What is Long-Term Disability Insurance?

Generally, employer-provided LTD insurance is intended to protect an employee who is unable to work for an extended period of time due to illness, injury, or accident. LTD insurance pays out benefits, in the form of a percentage of an employee’s pay, when it is determined that the illness, injury, or accident has caused an inability to work for a specified period of time (although it varies by policy, the specified period of time an individual must be unable to work is typically longer than 3 to 6 months). Further, these benefits will pay for a defined payout period, for example 2 to 10 years. It is important to note, however, that LTD insurance does not provide protection for work-related accidents and/or injuries that are covered by a worker’s compensation insurance policy.

Each LTD policy has different conditions for receiving a payout, including which disabilities are covered and whether any pre-existing conditions may exclude coverage. Further, some policies will provide benefits if the individual is unable to work in his/her current profession, while others may require the individual to work any job of which he/she is capable. In all cases, it is very important to understand the requirements and conditions of any LTD policy.

Part-Time Employment

In the example cited above, the employee suffered a brain injury as a result of an assault which prevented him from performing his job. After being off work for about a year (and receiving LTD benefits), he was cleared for part-time work, which allowed him to nap when necessary to combat ongoing cognitive fatigue and headaches. Although a physician indicated that the employee’s health was not likely to improve, the insurance company terminated benefits, claiming that the medical documentation did not preclude full-time employment.

After exhausting his appeals under the plan, the employee filed with the court system. The court reversed the denial of benefits. In doing so, the court held that the plain language of the LTD policy was controlling, and, in this case, it indicated that a disability exists if an employee is unable to perform “each and every material duty of his or her regular occupation on a full-time basis.” Since the medical evidence proved that this was not possible, the court held that the employee was able to receive LTD benefits.

Thus, it is imperative to know that the LTD plan controls how determinations are made pursuant to the plan. An experienced LTD insurance attorney can help in this regard, explaining to the LTD insurance company of this fact, and, if necessary, persuading a court to take the language of the LTD plan at face value.

Get Help

If you have filed (or are considering filing) a claim for long-term disability benefits as a part-time employee, and are curious about the coverage, contact the experienced disability legal team at Farrell Disability Law as soon as possible. It is crucial to have someone on your side who can maneuver through the process in such a way to best present your evidence and give you the best chance for success. Contact our Jacksonville office today.

Resource:

dol.gov/general/topic/health-plans/erisa

Listing of Impairments

Qualifying for SSDI benefits first presumes a person has the requisite work history and credits to show he/she contributed enough to receive benefits. Assuming this is satisfied, the applicant must then show he/she has a medically-determinable condition that is so severe it renders him/her unable to perform any type of work for at least one year. Bipolar Disorder is a psychotic mental disorder characterized by alternating bouts of depression and mania (unnaturally high and euphoric behavior). An individual must experience both mood cycles to be considered bipolar, though the length of time each mood lasts individually and the amount of time between moods can vary widely. The Listings of Impairments has a listing for bipolar disorder that, if satisfied, means an applicant is considered to suffer from a severe and debilitating condition that is a qualified disability. A person must have at least three of the following symptoms, despite appropriate medication:

• unnaturally fast speech;
• quick changing ideas and thought patterns;
• inflated self-esteem, usually with false beliefs;
• less need for sleep;
• easily distracted;
• engaging in risky activities without a reasonable appreciation of the consequences; and
• an increase in physical agitation.

In addition, an applicant must present medical evidence that these symptoms cause an extreme or marked (serious) limitation in the following areas:

• ability to learn new information, following instructions or apply new knowledge;
• ability to engage in socially appropriate behavior;
• ability to complete tasks; and
• ability to control behavior and engage in daily self-care tasks.

Alternatively, if a person has lived in a controlled environment for several years, showing a functional limitation is more difficult, but a second set of criteria exists to cover this situation and allow a person to qualify if:

• the disorder is documented as serious and persistent for at least two years;
• the applicant has been living in a highly structured environment to minimize symptoms; and
• the applicant has little ability to adapt to changes in the current daily routine.

Functional Capacity

If the applicant cannot present sufficient evidence to meet the listing requirements, he/she could be granted benefits under a medical-vocational allowance. The Social Security Administration (SSA) would need to examine evidence related to how bipolar symptoms affect an individual’s ability to work. Memory, judgment and following direction are typically the most pertinent factors in this assessment. Based upon an assessment of one’s residual functional capacity, a rating of the types of work he/she may be able to perform, from unskilled to skilled, will be assigned. Unless the bipolar is quite severe, and inhibits following any sort of routine, the SSA is likely to find an applicant can perform unskilled work. This possibility is one of the primary reasons an experienced disability insurance attorney should be consulted to prepare and file SSDI claims.

Get Help

If you paid into the system, you should be able to easily access benefits when a disability occurs. However, the reality is much more complex, and you need legal representation to give you a fighting chance to get approved. The team at Farrell Disability Law is dedicated to getting you the benefits you need and deserve. Contact the Jacksonville law firm for a free consultation.

Resource:

researchandmarkets.com/research/k4srj7/4_9_billion?w=4

General Perception of Fibromyalgia

The reason so many question the credibility of fibromyalgia is that diagnosis is based upon self-reporting by a patient and the elimination of other possible causes. In other words, no definitive objective test is available to confirm or deny existence of this condition. However, the subjectivity of this impairment seems to be changing as a biomedical company recently announced the development of a blood test that identifies the markers of fibromyalgia, currently in use for Gulf War veterans seeking disability benefits from the Veterans Administration. However, this test is still in the clinical phase, so more established standards still must be used for the foreseeable future to obtain SSDI benefits. SSDI examiners will expect treatment from particular specialists, principally rheumatologists, in order to accept the legitimacy of a disability claim. Further, keeping a consistent relationship with the same doctor is another key element of supporting a fibromyalgia disability claim, as it shows a member of the medical establishment has recognized the severity of the impairments present, and not a pattern of jumping from doctor to doctor, presumably to get a certain answer.

SSA Rules for the Existence of a Fibromyalgia Claim

A prerequisite for any SSDI disability claim is that the condition be recognized as causing a disability. Because fibromyalgia tends to be scrutinized more closely by SSDI examiners than other conditions, this is not a foregone conclusion in these cases. At a minimum, claimants will need to present medical evidence that widespread pain is present for three months or longer, and that objective tests (lab work, MRIs, X-rays, etc.) have eliminated other possible causes. Further, the presence of pain must be supported by the existence of at least 11 out of a possible 18 tender points at certain places in the body, or the regular recurrence of at least six symptoms associated with fibromyalgia, including:

• Fatigue;
• cognitive and memory difficulties;
• irritable bowel syndrome;
• anxiety; and
• depression.

However, note that establishing the existence of symptoms is not enough to get approved for SSDI benefits. The claimant must still prove to the examiners he/she is unable to perform past work or be retrained to perform a different type of job.

Proving Disability

Obtaining satisfactory evidence of a disabling condition is the crux of any SSDI claim, and an experienced disability insurance attorney can help someone seeking benefits with identifying holes in the medical record, and obtaining additional documentation of the impairment, particularly a residual functional capacity assessment (an evaluation of a person’s ability to perform work-related tasks). Having this support from the beginning means less time wasted filling in gaps after a claim is denied, and a higher likelihood of obtaining approval sooner, a goal all claimants share.

Contact a SSDI Disability Insurance Attorney

Working for years to establish self-sufficiency and financial security can, unfortunately, be quickly taken away when a disability hits. Let an experienced disability insurance attorney fight for the money you deserve, so you can focus on managing your condition instead of government bureaucracy. Farrell Disability Law understands the financial hardships disability brings, and knows how to give you the best chance at getting approved. Contact the Jacksonville office for a free consultation.

Resource:

businesswire.com/news/home/20171113005463/en/FMa%C2%AE-Test-Objective-Proof-Fibromyalgia-Gulf-War

Short-Term Disability

As alluded to above, Florida does not have a state-mandated program covering disabilities that occur off the job, so disabled individuals in this situation must look to private disability insurance policies to replace a portion of lost income. Many employers include short-term disability in an employee’s benefits plan at no cost, and others offer employees the option of enrolling in a self-funded group policy. Short-term disability coverage applies when a person is suffering from a temporary medical condition that prevents him/her from working for a period of time. Typically, policies will pay 40 to 60 percent of a person’s income after a short waiting period is satisfied, one to fourteen days is the norm. Further, short-term disability benefits are only paid for a certain period of time, usually 10 to 52 weeks, and if a person is still unable to work when the policy benefit is exhausted, long-term disability would take over, if available. Group policies through an employer frequently require a disabled employee to use all of his/her sick/personal days before the disability coverage would start, and documentation of the employee’s medical condition, inability to work, and projected return date must be provided to prove a disability exists.

Long-Term Disability

Long-term disability is insurance coverage that pays a portion of a disabled person’s income when he/she is unable to work for an extended period or permanently, often due to a major illness, such as cancer, or serious physical injury. As noted above, long-term disability benefits are usually available once short-term disability coverage has run out. Long-term disability offered through employers is often optional voluntary insurance an employee must choose to purchase, but doing it through an employer group plan is almost always less expensive than purchasing an individual policy. Further, many policies are portable, meaning once purchased, they stay with the person, even if he/she changes employers. In light of the longer period out of work, long-term disability usually pays a slightly higher percentage of person’s income, 60-80 is typical, but most have maximum monthly limits. Further, the duration of the plan can vary from a set number of years or until age 65. Importantly, long-term disability plans have waiting periods before the coverage is available, and include a definition for what constitutes a disability. The most common definitions differentiate between own occupation and any occupation. Own occupation disability means the policy will payout if a person is unable to work in his/her profession, in contrast with any occupation disability, which requires the person be unable to perform any job before benefits will be paid. Plainly, own occupation is the definition of disability that is most beneficial to the disabled policyholder, since it is less restrictive. However, insurance companies regularly deny legitimate disability claims, and the services of an experienced disability insurance attorney are often needed to force providers to honor the terms of their policies.

Talk to a Disability Insurance Attorney Today

Securing disability benefits is too important an issue to leave entirely in the hands of insurance companies out to maximize profits. Protect yourself by working with a knowledgeable disability insurance attorney who understands the law, and knows tactics used by insurers to deny claims. Farrell Disability Law has years of experience helping clients obtain the disability benefits they deserve, and is available to evaluate the merits of your case. Contact the Jacksonville office today for a free consultation.

Resource:

leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0627/Sections/0627.4233.html

Functional Limitations

People qualify for SSDI benefits in two ways – fit within the criteria of an impairment listing in the SSA’s Listing of Impairments, or be granted a medical vocational allowance. Few people fit in within the impairment listing criteria because the requirements are so specific, and many conditions are not included. Thus, most disability claimants must rely on receiving a medical vocational allowance. Basically, the SSA must evaluate the effect of a claimant’s impairment on his/her ability to perform daily activities, particularly the claimant’s capacity to function at work. The SSA examiner will look at a claimant’s work history for the 15 years prior to the onset of the disability to determine what skills he/she has, as well as the claimant’s age and education. Based on this information, the SSA will decide if a claimant could perform past work or be re-trained to do another job. The lighter and less physically demanding work a person has done in the past, the more likely the SSA will find a number of other jobs the claimant could do, though claimants over the age of 50 are not typically required to learn new types of work. If no type of work is possible, a medical vocational allowance will be granted and SSDI benefits awarded. Determining a claimant’s functional capacity for work is based heavily upon the functional restrictions an SSA medical consultant finds a claimant suffers from due to his/her disability, called a residual functional capacity (RFC) assessment, which specifies a claimant’s ability to lift, stand, sit, concentrate and reach overhead, among many others.

Grid Rules

Taking the claimant’s past relevant work experience and the RFC assessment from the medical consultant, an SSA examiner will then apply this information to a grid the SSA uses to measure whether a claimant qualifies for a medical vocational allowance. Specifically, the examiner is looking at the claimant’s age, types of work performed in the past, recent training and transferable skills to see if a new type of work is possible. The older a claimant is and the fewer transferable skills possessed, the more likely a disability will be found. One of the key parts of receiving a medical vocational allowance is providing enough information to the SSA about one’s past job duties and tasks so the examiner can properly identify and locate the claimant’s job in the government’s dictionary of occupational titles (DOT). This document classifies a job’s physical and mental requirements, against which the SSA measures a claimant’s limitations. An experienced disability insurance attorney can help claimants properly flesh out past work history so the SSA will be more likely to accurately identify the work a particular claimant can perform.

Get Help

A lot hinges on the outcome of a disability claim, and to better ensure approval, work with an experienced disability insurance attorney to prepare and present your claim. Farrell Disability Law knows how difficult a disability is, and works to get clients the benefits they need and deserve. Contact the Jacksonville office for a free consultation.

Resource:

cbsnews.com/news/social-security-disability-backlog-tops-1-million-thousands-die-on-waitlist/

Wait Times

It can be tempting to start the claim process on one’s own, thinking that an attorney is not necessary unless the initial application is rejected. It takes time to find an attorney, for the attorney to assess the merits of the claim, and to address any gaps in the application. Thus, having an attorney early in the process makes it more likely a claimant will get approval sooner because he/she will have a strong record from the beginning. However, most disability claims are not approved until a hearing is held before an administrative law judge, as this is the only opportunity for a claimant to meet the decision-maker in person. An attorney is even more crucial at this stage, and is much more likely to win approval than a claimant representing him/herself. But, the SSA is projecting the average national wait time for a disability hearing will be 604 days by the end of September, with 1.1 individuals currently sitting in this backlog. This means claimants are effectively in limbo for years, and can begin to feel as if the application process is a permanent state. While an attorney cannot, unfortunately, speed up the wait time for a hearing, he/she can make sure the claimant is fully prepared to address any concerns a judge may have, and ensure that all relevant records are available for the judge to review.

Substance of Claim

In addition to helping with the considerable procedural obstacles of the SSDI process, an experienced disability insurance attorney will also know the types of medical documentation a claimant will need to be successful, and can help a claimant get the documentation from a doctor that the SSA is more likely to seriously consider. Specifically, an attorney will understand the following key components of all disability claims:

• the requirements of the disability impairment listings;
• the vocational guidelines that dictate whether a claimant has the physical and mental capabilities to perform any type of work;
• the importance of a claimant’s work history; and
• how to document a claimant’s inability to perform other types of work – typically with a functional capacity assessment by the claimant’s primary treating physician.

Consult a Florida Disability Insurance Attorney

Getting the disability benefits you earned through years of hard work is not something you want to leave to chance. Work with an experienced disability insurance attorney to prepare and handle your claim so you can focus on your health. Farrell Disability Law serves clients in the Jacksonville area, and is available to assess your case. Contact the office for a free consultation.

Resource:

www.ssa.gov/budget/FY18Files/2018BO.pdf

Required Work History

SSDI is a program administered by the Social Security Administration (SSA) that offers benefits to disabled individuals who have paid a sufficient amount into the SSA system. This is calculated in the form of work credits, which are based on a person’s yearly earnings or self-employment income, with four work credits being the maximum a person can earn annually. The number of work credits a person needs for SSDI benefits depends upon his/her age when the disability first appeared. Thus, younger workers need fewer credits to qualify. Further, the work credits need to be earned recently enough in time for SSDI benefits to be available. Importantly, the work credit requirement must first be satisfied before an evaluation of the existence of a qualified disability is even begun. The maximum amount of credits a person would need is 40, with the last 20 earned in the ten years preceding the disability. Note that the majority of workers will earn more than the 40 work credits needed for SSDI, but the extra work credits do not increase a person’s benefit amount. Rather, the average amount an individual earned during all working years will be used to calculate the benefit amount. To put work credits in concrete numbers, a person 24 or younger needs just three years of work history and 6 work credits. By contrast, someone who becomes disabled at the age of 50 needs 28 work credits earned within the 10 year period before the disability onset.

Rules for Disabled Aged 22 or Younger

For adults disabled before the age of 22, the SSA has special rules that permit them to qualify for child benefits using their parent’s Social Security earnings record if the parent is deceased or is receiving retirement or disability benefits. To qualify, the individual must be unmarried, over the age of 18, and have experienced the onset of a disability before age 22. The individual need not have worked to qualify for disability benefits since the parent’s earning would be used, but he/she may still qualify for benefits under his/her own accord, though the benefits available through the parent are almost always higher. Note that if the parent never worked, SSDI benefits for the disabled adult would not be available, and he/she would have to depend on his/her own earnings record.

Consult a Disability Insurance Attorney

SSDI benefits are often difficult to obtain, and disability claims should be reviewed by an experienced disability insurance attorney before submitting an application. Disability insurance attorney know what the examiners are expecting to see, and can guide you on how to build the strongest possible claim. Farrell Disability Law has the knowledge you need to help you get the benefits you deserve. Contact the Jacksonville office today for a free consultation.

Resource:

ssa.gov/planners/disability/dqualify2.html

Early SS Retirement vs. SSDI Benefits

In order to capture early SS retirement benefits, a person must be willing to accept a reduced percentage of monthly benefits for the remainder of his/her life. Early SS retirement monthly benefits are typically 60 to 70 percent of the full SS retirement benefit amount. Through a complex formula, SSDI benefits are calculated based upon a percentage of an individual’s earnings throughout his/her working years, which typically results in a higher monthly benefit compared with early SS retirement benefits, and are ongoing once granted. Further, if an individual claiming a disability can prove the onset occurred before early retirement was taken, he/she would be eligible for retroactive SSDI benefits. The retroactive benefits would equal the difference between the early SS retirement benefit and what the person should have received from SSDI. Importantly, a person’s low-earning years due to disability would be disregarded under a disability freeze, and thus would not be calculated into the person’s disability benefit amount. If, on the other hand, SS determines the disability began after early retirement, there would be no retroactive payment, and the monthly benefit would merely convert to the SSDI amount. Finally, once full retirement age is reached, the monthly SSDI benefit converts to standard SS benefits, although the amount paid remains the same.

Factors that Increase Chances of Approval

Obtaining approval for SSDI benefits is no easy task, and can take years before success is achieved. As a consequence, someone suffering from a disability that is eligible to take early retirement will often take this option as he/she pursues a disability claim. Thus, if early retirement is a direct result of a disabling impairment, this factor works in favor of approval for SSDI benefits. Further, health issues that arose or worsened following retirement also contribute toward higher odds of being found disabled. A lack of gainful employment, less than $1,170 per month under the current income limits, is further evidence of disability, and a requirement to qualify for SSDI benefits.

One final point – substantial financial gains from SSDI benefits versus SS benefits diminishes the closer one gets to his/her retirement age. Thus, applying for SSDI benefits as early as possible is the best method of maximizing the monthly payout.

Contact a Disability Insurance Attorney

Dealing with a disability is overwhelming, and the complexities of getting SSDI benefits do not make your situation any easier. Talk with a disability insurance attorney about your claim to learn your chances of success, and how to build the strongest possible case. Farrell Disability Law has decades of experience helping individuals get the money they need and deserve, and serves clients in the Jacksonville area. Contact us for a free consultation.

Resource:

ssa.gov/planners/disability/dqualify.html

Signs a Denial Was Made in Bad Faith

Bad faith denials are often an issue in cases where the length of time a disability may last is unknown, which leaves an insurance company with the potential obligation to pay benefits for an uncertain number of years. However, this is the bargain the insurance company offered to policyholders, and it should not be able to avoid this obligation because the company no longer likes the terms. Examples of behavior commonly seen in bad faith denial of a claim include:

• unreasonable delay in processing a claim;
• denial of benefits without any support from the facts or law;
• misrepresentation of policy benefits;
• unnecessary or excessive requests for information;
• failure to promptly and fairly settle a claim when liability is clear; and
• advising a claimant not to consult an attorney.

How to Respond When a Bad Faith Denial Is Suspected

The appropriate response to instances of a bad faith claim denial will largely depend on whether State or federal law is applicable to the situation. ERISA covers most insurance plans offered through employers, including employer-sponsored disability coverage. If this is the case, all levels of appeal and administrative review must first be exhausted before a lawsuit can be filed to compel the insurance company to pay the claim. If the disability coverage was privately obtained by an individual, State law would control, and one’s ability to file a lawsuit would come much sooner. Unfair claim settlement practices and false representation of policy coverage are two of the more common bases for challenging a denial of coverage under Florida law. Determining if State or federal law applies to a case is a key assessment that represents just one of the many technical aspects of these cases. An experienced disability insurance attorney should be consulted as soon as practicable, as strict time limits govern when action must be taken, and failure to do so could result in the loss of the right to appeal a denial or sue.

Talk to a Disability Insurance Attorney

Getting the money you need to provide for yourself and your family is a big priority once it becomes apparent working is no longer possible. Working with a disability insurance attorney before the initial claim is even filed will give you the best chance for success, and likely shorten the time it takes to receive benefits if the claim is at first denied. Farrell Disability Law handles all aspects of the disability claim process, and is available to assess your case. If you live in the Jacksonville area, contact the office today for a free consultation.

Resource:

dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/filing-a-claim-for-your-health-or-disability-benefits

What Is Considered Blindness or Low Vision?

Under SSDI definitions, someone is considered legally blind if his/her vision cannot be corrected more than 20/200 in either eye, or if a person’s visual field (peripheral vision) was 20 degrees or less in the better eye during the previous 12 months or is expected to last at least that long. In addition, even if the person does not meet the definition of legal blindness, he/she could still qualify for disability benefits if the person has low vision. The vision deficit must be severe enough alone, or in conjunction with other medical issues, to prevent the person from working. Note that the SSA looks at someone’s total visual capacity, so if one eye has good vision disability benefits under SSDI are unavailable.

Work Credits

Generally, in order to qualify for SSDI benefits, the applicant must work and pay Social Security taxes for a certain number of years. Working and paying into the Social Security system allows a person to accumulate a minimum number of work credits that entitle him/her to receive specific government benefits. However, with blindness, credits may be earned during any working year, including years worked after the onset of blindness if a person does not have a sufficient number of credits when the blindness first occurs.

Working While on Disability

The SSA wants to encourage disabled individuals to work and earn income to the extent possible, and does so by offering work incentives to those receiving benefits. As long as the person’s monthly earnings do not rise above the set amount ($1,170 for most SSDI recipients), benefits are still paid. However, for those receiving benefits due to blindness, the amount a recipient is permitted to earn each month and still receive SSDI payments is significantly higher – $1,950 as of 2017. In addition, if someone with blindness is self-employed, he/she is permitted to do a substantial amount of work for the business and still keep SSDI benefits as long as monthly profits do not exceed $1,950. Finally, once an individual with blindness reaches the age of 55, the rules for monthly earnings change further by allowing a blind person to earn more than $1,950 per month and not completely lose SSDI benefits. Instead of terminating benefits, which is the standard action taken if someone’s work earnings exceed the monthly thresholds, those with blindness over age 55 will have benefits suspended during any month earnings are too high. During months when earnings come in at or below the allowable amount, benefits will be paid.

Talk to a Disability Attorney

Dealing with any type of disability is a challenge that often limits a person’s ability to work and earn money. If you are facing a disabling condition that prevents you from working, consult a disability attorney about qualifying for SSDI benefits. Farrell Disability Law helps clients throughout Florida and South Georgia qualify for disability benefits, and can help you get the benefits you need and deserve. Contact the office today for a free consultation.

Resources:

ssa.gov/planners/disability/dqualify8.html

ssa.gov/planners/disability/dqualify2.html