they cover. If you have a group long-term disability policy, there’s a good chance that it includes a complete exclusion for any disabilities caused by a pre-existing condition. Many private long-term disability insurance policies normally include this exclusion as well. To get around this exclusion, some policies force individuals to pay higher premiums for special coverage that does not include this exclusion.

Pre-Existing Condition Exclusion | Houston TX Disability Attorney

With a pre-existing condition, whether physical or mental, you might not be able to receive benefits if your disability arises from the pre-existing conditions. By contacting Herren Law in Houston TX, long-term disability attorney William Herren fully understands the nuances of pre-existing condition exclusions in LTD policies. As such, if you are thinking of claiming disability benefits, call attorney Herren today by dialing (800) 529-7707. Free consultations are always available.

What is the Pre-Existing Condition Exclusion?

A disability insurance pre-existing condition is a mental or physical condition that the applicant has prior to the effective date of the insurance policy. If you have such a condition that you knew about or should have known about for two years prior to the effective date of the policy, then you need to look over your policy, as many LTD insurance policies won’t pay benefits for disabilities coming out of a pre-existing condition.

The company that issued the LTD insurance may deny a claim if it finds that the disability:

  • Resulted from a pre-existing condition which was not disclosed in this policy’s application; and
  • Begins within 2 years after the Policy Date

Additionally, a pre-existing condition is defined as:

  • A condition in which medical treatment was recommended by a doctor or received from a doctor within the 2 year period prior to your Policy Date; or
  • A condition that has caused symptoms within the 1 year period prior to your Policy Date, which would cause an ordinarily prudent person to seek diagnosis, care or treatment.
  • Any condition that was misrepresented or undisclosed at the time of application.

It is important to note that some insurance providers misuse the exclusion to avoid paying disability insurance claims or to delay or deny payment of legitimate claims. As such, when three years or more have elapsed since the onset of a disabling condition which manifested itself from a pre-existing ailment, then, in theory, the insurance company should pay benefits. Nevertheless, the insurance company may still deny benefits, in which it is highly advised to contact an experienced disability insurance attorney.

Disability Insurance and Pre-Existing Conditions

There are virtually endless pre-existing conditions that can form the basis of a disability. However, some of the most common pre-existing conditions to know about include, but are not limited to:

  • Pregnancy — A pregnant woman applying in her first trimester may still receive benefits; nevertheless, the insurance company may deny benefits if she is unable to continue to work as a result of complications arising from her pregnancy.
  • Diabetes — Most people with diabetes have difficulties in even getting a policy. Experts recommend getting the disease under control first to increase chances of finding an insurer.
  • Alcoholism and Drug Use — Getting a disability policy as an alcoholic or drug addict depends on how these conditions contribute to the person’s disabling health condition. A DAA determination (drug and alcohol abuse) will be used to evaluate an applicant.
  • Cancer — Cancer survivors also find difficulties in getting a policy. In general, access to insurance may depend on the individual company or Texas laws.

How to Avoid Claims From Being Denied Because of Pre-Existing Medical Conditions

To minimize the chances of your claim being denied because of a pre-existing medical condition, there are a couple of things you can do. For instance, you should be aware of the medicines you are taking, as some medicines may classify you under a high-risk group. Also, take note of any past injury treatments administered before you purchased your policy; these may be used against your claim. Lastly, simply understand that any record of treatment or surgery that shows you are prone to suffer disability can also be used to deny a claim.

Contact Disability Insurance Attorney William Herren Today!

If your insurance claim is denied due to a pre-existing condition and you might want to appeal, make sure to call Houston TX long-term disability attorney William Herren today. We offer comprehensive legal representation to make sure that your rights are protected and that your voice is heard. In the Houston area, we have helped numerous people just like you with their insurance claims, and we have the resources and legal know-how to represent your interests in front of the major insurance providers, including the Social Security Administration.

For a free, no-obligation consultation with attorney Herren, call Herren Law in Houston today at (713) 682-8194.