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

July 18, 2017 by

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 30 years, and would be happy to help you too.

Filed Under: Uncategorized Tagged With: , ,

How to Establish a Service Connection to Your Disability

May 2, 2017 by

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.

Filed Under: Veterans Disability Tagged With: , , ,

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

March 28, 2017 by

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.

Filed Under: Long Term Disability Tagged With: , ,

What is “Gainful Employment” for Long Term Disability?

February 13, 2017 by

When trying to better understand long-term disability, or when applying for disability benefits for your long-term disability, one term that you may come across is “gainful employment.” In short, this term refers to an LTD applicant’s ability to work, and if an individual is unable to engage in a substantial gainful activity (SGA), then he/she may be eligible to receive long-term disability benefits for his/her disability.

What Is "Gainful Employment" for Long Term Disability? - Herren Law

More specifically, if you are unable to hold any job where you would make 60-80% of your pre-disability earnings, then your long-term disability provider should pay benefits. Whether you are applying for LTD benefits, or the gainful employment aspect of your application is giving you troubles, then call Houston LTD attorney William Herren today. With decades of experience helping individuals like you, we fully understand the legal processes, what insurance companies are looking for, and how you can optimize your application.

We work on a contingency basis, and so you won’t pay a thing unless we win your case. For a free consultation with Houston attorney Bill Herren, call Herren Law today at (800) 529-7707.

What is a Gainful Occupation?

LTD policies often define “disability” in one of two ways, including:

  • Own Occupation: Your disability prevents you from the duties of your own occupation.
  • Any Occupation: Your disability prevents you from working in any gainful occupation for which you are reasonably suited, considering your education, training, and experience.

If you are able to work in any gainful employment, there is a higher possibility that your insurance company will deny your benefits. Furthermore, many LTD policies shift from “own occupation” to “any occupation” after a period of time (usually, it’s 24 months). This allows disabled individuals to find work outside of their own occupation.

Most LTD policies define “gainful employment,” however, as a job that is able to provide you with at least 60% of your pre-disability wages. Keep in mind that this 60% number is not universal, and so it’s important to refer to your specific LTD policy.

How Do You Know If You’re Reasonably Suited to Work?

In addition to understanding “gainful employment,” you also need to understand whether or not an LTD policy considers you as “reasonably suited” to work in your own occupation or any occupation. As you can imagine, the word “reasonably” is broad and open to interpretation, but in most cases, “reasonable suited” refers to an individual’s location, skills, education, and limitations.

An occupation would be considered “unreasonable” if some of the following factors apply:

  • There are few or no occupations available that are within a reasonable commute from your home.
  • The occupations available are beyond your skills or education level.
  • The occupation will interfere with your regular medical appointments, if applicable.
  • Your doctor has not provided a release that allows you to perform the tasks required of the occupation.

When submitting your application for LTD disability benefits, it’s very important to include as much evidence and information as you can. This information should include an opinion from your doctor that fully explains your working limitations, allowing the LTD provider to better assess your limitations as well as what types of jobs, if any, you’d be reasonably suitable to do.

Who Determines Whether You Work at Another Job?

Although you’ll be submitting your LTD benefits application to your insurance provider, your insurance provider will often work with vocational experts (VEs) to determine your employment possibilities and the compensation offered at various types of jobs available to you.

When making these assessments, the VE should be an expert in his/her field and rely on a number of sources, such as the Bureau of Labor Statistics, among others.

With the help of an LTD benefits attorney, your attorney should cross-examine the VE associated with your case, while making sure that the VE has all of the information he/she needs to know. A good attorney will also try to elicit a favorable response from the VE.

Call Houston LTD Attorney Bill Herren

Many insurance companies employ a long, complex rubric when determining whether an applicant has a disability that prevents him/her from working in his/her own occupation or any occupation. Showing your ability, or inability, for gainful employment will be an essential component for winning your LTD benefits case.

As such, you’ll need an experienced and capable attorney at the helm of your case, making sure that all of the necessary information is included in your application. For a free, no-obligation consultation with Houston attorney William Herren, call our law office today at (800) 529-7707.

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

What is ERISA and How Does It Affect My Long Term Disability Case?

November 23, 2016 by

ERISA & Long-Term Disability Claims Attorney | Houston TX Herren Law

ERISA is an acronym for the Employee Retirement Income Security Act, and ERISA is a federal law originally designed to protect workers from the possibility of bankrupt pension plans. Additionally, ERISA included provisions regarding disability and long-term disability. One of the most important distinctions of ERISA, compared to long-term disability plans, is that ERISA only really applies when you receive a plan offered by private employers (not churches or government organizations).

If you’re unsure of how ERISA affects your long term disability (LTD) case, and you’ve suffered a disability that prevents you from working, make sure to call Houston LTD benefits attorney William Herren as soon as possible. Whether you’re in the beginning stages of preparing your claim, or you’ve received a benefits claim denial and you need to appeal the decision, we at Herren Law boast the resources and legal know-how to give you a strong, thorough representation. We work on a contingency basis, which means that we won’t accept a fee unless you win your case with us by your side. To speak with Houston attorney William Herren, call Herren Law today at (713) 682-8194.

In the meantime, you can learn more about ERISA and LTD claims below.

Understanding Long Term Disability and ERISA

As mentioned above, ERISA applies to employer-provided insurance policies. If you have purchased long term disability insurance directly from an insurer (rather than receiving it as an employee benefit), then ERISA probably doesn’t apply. In this case, the laws regarding your insurance plan will most likely come from the State.

Although the original idea for ERISA was to protect workers, it is now known as an extremely pro-insurance law. This is why you need to understand ERISA and your long term disability plan, as you need to be prepared for the claim process and how ERISA affects your disability benefits claim. For example, ERISA claims can be very drawn out. Before you’re able to file a federal lawsuit regarding your benefits claim, you will need to exhaust any and all processes with the insurer; this means that you will need to go through the in-house appeal process with your insurance carrier before filing a lawsuit with ERISA.

Furthermore, the time to appeal in ERISA cases is limited. After receiving a claim denial, you have only 180 days to appeal; after filing the appeal, your insurers will have up to 90 days to make a decision. This means that you’ll be in a “limbo” for up to 270 days, all while you’re disabled and unable to work and bring in an income.

How ERISA Affects a Claim for Long Term Disability Benefits

For employees of private companies, ERISA will probably apply to your long term disability case. Keep in mind that ERISA statutes are long-winded and incredibly complex, and how ERISA will affect your disability case depends on the unique circumstances of your disability claim and other factors. Nonetheless, with decades of experience as a Houston disability benefits attorney, we at Herren Law have witnessed a few ways that ERISA affects long term disability cases. Below, we’ve included just a few of these ways:

  • Following a denial of benefits, ERISA requires that the disability insurance plan must provide the claimant with copies of documents, records, and any other information that is relevant to the claim.
  • If a claimant fails to appeal within ERISA’s guidelines (180 days), then the claimant forfeits his/her rights to appeal or file a lawsuit later on.
  • ERISA requires that the insurance company must make an appeal determination within 90 days of receiving the appeal.
  • Some disability benefits plans require two appeals, but ERISA specifically states that plans cannot require a claimant to file more than two appeals before filing a civil lawsuit.
  • After exhausting the appeal process, a claimant may file a civil lawsuit, but due to ERISA, the claimant must file in federal courts.
  • ERISA preempts state laws, which means that disability claims under ERISA cannot include bad faith damages as well as damages for pain and suffering.
  • The federal court’s review will ordinarily be limited to evidence available at the time of the final determination. Limited discovery is allowed in some ERISA claims.

Contact Houston LTD Attorney William Herren Today

Despite the long and complex regulations set forth by ERISA, some of the most important pieces of information include the appeal process as well as the deadline for appeal. With years of experience dealing with long term disability claims and ERISA cases, we at Herren Law have the in-depth legal knowledge and litigation strategies that you need to put forward a strong and comprehensive case. For a free, no-obligation consultation with our Houston-based firm, call long term disability attorney William Herren today at (713) 682-8194.

Filed Under: Long Term Disability Tagged With: , ,
« Previous Page
MENU
Call Now Button