What is Parkinson’s Disease?

PD is a neurodegenerative disorder that affects predominantly dopamine-producing neurons, causing cell death in a specific area of the brain called substantia nigra. Primarily affecting the motor system, symptoms of PD generally develop slowly over years. Further, the progression of symptoms varies from one person to another due to the diversity of the disease. People with PD may experience one or more of the following:

• Tremors, mainly at rest;
• Bradykinesia (slowness of movement);
• Limb rigidity; and
• Gait and balance problems.

The cause of PD is generally unknown, but is believed to involve both genetic and environmental factors. As an example, there is an increased risk in people exposed to certain pesticides and among those who have had head injuries, while there is a reduced risk in tobacco smokers and those who drink coffee or tea.

Treatment of Parkinson’s Disease by LTD Insurers

As LTD insurance companies understand that symptoms of PD can vary drastically between individuals, a simple diagnosis is usually insufficient to succeed in an LTD claim. Rather, the insurance company will analyze each individual on a case-by-case basis, looking at the following factors:

• Motor Function, and especially how motor deficits impact a claimant’s ability to work. That is, the insurance company will analyze a claimant’s ability to walk, stand, and remain balanced, as well as muscular rigidity.
• Mental Function. For this factor, the insurance company will analyze the claimant’s ability to stay organized, to communicate, to handle tasks, and any memory issues.
• With regard to this factor, the insurance company will not merely look at whether the claimant is tired, but also how the fatigue affects a claimant from working, such as the ability to handle both the sustained demands of his/her job, as well as the cognitive demands.
• Non-Motor Physical Symptoms. Finally, the insurance company may also look at non-motor related physical symptoms that PD may affect, such as vision, nausea, incontinence, and sleep deprivation.

An experienced disability attorney can help claimant create a strong body of support for a disability claim, and should be consulted on the best way to proceed in these cases to avoid delays and potential loss of benefits.

Get Help

If you, or someone you love, are considering filing for LTD benefits, based on a diagnosis of PD, contact a disability benefits attorney as soon as possible. Submitting a thorough and accurate claim for LTD benefits with the help of an experienced disability benefits attorney is essential to approval. The legal team at Farrell Disability Law has the experience with LTD claims and will work to get you the benefits you deserve as soon as possible. Contact our Jacksonville office today.

SSDI Benefits for Adult Disabled Children

According to the SSA, eligible adult disabled children can receive monthly payments through the SSDI program. Typically, eligible disabled individuals over the age of 18 are considered by the SSA to be adult children. Accordingly, the SSA will consider their benefit amount based on a qualifying parent’s Social Security earnings. It is important to note that the adult disabled child, if he/she has enough work experience, may qualify for SSDI benefits on his/her own, but the focus of this post is on those who do not have the necessary work history.

Qualifications

The SSA considers someone an adult disabled child if he/she meets the following criteria:

• The individual is over the age of 18;
• The individual is single;
• The individual has a disability that began before he/she was 22; and
• One of the parents of the individual receives Social Security benefits or is deceased (but at death was insured for Social Security benefits).

The SSA will determine if the individual qualifies as disabled by using the same eligibility standards that they use with any adult that is applying for disability. That is, the individual must show both of the following elements in order to be considered disabled for purposes of collecting SSDI:

• The individual has a disability that is expected to last at least 12 months, or is expected to result in death; and
• The disability causes the individual to be unable to perform substantial work.

Benefit Amount

A qualifying adult disabled child can receive up to 50% of the parent’s benefit amount. However, this amount can be reduced, depending on whether there are other family members getting benefits based on the parent’s work record.

Disqualifiers

If an adult disabled child does not meet any of the above qualifications, he/she will not be able to qualify based on his/her parent’s Social Security benefits and their work record. For example, if the disability manifests after age 22, this will disqualify the individual. Further, if the individual gets married, this will also be a disqualifying factor. However, the individual may then apply for SSDI benefits based on his/her own record. An experienced disability benefits attorney can help make a reasoned determination about the best and most effective route to pursue.

Contact Us Today for Help

If you, or someone you love, are considering filing for SSDI adult child benefits, and are curious about the available options, contact a disability benefits attorney as soon as possible. Preparing an SSDI application for an adult disabled child is a complex undertaking, and the legal team at Farrell Disability Law has the experience to help you or your loved one handle this matter. After analyzing your claim, we will work to get you the benefits you deserve as soon as possible. Contact our Jacksonville office today.

Resource:

ssa.gov/pubs/EN-05-10026.pdf

Fibromyalgia as a Basis for an SSDI Claim

SSDI is another stream of disability benefits, in which a claimant applies for benefits through the SSA, based on his/her employment record. While it is distinct from LTD insurance policies, knowing the manner in which the SSA evaluates fibromyalgia sufferers can be crucial when submitting a claim for LTD benefits.

Generally, in order for an SSDI applicant to receive benefits based on fibromyalgia, that applicant must be able to provide proof of the following:

• A history of widespread pain in all quadrants of the body, as well as axial skeletal pain, which has persisted for at least 3 months;
• At least 11 positive tender points on physical examination, which must be found on both the left and right side of the body, above and below the waist; and
• Proof that other disorders that could cause the same symptoms were excluded.

Fibromyalgia in the LTD Context

Traditionally, LTD insurance companies did not give much weight to a claim of fibromyalgia unless another severe medical condition was involved. Accordingly, many claims for LTD benefits based on fibromyalgia were ultimately denied. This is due to, as alluded above, that fibromyalgia is diagnosed primarily on a subjective nature, and, even today, the causes of fibromyalgia are not fully understood.

More recently, however, fibromyalgia, while it still may not be completely understood, has begun to receive recognition as a serious debilitating condition. For example, the American College of Rheumatology (ACR) has issued the following criteria to help LTD insurance companies determine whether an applicant has fibromyalgia (which are very similar to the SSDI factors listed above):

• Evidence of chronic widespread pain, including pain in the back, neck, or chest;
• Proof that a medical professional has ruled out other diseases that could cause the same symptoms; and
• Either (1) tender points sites in at least 11 of 18 tender point areas of the body, occurring on both sides of the body and both above and below the waist, or (2) repeated manifestations of six or more fibromyalgia symptoms, signs, or conditions that often occur with fibromyalgia, such as fatigue, non-restorative sleep, cognitive or memory problems, depression, anxiety, or irritable bowel syndrome.

An experienced disability benefits attorney can help in framing the LTD claim so that it has the best chance of success.

Contact Us Today for Help

If you, or someone you love, are considering filing for LTD benefits due to fibromyalgia, and are curious about how this complicated condition can be the basis for filing LTD benefits, contact a disability benefits attorney as soon as possible. The legal team at Farrell Disability Law has the experience to help you. After analyzing your claim, we will work with you on the LTD application to get you the benefits you deserve as soon as possible. Contact our Jacksonville office today.

Resource:

ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html

Long-Term Disability Insurance

LTD insurance is a form of disability insurance that is offered through group plans and private policies. When offered as part of employee benefits package, federal law governs how it operates. In the simplest terms, if a policyholder suffers a disability which is expected to last long-term (at least one year) and prevents him/her from working in his profession, he/she may be eligible to recoup compensation pursuant to the terms of his/her LTD policy. Of course, in reality, making an LTD claim is not that simple. Insurance companies do not want to part with their money, and, as a result, will analyze each claim with a very exacting review. Ensuring the claimant truly has a disability, the extent of the disability, and whether he/she can perform other occupations are three of several areas an LTD insurance company will analyze as part of approving a disability claim.

Common Deficiencies

Unfortunately, most people do not realize that the disability coverage they have is insufficient until it is needed. To urge those considering a new policy, as well as individuals with existing coverage, of the vital importance of assessing the coverage levels, here is a list of the potential ways a policyholder’s LTD insurance policy can be deficient:

• Benefits for mental conditions. Such benefits, for disabilities based on mental and nervous conditions, are typically capped at 24 months, though there are some common exceptions (schizophrenia and organic brain disease, for example).
• Prohibition on abuse-based disabilities. Typically, disabilities arising from substance or alcohol abuse are excluded from coverage.
• Pre-Existing conditions. Most LTD policies will not compensate for pre-existing conditions for a specified period of time.
• Waiting period. Most LTD policies include a waiting period, during which the policyholder is not entitled to benefits.
• Duration of benefits. Most LTD policies will pay benefits for a set time – typically until the policyholder turns a specific age or for a specified number of years.
• The amount of benefits a policyholder can receive typically varies, with most paying between 50% and 80% of a policyholder’s salary.
• Other income benefits. Typically, LTD policies allow an administrator to reduce the monthly benefit if the policyholder is receiving income from a specified list of alternate sources, such as Social Security.
• Tax consequences. As most LTD plans are paid for with pre-tax dollars, the benefit is subject to federal, state, and, in some cases, city income tax liability.

Get Help

If you have suffered a disability, and need to secure LTD insurance benefits, contact a disability benefits attorney as soon as possible. The legal team at Farrell Disability Law has the experience and skill necessary to analyze your potential claim, and will help you develop a strategy to get you the benefits you deserve. Contact our Jacksonville office today.

Resource:

kiplinger.com/article/insurance/T012-C032-S014-dont-underestimate-need-for-disability-insurance.html

Private v. Employer

There are two ways in which an employee can obtain LTD benefits – privately or as part of a group plan offered by his/her employer. If purchased through the group plan, the LTD policy is governed by the Employees Retirement Income Security Act (ERISA); if bought privately, it is governed according to the terms of the insurance contract. ERISA is a federal law that has effectively superseded the terms of the insurance contract between the insurance company and the insured individual.

Differences

As a result of the different terms governing the two types of LTD policies, there are also differences in trying to appeal a denial of benefits. Some of the more significant differences between private LTD policies and group, or employer-provided, LTD policies include the following:

• Since ERISA is a federal provision, all appeals from a denial of a group LTD policy must be brought in federal court. Further, since ERISA was developed by Congress in conjunction with the insurance companies, the laws controlling how they are applied may be skewed in favor of the insurance company. By contrast, a privately-purchased policy may be brought in state court, under legal rules and procedures that may be more favorable to the policyholder.
• Privately-bought LTD insurance may, at the insured’s choice, be decided by a jury of his/her peers, as opposed to a federal judge.
• No additional evidence may be submitted for the appeal of a denial of a group LTD insurance policy. By contrast, this restriction does not apply to appeals of private disability policies.
• Discovery (gathering information and evidence). In a privately-purchased LTD insurance appeal, the plaintiff may conduct discovery relating to any issue relevant to the appeal, including the right to bring expert witnesses to support the appellant’s claim. Unfortunately, with an appeal of most group LTD plans, this expanded discovery is not permitted, in light of the restriction on evidence, mentioned above.
• A successful legal appeal of a denial of group LTD insurance can only award a lump-sum payout of the policyholder’s actual policy benefits (that is, what he/she would have been paid in the first place), a clarification of the policyholder’s rights under the plan going forward, and, in some cases, attorney’s fees. By contrast, a privately-purchased LTD policy allows a successful appellant to recover several types of damages from the insurer, such as pain and suffering, emotional distress, bad faith and punitive damages.

Get Help

If you have received a denial on a previously-filed LTD benefits claim, and are curious about any options you may have at your disposal, including whether you have the ability to file a complaint in court, contact an experienced LTD benefits attorney as soon as possible. The legal team at Farrell Disability Law has the experience necessary to analyze your claim will help you develop a strategy to get you the benefits you deserve. Contact our Jacksonville office today.

Resource:

law360.com/articles/1054307/ex-nfler-wins-fight-with-league-over-disability-benefits

LTD Insurance Benefits for Chronic Pain Issues

As alluded to above, LTD insurance benefits may be accessed to provide financial support to a disabled employee. Although LTD policies may be purchased individually, if part of an employer’s benefits package, the policy is governed by the Employee Retirement Income Security Act (ERISA).

In cases in which the applicant for benefits has a condition that is characterized by chronic pain, it is important to understand that such conditions can be difficult to diagnose. Some days, the pain is debilitating; sometimes, it seems controllable. This difficulty is primarily a result of the fact that there is no objective test for many chronic pain issues, and diagnosis is based largely on self-reported symptoms. Although each LTD policy is different, generally, insurance adjusters will look for consistency in symptoms, as well as a regular effort, on the part of the applicant, to seek treatment. In the lawsuit above, the applicant’s physicians noted that her condition actually appeared to deteriorate, despite a history of treatment, and that her limitations will most likely be lifelong.

Strengthening an Application for LTD Benefits

The following are a few pointers to keep in mind which can increase the likelihood of a successful LTD claim for benefits:

• Medical Treatment. In addition to treatment from a general physician, if chronic pain is involved, it may be worthwhile to seek treatment from a specialist, such as a rheumatologist or another physician who uses different diagnostic techniques to evaluate a patient.
• An accurate accounting of all symptoms, both mental and physical, should be kept, such as in a journal. Not only will this help one’s physician, but it can also provide support for an experienced attorney in developing a strong claim.
• Physician Opinions. Probably the most critical aspect, a physician’s opinion should identify the extent of any work-related limitations, including the length of time an applicant can sit, stand, and walk; the amount of weight he/she can lift and carry; and the ability to bend, stoop, balance, crouch, and crawl. Additionally, the physician opinion will indicate whether work will need to be missed, whether on a day-to-day basis or via breaks within the day. If the applicant is also seeing a mental health professional, an opinion from this person should also be provided.
• Finally, third-party reports from persons such as friends, family, and colleagues can help to bolster an LTD disability claim.

Get Help

If you, or a loved one, have been diagnosed with a condition involving chronic pain and are considering filing, or have already filed, an application for LTD benefits, the services of an attorney having experience with LTD applications can be the difference between approval and denial. The legal team at Farrell Disability Law has the experience necessary to help you obtain the benefits to which you are entitled. Contact our Jacksonville office today.

casetext.com/case/reetz-v-hartford-life-accident-ins-co-1

Qualifying for SSDI Benefits with Blindness

Generally, to qualify for SSDI benefits, the SSA will consult the Listing of Impairments, a publicly-available listing of medical impairments that define various aspects of disabilities which, if present in an application, will qualify him/her for SSDI benefits. With regard to blindness, one must meet one or more of the following qualifications:

• Loss of central visual acuity. This requirement means that vision loss within an applicant’s central field of vision must result in a vision rating of no better than 20/200 in the better eye.
• Contraction of the visual field in the better eye. If an applicant has a very narrow and shrinking field of vision, in which the diameter is no greater than 20-30 degrees, as measured by a physician pursuant to standard tests, he/she can qualify.
• Loss of visual efficiency or visual impairment. This requirement, which covers issues of blurry or unfocused vision, as opposed to legal blindness, in which the applicant has a vision rating of no greater than 20/200 when wearing corrective lenses.

If an applicant cannot qualify according to one or more of the above Blue Book categories, then the SSA examiner can conduct a residual functional capacity analysis. In this case, the examiner will ascertain whether the decreased vision, or blindness, prevents the applicant from working in any job. The examiner will do this by reviewing the applicant’s functional limitations, such as limitations on the ability to drive, read, or get around in unfamiliar locales. Qualifying under the residual functional capacity analysis means that the SSA believes the applicant cannot work in any job due to his/her functional limitations, depending on the applicant’s age.

It should be noted that, in practice, it is actually more difficult to be successful in obtaining SSDI benefits if an applicant suffers from low vision, as opposed to being totally (or legally) blind. This is due to the fact, that in most of these cases, the applicant must qualify through the residual functional capacity analysis.

Special Rules for Blind Individuals

The SSA does, in fact, have special rules that apply to individuals who receive SSDI benefits as a result of vision disabilities.

• Typically, SSDI benefits recipients are encouraged to obtain employment. However, once a recipient makes above a specified amount, SSDI benefits will be phased out. For vision impaired individuals, this phase-out occurs at a much higher level than recipients who are not vision impaired.
• As part of encouraging recipients to obtain employment, the SSA includes time spent working on and building a solo business. However, the SSA does not include this if a recipient is vision impaired.
• Vision impaired recipients over the age of 55 can exceed the work amount and have their benefits suspended, as opposed to stopped, which is the normal result for types of impairments. This means that benefits will automatically resume for any month in which income falls below that specified amount.

Get Help

If you are vision impaired, speak to an attorney having experience with directing SSDI applications through the SSA. The legal team at Farrell Disability Law has the experience necessary to help you obtain the benefits you deserve. Contact our Jacksonville office today.

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

Your Rights

If a claim for LTD benefits has been denied, there are options. Most, if not, all LTD policies provide for one or more appeals. It is not unusual for a claimant to receive benefits via the appeals process. While it may seem counterintuitive for the same insurance company to deny a covered individual and then approve him/her on appeal, it should be noted that appeals are typically evaluated by an appeals department, which is most likely made up of different people than those who initially denied the claim. Thus, your first strategy is to exhaust all appeals through the insurance company. In fact, if the LTD policy is provided through an employer, exhausting administrative appeals is required under federal law.

Your Denial Letter

Typically, the denial letter is supposed to indicate the exact reasons why the claim for LTD benefits was denied. Having this information helps to strategically plan an appeal. Also, the denial letter will indicate specifically how to file the appeal, as well as deadlines and any other items required to be included with the appeal. A knowledgeable disability law attorney can help organize and file the appeal, because failure to meet even one of these requirements can be cause for a second denial.

Your Record

Immediately after receiving the denial, the policyholder should request a copy of his/her file from the insurance company. Similar to the denial letter, information contained in one’s file will help to strategically prepare an appeal. It is important, at this stage, to supplement any omissions or inaccuracies in the record by submitting additional evidence while the appeal is pending, and an experienced disability law attorney will know exactly how to do this. A complete record is essential, because after one has exhausted the appeals process with the insurance company, and then decided to pursue the denial through the court system, the record will be considered closed, and no further information may be added.

Get Help

While you are able to secure legal representation at any stage in this process, it is better to do it as early as possible. The insurance company will not hesitate to use your unfamiliarity with the process against you, and a missed deadline, or the omission of a necessary step, will doom your claim. Having an experienced disability law attorney on your side will improves your chances of success, as he/she will know how to draft an effective appeal, and what kinds of evidence to submit. The legal team at Farrell Disability Law have the knowledge and skill necessary to advocate on your behalf so that you will have a better chance of success. Contact our Jacksonville office today.

Mental Illness and SSDI

While mental illnesses can be officially considered as a disabling condition, eligibility for SSDI benefits under a mental illness can be harder to collect. One reason for this is in the nature of mental illness. Specifically, mental illness symptoms cannot easily be evaluated, and the acuteness of the illness is typically hard to objectively measure. Further, SSA examiners are not psychiatrists, and, consequently, may not be able to grasp the scope of various mental illnesses. Thus, while it is easy for an SSA examiner to determine that a person who has lost a limb cannot drive a vehicle (if his/her occupation is a truck driver, for example), it can be difficult to determine that a person with a mental illness is similarly disabled. Finally, and unfortunately, those claimants suffering from mental illness can carry a stigma that they are lazy and fabricating the illness solely in an effort to receive benefits.

Nevertheless, there are a number of mental illnesses recognized as a disability by the SSA, and to qualify, an individual’s condition must have been diagnosed by a physician. Further, the individual must meet the following qualifications:

• The mental illnesses should prevent an individual from performing any work that he/she had previously been able to perform;
• The mental illness must be of such a severe level that the individual cannot be trained for any other jobs; and
• The mental illness should be expected to last at least a year

Specifically, the SSA has classified mental illnesses under the following categories:

• Organic disorders, such as dementia or delirium.
• Psychotic disorders, such as paranoia and schizophrenia.
• Affective disorders, such as depression and bipolar disorders.
• Learning disorders.
• Anxiety-related disorders, such as phobias, abnormal fears, and panic attacks.
• Somatic Symptom Disorder (causes bodily symptoms for unknown organic causes).
• Personality disorders, such as passive-aggressive or obsessive-compulsive disorders.
• Substance addiction disorders, such as alcoholism and drug addiction.
• Autistic/Pervasive developmental disorders.

Strategies

Since diagnosis of a mental disorder is very subjective, it is best to develop your strategy with the assistance of an experienced disability attorney, who will help the claimant develop his/her claim. Typically, this assistance will encompass keeping a journal or notes that describe a claimant’s mental state at various points in time, as well as providing an indication of how the mental illness has affected the claimant’s daily life and work life. Further, the attorney will work with medical professionals to ensure that the claimant’s medical record is as accurate and all-encompassing as possible.

Seek Legal Advice

If you, or someone you love, are suffering from a mental illness that is negatively affecting your work life, contact the legal team at Farrell Disability Law as soon as possible. Although difficult, we will know how to develop your SSDI claim, so you can obtain benefits which will allow you to focus more on recovery from your illness than how to pay the bills. Contact our Jacksonville office today for an initial consultation.

Resource:

bangordailynews.com/2017/10/31/health/mental-illness-rate-on-the-rise-in-vermont-bucking-national-trend/