How to Appeal a Long-Term Disability Denial

Receiving a disability denial letter can be discouraging, especially when you’re trying to recuperate. The denial means you’ll have to deal with the insurer to find out why and what to do next. The letter will explain why your claim was denied, that you have the right to appeal, and include a deadline by which you must file that appeal. These deadlines are strict, so don’t ignore them, or your claim will be denied.

long term disability denial

Do not be discouraged if you receive a denial letter. Long-term disability claims can be complex, so enlisting the help of a Houston disability attorney can make the process easier and increase your chances for approval.

The Appeals Process

With most insurers, you’ll need to go through the appeals process before you can file any legal action like a lawsuit. Appeals give the insurance company another chance to review your claim and any additional information they did not review before.

The insurer may also request additional information from you, including additional medical records. They may also request an independent medical examination from their doctor, or a functional capacity evaluation to determine if they can work at any job.

In many cases, insurance companies issue more than one denial, but you still have an opportunity to appeal a second time. Once again, you’ll receive a strict deadline by which you must file your appeal, so make sure you submit your appeal timely.

Additional Documentation

Your first step is to request a copy of your claims file from the insurer. You’ll see what the company is working with, and what you need to do to file your appeal. If you have already enlisted the help of a Houston disability attorney, they can help in getting your copy of the file.

Your file should contain as much information as you need to support your claim and show that your condition warrants long-term disability. This can include:

• Medical reports from your medical providers, such as your primary care physician, along with any specialists who are involved in your care and treatment.

• Letters of support from your healthcare providers, vocational evaluation experts, and others directly involved in your claim.

• Information that clarifies or further explains anything that was overlooked or not correctly determined in the denial

• Any other information that clears up any legal mistakes or other misunderstandings that led to the denial of your claim

Once you’ve completed your due diligence and gathered additional information, work with your disability attorney to begin your appeal. You may need additional information, and your attorney can help you obtain the rest for your claim, and then draft your letter of appeal.

When Can I Sue?

If your long-term insurance is employer-provided, you’ll need to go through the entire appeals process first. After you’ve exhausted all your appeals rights, you can then file a lawsuit under ERISA (Employment Retirement Income Security Act.) However, if you bought your policy yourself, the policy is regulated by insurance laws in the State of Texas.

The evidence submitted for your claim and appeals will become part of the lawsuit.

When you’ve decided to pursue litigation, work with an attorney who has experience with disability claims and understands the process.

Your Houston LTD Disability Attorney

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

We’ve helped over 4,000 Houstonians receive 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 a fee if we win your case.

Is Anxiety a Long-Term Disability?

Anxiety Can Be a Debilitating Condition That Can Cause Long-Term Disability

After an upsetting life event, such as losing a loved one, going through a divorce, or losing a job, it’s understandable that a person might find themselves feeling anxious or depressed. But if the anxiety continues long after the event, it becomes chronic and may lead to something more complex.

Anxiety Can Be a Debilitating Condition That Can Cause Long-Term Disability

Anxiety and anxiety disorders can be a crippling and disabling medical conditions for some. If you are experiencing anxiety symptoms that are preventing you from working and everyday life, long-term disability may give you a period in which to receive treatment and recover. But it’s not as easy as it sounds, and denials are common.

Generalized Anxiety Disorder (GAD)

While anxiety can visit most people at any time, individuals with chronic anxiety experience symptoms such as insomnia or hypersomnia, chronic fatigue, and cognitive issues such as lack of concentration. For many people, these impediments are temporary, or manageable to the point where they can work without a problem.

However, GAD may also include symptoms such as:

• Irritability and agitation
• Heart racing
• Restlessness
• Shortness of breath
• Muscle tension
• Grinding of teeth that leads to jaw pain
• Panic, fear, dread, and excessive worrying

These symptoms and others can lead to functional impairment that directly impacts your daily life and employment.

Proving Disability

As with any medical condition, you’ll first have to demonstrate to your insurer that you are, in fact, disabled. Mental conditions such as anxiety will require a more thorough degree of proof.

An evaluator will review all of your medical records, including treatments. This includes things such as weekly visits to a therapist, psychologist, psychotherapist, or psychiatrist, and any prescriptions for your condition.

It’s also important that the evaluator see that not only are you following through with treatment, but your provider is also offering the correct standard of care. This means that although they have prescribed treatment, they must also follow through with monitoring your progress, make adjustments, or even change medication as necessary. If you believe your current provider isn’t offering the correct standard of care, you should seek out another provider, or at least a second opinion.

A strong indicator of disability would be if your doctor suggested you would benefit from hospitalization or intensive outpatient treatment. For that period, you would be unavailable for work which shows that your condition is incompatible with regular employment.

Documentation and letters from your treating physician that describe and support your diagnosis should also be included in your case file. This would include medical records and notes from therapy that describe your ability and limitations on employment-related activities. Your doctor should include specific and distinct restrictions and limitations on your abilities that detail your limitations, rather than generalized statements such as “inability to tolerate stress.”

Mental Illness Limitations

Many LTD policies have strict limits on anxiety and other mental illnesses, which are typically 24 months, or two years. After the period ends, your benefits run out. Some policies may specifically exclude mental illnesses entirely. However, some conditions may have an exemption; that’s why it’s important to read your policy carefully to find out.

A disability attorney can help you with record gathering and make sure your application and claim file has everything you need for a successful LTD claim.

Houston’s LTD Disability Attorney

Over 4,000 Houstonians have come to us for help with LTD claims. The Herren Law Firm can help you with your application, appeals, and through the process. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, no up-front fees, and we only collect if we win your case.

What is VOC Rehab, In Houston?

For anyone in Houston who has a type of disability and wants to work, vocational rehabilitation, or VOC Rehab, maybe an answer.

The VOC Rehab program is administered through the Texas Workforce Commission (TWC) in conjunction with the Rehabilitation Council of Texas. The TWC’s program assists those with disabilities to train for, find, and maintain gainful employment. The program also works with employers and businesses to recruit, keep, and accommodate employees with disabilities.

What is "VOC Rehab” In Houston?

Eligibility

If you have a disability that makes it difficult for you to find and/or keep employment and need services in order to get to the point of employment, TWC’s VOC Rehab program may be able to help you get to that point.

Disabilities such as:

  • Learning, developmental and intellectual
  • Physical disabilities such as:
    • Paralysis
    • Impaired movement
    • Back injuries
    • Spinal and brain injuries
  • Drug or alcohol addiction
  • Hearing impairment
  • Behavioral/mental health conditions
  • Visual impairments including blindness

You can apply for these services at your Texas Workforce Solutions Vocational Rehabilitation Services office, call TWC Vocational Rehabilitation Inquiries at 800-628-5115, or by email at customers@twc.state.tx.us. Include your name, address (including city, state, and zip code) and your phone number in your email.

There are services for both adults and for youth and students and are based on need and eligibility. Youth services include vocational counseling and opportunities for post-secondary education, as well as on-the-job training and internships.

For Veterans: Vocational Rehab & Employment

If you’re a veteran, there are additional services available that can help you if you have a service-connected disability.

The VA has its own VR&E program to offer veterans the assistance they need to find employment and achieve independent living.

If you:

  • Received a discharge that was not dishonorable
  • Have at least a 10% disability rating from the VA, and
  • You apply for VR&E services

Your period of eligibility will end 12 years from the date you separated from active-duty military status, or the date you received notice of your first VA disability rating for a service-connected condition. If your vocational rehabilitation counselor (VRC) finds that you have a serious employment handicap, the period could be extended.

Active-duty military members who are “short-timers” (leaving the military soon) may also be eligible for VR&E if they have a 20% or higher pre-discharge disability rating (a “memorandum rating”), participating in the Integrated Disability Evaluation System (IDES) process, or are awaiting discharge due to a service-connected injury or illness that occurred in the line of duty.

VR&E services can include, as needed:

  • Skillset and abilities evaluation for employment
  • Vocational counseling
  • Job readiness training, including resume preparation and job training
  • On the job training (OJT), including apprenticeships and unpaid work opportunities
  • Post-secondary training at a college, business school, vo-tech or trade school
  • Supportive rehabilitation services as needed (i.e., counseling, medical referrals, case management, etc.)
  • Assistance finding and keeping a job, which may include special employer incentives and job accommodations

You can find out more about these benefits here and submit your application here.

We’re Ready To Help

The Herren Law Firm has helped over 4,000 Houstonians get the veteran’s benefits they deserve, and we’ll be happy to help you get yours. Call us at (713) 682-8194 or (800) 529-7707 or use our online contact form for a free consultation. You can ask questions, and we can discuss your legal options. We offer a contingency fee arrangement, and you won’t owe us anything unless we win your case.

 

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.

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