Mental Illness and Long-Term Disability: Understanding Coverage for Depression and Anxiety

January 18, 2024 by

Most long-term disability policies cover conditions that prevent a person from working for an extended period but will eventually be resolved. The person will eventually return to work. A mental illness disability can also interfere with a person’s life, leading to functional impairments that can prevent them from working. The World Health Organization reports that depression is a leading cause of disability worldwide.

mental health and long term disability

Depression, anxiety, and other mental illnesses must be diagnosed and documented just like any other physical condition. In many cases, these illnesses also exhibit physical symptoms like fatigue, headaches, and other aches and pains that do not resolve. But since there isn’t a physical diagnostic like an X-ray or a blood test that shows mental illness, you’ll need to show proof that it’s as equally disabling as a physical injury.

What The Policy Says

If you’re planning to file for long-term disability for depression, the first thing you need to do is read your policy. You need to know if it allows for mental illness, and for how long.

Typically, LTD coverage for mental illness is 12 to 24 months. If that’s the case, you will only have one to two years of coverage, maximum. Benefits will end once the period ends, and the severity of your illness will no longer matter.

Some policies consider mental illness an “exclusion.” That is, the policy does not offer LTD benefits for any type of mental illness. You’ll need to know this before you begin your application.

Proving Disability

To have a successful LTD claim for depression, anxiety, or other mental illness, you’ll have to prove that it meets the definition of “disability” that’s described in your policy. This also requires you to demonstrate that your symptoms are severe enough to prevent you from performing the primary functions of your occupation. Some policies may go so far as to require proof that the symptoms prevent you from working in any occupation.

An insurer wants to see that you are undergoing treatment and doing what’s needed to improve your symptoms. Regular medical care is essential to show that there is a debilitating mental illness present and that you are actively working to resolve it. Without medical care, the insurer can deny your claim or terminate your benefits for non-compliance and lack of medical care.

You should also ensure that your medical records with your treating physician are accurate and complete. Document all appointments and treatments you receive, including medications and their side effects.

Your treating physician is a vital link in the process, and your insurer will require input from them. This includes doctor’s reports that include:

• The occurrence and intensity of your symptoms

• Any favorable findings in the mental status examination

• Their firsthand observations of you during office visits

• The precise restrictions and limitations hindering your ability to work

If your mental illness is due to objective cognitive problems, your benefits may be extended beyond the policy’s standard limits. Your physician may request a neuropsychological evaluation to measure your cognitive deficits. This testing can provide more substantial evidence of mental illness and the disability that it causes.

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 will only collect a fee if we win your case.

Filed Under: mental health disability Tagged With: , ,

What is VOC Rehab, In Houston?

July 10, 2020 by

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.

 

Filed Under: Long Term Disability Tagged With: , ,

Reasons For Long Term Disability Denial Of Claim

March 3, 2020 by

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

Reasons For Long Term Disability Denial Of Claim

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

They’re Watching You

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

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

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

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

Not Enough Medical Evidence

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

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

Missed Deadlines

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

You Don’t Meet Their Definition Of “Disabled”

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

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

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

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

Your Houston LTD Disability Attorney

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

Filed Under: Long Term Disability Tagged With: , ,

How To Increase Your Odds Of Being Awarded Social Security Disability Benefits On Your First Try

March 4, 2019 by

Many people are denied when they first apply for Houston Social Security disability benefits. In fact, over 65% are denied on their first application, meaning less than 40% of applicants are approved. So what’s the difference?

Houston Social Security Disability Benefits

The Application Process

Contrary to popular belief, it isn’t SSA’s policy to delay and deny claims the first time around. One of the biggest reasons for an initial denial is an incomplete application form.

You’ll start with the application, and go from there. The Social Security Administration has a printable checklist on its website, along with instructions to complete it. You can download, print, and use this checklist to complete your initial application. If you meet certain conditions, you may be able to complete your application online, without visiting your Social Security office.

Your eligibility assessment is also assessed on your previous work history.

It’s important to have all of the requested information as well as medical information. If you haven’t been under the care of a physician, you may have a more difficult time proving a medical disability. You would need a very good reason, such as not having medical insurance or not being able to afford any, but you still have a very high chance of denial.

Ways To Increase Your Odds Of Approval

  1. File Your Claim Immediately. Getting approved for benefits can be a very long process, and if you wait, your disability insurance may expire. You will have to have worked five of the last ten years to be eligible, and waiting to apply may be too late.
  2. Get Help With Your Application If You Need It. Mistakes and missing information are the main reasons applications are denied. Contact a disability attorney, a family member, or someone from a Social Security field office for help.
  3. Find A Disability Attorney If You Have To Appeal. An attorney who specializes in disability work will know what to do and how to do it, and make sure you’ve done everything correctly by the deadline. More applicants win on appeal with an attorney than without.
  4. Keep Up With Doctor Visits And Medical Treatment. If your disability requires medical treatment, keep up with every appointment, test, prescription and doctor visit. Failing to seek medical treatment for your condition will lead SSA to believe that your condition is not serious enough to warrant disability. SSA believes you should be seen by a “provider” every two months. If you’ve lost your health insurance, using local “free clinics” or other available care may satisfy the requirement. You should also keep up with prescribed medications.
  5. Request An RFC Form From Your Physician. The Residual Functional Capacity (RFC) form is used by examiners to determine your functional ability with your medical condition. These forms are needed to close out a case, and are usually completed by a DDS physician or psychologist. If your treating physician completes it, the claims examiner may use it to create an internal RFC for your case.
  6. Use A Businesslike Demeanor With Everyone You Deal With. In other words, be nice, or it could make your journey a lot more difficult. Caseworkers deal with hundreds of individuals every day in the same situation, and losing your temper or being rude can lead to even more delays in your case. No matter what the situation, be polite and cordial no matter what the situation to maintain good relations and communications.
  7. Contact Your Local SSA Office or Office of Disability Determination Services to check on your case’s status. Don’t make the mistake of calling SSA’s toll-free number, where they don’t have the most current information. Contact the office where you made your application, or the Office of Disability Adjudication and Review if a hearing has been requested.

Why Are More Applicants Approved On Appeal?

It’s a little odd, but true. Administrative hearings may take a year or more to be scheduled. A individual’s disability progresses in that time, increasing his or her inability to work. When appearing in front of an administrative judge, he or she will see you face-to-face and determine disability on sight, rather than on paper. If it’s obvious from seeing you that you’re unable to work, as it is in a hearing, your chances of approval increase as well.

Of the applicants that file an appeal, 60% who hire a disability attorney are approved, compared to the 34% who don’t have legal counsel. A disability attorney who is experienced with Social Security disability claims is familiar with the application and appeals process, and can guide you through it.

Houston Social Security Disability Benefits Attorney

Getting disability is a long process, but we can make it easier. We’ve helped over 4,000 Houstonians win their claims and get the benefits they need. We have the experience to help you with your Social Security application and/or appeals process.  The Herren Law Firm can help you with your application and any necessary appeals. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

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

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

September 14, 2018 by

If you’re one of the 28 million Americans who suffer with migraines, you know the signs when you’re getting one. Lethargy, increases in pain and the so-called “auras” are sure indicators that it’s about to happen. You may have stressors or triggers that bring on a migraine (like a smell or bright light) that tell you it’s coming. Once that happens, you know you’re down for the count until it passes.

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

You may have relatives, friends or coworkers who don’t offer support. You may even hear the comment, “but you don’t LOOK sick.”  You know you’re in pain, even if they don’t. Medications have varying degrees of effectiveness; some don’t help at all. And if you go to work anyway, instead of staying home, you know your quality of work will suffer until it passes. Meantime, you manage the best you can.

What Is A Migraine?

A migraine is a headache and condition that can seriously impact your quality of life. According to Migraine.com, migraines are the 7th leading cause of disability worldwide. Common symptoms include:

  • Light and/or sound sensitivity
  • Throbbing headaches
  • Blurred vision or other visual disruptions
  • Nausea
  • An “aura”—visual disturbances that includes blind spots, flashing lights, zig-zagging lines, and/or “seeing stars”

There may be other accompanying symptoms, such as fatigue and/or lethargy. Migraine episodes typically last 4 hours to 72 hours. These symptoms can also make work, social events and other everyday activities difficult or impossible to engage in.

Proving The Disability

Getting disability for migraine conditions can be difficult, even though one in four households are likely to have someone who suffers with it. As a neurological condition that’s not visible or diagnosed by a regular blood test, filing for long-term disability can be more difficult.

Note that “self-reporting” your condition may severely limit your benefits, or see them declined Migraines aren’t obvious or detectible through conventional medical testing. Supplying sufficient evidence to prove your inability to work is essential, so you’ll need to use other means of reporting to support your claim. Insurance companies want objective evidence for your diagnosis. A series of documentation will be required to successfully defend your claim, including:

·         Your own journal: record everything related to your condition truthfully and thoroughly—pain, frequency, intensity, severity, treatment, and your level of difficulty. Include dates, times, duration, and other relevant details, i.e., hospital visits, treatments given, side effects of medicines, etc. Your physician may include a review of your notes in your patient record, making it part of any claim evidence.

·         Work with your doctor: you’ll need your doctor’s support for your claim, so you’ll need to follow his or her instructions, including taking prescribed medications. If you’re unable to comply with your physician’s instructions (i.e., side effects of medication) make sure to inform him or her of these difficulties. Their records should indicate that you are doing your best to follow their instructions.

·         Other documentation to support your disability claim: this should include days missed from work, test results taken to rule out any other conditions, any treatments or medications you tried, their effectiveness, and any side effects

·         Testimony from family/friends supporting your activities that are limited by the headaches

·         Your doctor’s notes about your migraines (intensity, frequency, severity, etc.), and if these headaches are compounded by other illnesses or injuries.

·         Records of any hospital visits (including ER) related to your migraines

·         If you’re a veteran, medical evidence verifying the service-related connection, such as an incident that occurred during service time, or that it’s related to another service-related condition.

Migraines As A Catalyst

As painful as migraines are, they can also be a catalyst for additional conditions, such as fatigue, depression, sleep disorders, additional pain as well as other conditions.  If you also experience the “aura” symptoms, you may also be at increased risk for strokes and heart attacks.

Houston’s Attorney For Long-Term Disability Help

Filling for LTD can be a chore under the best of circumstances. With a condition like migraines, it’s more complicated, and of course, can be more difficult. But an attorney experienced in disability filings and appeals can help you gather the necessary information needed to file and increase your chances for a successful outcome.

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 concentrate on getting better. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

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

What Kind Of Disability Benefits Can You Expect In Houston, TX?

August 30, 2018 by

If you’re applying for disability for the first time, you may be wondering what to expect after your application is approved and you’re successful. Of course, every case is different, and we can’t give specific legal advice here. But if you’re getting ready to apply for disability benefits, we can offer a general idea of what you might be able to receive.

What Kind Of Disability Benefits Can You Expect In Houston, TX?

Two Types Of Disability

Disability comes in two versions: SSDI and SSI. While they’re both commonly called “Social Security,” they’re slightly different, but use the same means for determining disability.

  • Supplemental Security Income—for those who have never worked, and/or have limited income. SSI is need-based, and is not related to work history. To apply, you must have less than $2,000 in assets of any kind (cash, stocks, bonds, life insurance, etc.) as an individual, or $3,000 as a couple.
  • Social Security Disability Insurance—for those who have worked and earned enough “work credits,” this program is paid into through payroll taxes (visible on your paycheck stub and W-2.) SSDI pays you or certain members of your family if you worked long enough and paid Social Security taxes through regular payroll deductions. You’ll also need to be “medically eligible,” that is, have a long term severe and total disability that keeps you from doing “substantial gainful activity.”

It’s also possible to receive both SSDI and SSI at the same time, depending on your situation. The current maximum federal benefit rate is $750. Should your SSDI fall below that, SSI could make up the difference, depending on what other incomes you may have. However, if you are living with someone, and they are providing food and/or shelter without charge, these “in kind” benefits can be subtracted from your monthly benefit checks.

Texas Disability Benefits

Once you’ve applied for either SSI or SSDI, your claim file is sent to the Texas’s Disability Determination Services (DDS) agency, part of the state’s Department of Assistive and Rehabilitation Services (DARS). DDS claim examiners will review your file, including medical information, and decide whether you meet Social Security’s disability definition. If your claim is denied, you can request a DDS reconsideration.

If you’re eligible for SSI in Texas, you are automatically eligible for Medicare, and should be automatically enrolled. If you’re not automatically enrolled, you should contact your local Social Security to ask about it. You may also be eligible for SNAP benefits (also known as “food stamps.”) These depend on where you live and what your monthly income is.

For disability recipients in who receive Medicare-paid institutional care, Texas adds $60 for those with “countable income” of less than $60 per month. Additionally, as a resident in institutional care, you would only be able to keep $30 of your federal SSI payments.

While Texas doesn’t award additional disability benefits, the state offers additional resources and programs for individuals who are on disability. You can find some Texas disability resources here.

The Texas Health and Human Services Commission is also available to help with applying for SSI, SSDI and SNAP benefits, as well as independent living services. You can call 211 from anywhere in Texas, or go to Your Texas Benefits website to find a local office.

Assistance is available in the City of Houston through The Houston Mayor’s Office For People With Disabilities. You can contact them by calling 832-394-0814, or email at mopdmail@houstontx.gov.

Waiting Periods

SSDI has a five-month waiting period to begin benefits. Even if your disability is approved on the first try, you won’t be receiving checks until at least the fifth completed month after you become disabled. However, it’s more likely that approval will take six months to a year. Once your payments start, you’ll also receive a “backpay” lump sum for the months you were eligible but weren’t paid.

Your Houston LTD Disability Attorney

Most attorneys aren’t familiar with the intricacies of disability filings, but we are. With over 4,000 successful cases, we focus on helping disabled people receive the benefits they need. We’ve handled multiple situations that are similar to yours. We have the experience to help you through the process for a successful outcome.  The Herren Law Firm can help you with your application, any necessary appeals and help you get the disability benefits you need so you can live your life. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation, and no up-front fees.  We only collect if we win your case.

 

Filed Under: Long Term Disability Tagged With: , ,

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

July 31, 2018 by

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.

 

Filed Under: Long Term Disability Tagged With: , ,

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

June 27, 2018 by

After months of wondering, you’ve finally received a diagnosis for your chronic pain: fibromyalgia. Maybe you have increasing symptoms, or you’re taking off a little more work than you’d like because you’re in pain and tired all the time. Or you need to take some time off to take care of yourself.  Is it time to retire and take long-term disability? Or have you reached the point where you can’t get through the day at work anymore?

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

Fibromyalgia afflicts as many as an estimated 10 million Americans but doesn’t have a specific diagnostic (like a blood test.) Characterized by widespread chronic pain, fatigue, and sensitive sore spots, the causes and workings elude doctors and refuse to be nailed down.

People who have fibromyalgia live with varying degrees of pain, fatigue, difficulty concentrating (called “fibro-fog” by patients), depression, and other symptoms that leave them eventually unable to work. It’s known as an “invisible illness” because of the difficulty of diagnosis. Fibro is also thought of as a “women’s disease,” since women are more likely to be diagnosed with it than men.

So what makes fibromyalgia so difficult? And why do insurers turn down claims for fibromyalgia so often?

Mental or Physical?

As anyone with fibromyalgia will tell you, they frequently hurt all over, and they’re tired, but they’re not crazy.

Even with repeated trips to their physicians, there’s no way to definitively diagnose fibro, unlike diabetes or cancer. Insurers tend to think of it as a mental illness that manifests itself physically rather than a specific illness with obvious physical causes. Many label fibro as a “subjective” illness, and therefore mental. Most policies cap mental illness benefits at 24 months, leaving you without benefits after that point.

Proving Your Claim

If fibromyalgia can’t be diagnosed with actual physical proof and standard medical testing, how do you prove it?

  • Relevant medical records—fibromyalgia is an illness with symptoms that are self-reported; there is no medical testing available. Your doctor will have to make a clear diagnosis in the records, not vague like “reporting symptoms of fibromyalgia.”
  • In addition to your regular physician, a rheumatologist can also give a positive diagnosis for fibro, which includes testing “tender points.” If you have 11 of the 18 points, you’ll usually receive a positive diagnosis.
  • Repeated occurrences of at least six fibromyalgia symptoms (fatigue, memory problems, depression, anxiety, muscle weakness, dizziness, abdominal pain, etc.)
  • Lab tests—while there are no specific diagnostic tests for fibro, any tests taken to rule out other conditions (i.e., hypothyroidism) should be documented with results.
  • Doctor’s opinions—any additional opinions you get should also be in writing.
  • First-hand statements from family and associates—these are strong evidence that you are having difficulties in everyday life because of fibro.
  • Keep a diary of all your symptoms, physical and mental, and use it both in doctor visits and in your claim file.

Increasing Your Chances Of Approval

While there are no guarantees, there are some things you can do to improve your chances of getting long-term disability payments for fibromyalgia.

  • A confirmed diagnosis from your rheumatologist
  • Relevant related medical records (lab tests, prescriptions, hospital visits, etc.)
  • Dates of visits and contact information for doctors, therapists, hospitals, etc.
  • Doctor’s report on the extent of your work-related limitations
  • Any treatments you are currently receiving

A lawyer should supply you with an assessment form for your doctor to complete that asks for greater detail of your limitations than an insurance company might provide.

Hiring a Houston lawyer experienced in long-term disability claims and who understands the law around long-term disability claims can help ensure that you’re following the process properly. He or she can also work with you to submit any appeals that you’re allowed to.

Don’t Let Fibromyalgia Stop You

If your insurance company has denied you benefits based on fibromyalgia, we’re ready to help you. The Herren Law Firm in Houston, TX can assist with your application, appeals and help you get the long-term disability benefits you need so you can get the help and medical care you need. Contact us today at 713-682-8194 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.

Filed Under: Long Term Disability Tagged With: , ,

FINALLY Get The Long-Term Disability You Deserve In 2018

January 31, 2018 by

If you’ve been out of work after a disabling accident, illness or injury, chances are you have a lot going on at once. Between doctor visits and other necessary outings, you’re taking care of yourself and trying to heal while dealing with insurance company requirements. But what about long-term disability?

FINALLY Get The Long-Term Disability You Deserve In 2018

Are you trying to get long-term disability, or headed in that direction? Here are a few things you need to know.

Disability Defined

The definition of your disability is whatever your policy says it is. But the policy definition, rules and exclusions define what they consider to be “disabled.” Your policy definition may look something like this:

Disability exists when, due to illness or accidental injury, you are not able to perform, for wage or profit, the material and substantial duties of your regular occupation.

This definition, known as “own occupation,” means that your illness or injury prevents you from performing your current job and/or occupation. However, an “any job” definition means that you may not be able to perform your current job/occupation, but you are well enough to perform another one, even if it pays less than your current salary. This assessment is also based on your training, education, and experience.

Some policies change from “own occupation” to “any occupation” after 24 months, and benefits may be terminated at that time, particularly if there has been significant medical improvement.

Are You Still Using Paid Time Off?

Long-term disability has a waiting or “elimination” period, generally three to six months, before you’re eligible. You’re required to exhaust all of your sick, vacation, personal and any other paid absence time before you can become eligible for LTO.

Short-Term Disability

The elimination period LTD also takes into account the short-term disability payments you may be receiving. This type of insurance typically lasts less than six months and is intended for a short-term illness that isn’t work-related.

Long-term disability starts when your short-term disability ends.

Short-term disability differs from worker’s compensation, which is for employees who have work-related injuries and/or are injured on the job.

The Length Of Long-Term Disability

LTD starts three to six months after your disability begins, and after you’ve exhausted all time off and short-term disability.

Some policies will pay you until the age of 65 when most people generally retire and will file for Social Security (retirement) and Medicare. If not, there is a limit to the number of years the policy will pay you. Most will pay between 50% and 80% of your former salary.

Social Security Disability Insurance

Most LTD policies will require you to apply for SSDI. If and when your SSDI application is approved, and you start receiving benefits, your LTD payments will be offset by that amount. For instance, if your monthly LTD payment is $2500, and you’re awarded $1800 in SSDI, your insurance company will reduce your LTD payments by that amount, to $700 per month. You’ll still receive $2500 a month, but not from one source.

Working While Collecting LTD

It is possible (although not necessarily recommended) to work while you’re collecting long-term disability. Your benefits could be cut or terminated, particularly if you make too much. Before you start sending out resumes for a new job, even for part-time work, it’s best to read your policy and make sure you understand it first. Speak to your claims administrator to answer any questions.

Some policies may discontinue your benefits even if you’re still technically disabled, especially if you make more than 80% of your previous income. If yours is an “own occupation” policy, you may be able to work in a different occupation and still collect LTD. Again, this is based on how the policy is written, so you’ll need to read it before you start.

Some policies have “return to work” incentives, limiting your benefits and income to 100% of your previous earnings. If your earnings and LTD payments exceed 100% of your previous income, your benefits will be reduced to your pre-disability earnings and will reduce further over time.

Denied Your LTD?

If your insurance company (or your employers) has unfairly denied your claim, stopped your benefits or you need help filing an appeal, The Herren Law Firm is ready to help. We’ve helped over 4.000 Houstonians with their long-term disability cases and can answer any questions.  Call us at (713) 682-8194 or (800) 529-7707 for a free consultation. Our contingency fee arrangement means you won’t owe us anything unless we win your case.

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

Can I Receive Long Term Disability While on FMLA Leave?

December 28, 2017 by

If you find yourself needing to take time from your job for an illness, injury, pregnancy or other reason, there are a lot of things you’ll need to address. Replacing your income via disability insurance is one important factor to consider, particularly if your leave is unexpected. Here are some things to know when going on FMLA leave.

Can I Receive Long Term Disability While on FMLA Leave?

Long Term and Short Term Disability are two separate insurance policies that many people get through their employer. They’re used separately as well as in conjunction when you’re injured and can’t work.

To better answer this question, let’s examine the parts of it first.

FMLA

The Family Medical Leave Act of 1993 (FMLA) is a law that allows workers 12 weeks of unpaid leave for a variety of medial or family reasons. Your job is protected because your employer is required to hold your job for those 12 weeks. (Many states, localities and municipalities have also adopted their own supplemental “family leave” styled policies.) When you’re able to go back to work, you’ll return to that job or one that is “substantially similar,” assuming you are still able to do your job after your leave is over. You’ll have job reinstatement rights and continued health coverage during the 12-week period (but not after.)

FMLA leave is generally unpaid, although there are some employers who pay during the leave time. However, your health coverage and other benefits are still in place as if you’d never left (although you may be required to pay your portion if your employer covers most of it.)

The FMLA applies to companies with 50 or more employees who work within 75 miles of the company’s location. You must have worked for 12 months in the preview year, totaling at least 1,250 hours, part or full time.

Notification should be given to your company at least 30 days in advance, if possible. (This is for cases like pregnancy, scheduled surgery, etc.) FMLA leave can also be used intermittently, for medical treatments that can’t be done off-hours, physical therapy, etc. Your personnel department can advise you about the best way to schedule this leave and when to notify your supervisor that you’ll be using it.

Short Term Disability

Short Term Disability (STDI) is an income replacement insurance offered as a benefit by many companies, and isn’t available for purchase as an individual policy. STDI partially replaces your income (usually about 60% to 65%) for your immediate financial needs until you are able to return to work.

STDI lasts anywhere from 30 to 180 days, and doesn’t start until after you’ve used up all of your paid time off (sick time, vacation, etc.) Decisions are quick, and payments usually start within about 14 days. A lot of what and how long you’ll receive benefits depends on how your employer structures the benefit policy.

On-the-job injuries are covered under Worker’s Compensation.

Long Term Disability

Long Term Disability (LTD) is an income replacement insurance that begins when your short-term disability ends. LTD is both an employee benefit at many companies as well as a policy you can purchase yourself.

This type of coverage pays you a reduced amount of your salary (generally two-thirds) for the length of your disability. Most disabilities last anywhere from six months to three years, but some may be lifelong disabilities. Your policy will cover you according to how it’s structured. Depending on your disability, LTD could replace your income until you reach retirement age.

Generally, LTD policies require that you exhaust your STDI coverage before you can receive LTD payments, and there isn’t any “overlap.” The LTD elimination period is anywhere from one month to one year.

So To Answer The Question

It Depends.

FMLA leave only lasts 12 weeks (about 3 months) so most of it will depend on how long your STDI coverage lasts. If your STDI coverage is less than 120 days, you’ll have to apply for LTD after the STDI coverage ends, and you have no other “coverage” available (savings, lines of credit, etc.)

Should your STDI coverage last less than the 12 weeks, and you need to cover the rest of your leave with LTD, it is possible to use LTD during an FMLA period.

If You Need Help

Call The Herren Law Firm at 713-682-8194. We’ll be happy to help you with claims, appeals, and other insurance claim related issues that you’re having trouble with. We’ll give you a free consultation and offer a contingency fee arrangement to make payment easier.

Filed Under: Long Term Disability Tagged With: ,
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