Answers to Medical Malpractice, Workers Comp, Long Term Disability Insurance, and Car Accident Questions
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Contact us directly 202-393-3320
At Donahoe Kearney, we believe it's important to empower through education. Here are some of the questions people have when they first contact us about D.C., Maryland and Virginia medical malpractice, serious car accidents, long term disability insurance claims, or workers compensation. We try to provide as much information as we can based on our experience as medical malpractice lawyers in D.C., Maryland and Virginia.
Since every person is unique, if you have questions or need information about an injury or death in your family, please contact us to talk it through.We'll talk to you, schedule a free initial meeting and give you all the information we can. Call us today at 202-393-3320.
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How do the smartest executives, lawyers and doctors in DC get long term disability benefits?
Getting long term disability benefits after a serious illness or injury.
Most executives, lobbyists, lawyers and doctors working in DC have worked really hard for their entire career to make a difference and provide for their family. Most had absolutely nothing given to them, they paid their own way.
But what happens when a medical condition or injury keeps you from working and you suddenly need long term disability benefits?
First, you have to realize that, even though you may have paid premiums for a long term disability policy for many years, the policy gives your disability insurance company a lot of discretion in how to decide your claim for benefits - it's obviously written to favor the insurance company.
So you don't want to take any chances. You don't want any close calls.
If your claim for long term disability was denied, formulate evidence and write your appeal as if a federal judge were deciding your case based on the appeal and evidence you submit.
Once your benefits are denied under a long term disability plan covered by ERISA (the vast majority of long term disability policies are governed by ERISA) you only have 180 days to file your appeal with the insurance company. This is not just some form you complete - it's an opportunity to add evidence in support of your claim, so you need to work with medical experts, specialists, vocational experts, medical researchers and others to make sure you have the medical evidence (testing, physician reports, expert opinions, medical literature, etc.), vocational and occupational evidence you need.
This is critical because if your appeal is denied, the next step is to file your case in federal court (in D.C., the U.S. District Court for the District of Columbia) where a federal judge will decide your case without witnesses or discovery - the decision in your case will be based on the administrative record, including your appeal and everything submitted with it.
In our complex medical malpractice cases, we always say the best way to get a good settlement is to prepare for trial, so we do an incredible amount of work before the case is ever filed in court. The same concept applies here - everything you do should be done to persuade a federal judge.
It's best to get a long term disability attorney working for you early in the process.
The best way to win a long term disability appeal is to identify all of the additional evidence that supports your disability, analyze the policy, work with your physicians and other specialists and experts to develop additional support that you are disabled under the policy, draft personal statements from you, co-workers and others who have witnessed the effects of your medical condition, analyze the legal weaknesses in the insurance company's decision to deny your benefits, and draft an appeal that incorporates all of the facts, law and medicine.
No matter how successful you are, once you have a serious injury or medical condition, this is an almost impossible task.
Let an experienced long term disability attorney take this on for you.
We start by analyzing the insurance company's position in denying or terminating your long term disability benefits and give you the next steps that can help. And we work with you, your family, your doctors as well as other experts and specialists to put your appeal in the best position to get you the long term disability benefits you deserve.
Call us today at (202) 393 - 3320 to get started.
How Do I Get the Best Lawyer For My Accident Case - Someone I Can Trust to Take Care of Me?
We talk to people every week who got the wrong lawyer for their accident case.
Maybe they got a lawyer from a TV commercial or one who handled their brother's divorce or their friend's DUI. But they didn't do their homework - they didn't check the lawyer out. Read his reviews. Read the books he's published. Read what real clients say about him.
Unfortunately, a lot of people end up with the wrong lawyer, and their case is either not taken seriously or the whole process is difficult and takes too long.
First of all - if you have a serious injury and need surgery, hospitalizations, rehab, and can't work, you need an attorney who only represents people like you who are seriously injured. Insurance issues are complicated and insurance coverage needs to be investigated from the beginning by lawyers who do that every day.
Getting the best lawyer for your accident case in DC.
Above all else, these cases come down to trust. You need to be able to trust that your attorney is doing everything he or she can for you and your family.
For our clients, we have a relationship, so you want someone you can talk to, work with and trust.
You want someone who is experienced and understands the medicine to better understand your medical condition and your medical and rehab needs, both now and what those will look like in the future. There are a lot of issues we discuss with our seriously injured clients, like:
- Will you need full or part time nursing care?
- Will you need modifications to your home so you can live comfortably even after a serious injury?
- What kind of disability benefits will you be able to get in addition to any settlement from the other driver's insurance company?
- How will your medical treatment be paid for?
- How soon will you be able to get a settlement that starts helping you?
- Will you have to go to Court?
So the best accident lawyer is experienced and specializes in helping people with serious injuries, but is also easy to talk to.
Need help finding the best lawyer for you and your family?
We feel so strongly about helping you and your family get the best lawyer after an accident that we developed a checklist, or list of questions for you to ask any lawyer you may be thinking of working with, to make sure they have the right experience to help you. Just call us at (202) 393 - 3320 or email us at [email protected] and we'll send you a free copy.
Why do we do this?
First, we have a very exclusive law firm and we have to turn away many more people than we can help - we only agree to work with a select few, people with very serious injuries after an accident, because that is where we can do the most good.
Second, we see a lot of people who got the wrong lawyer for their case, and that just sucks.
If you've been in a serious accident in DC, Maryland or Virginia and need a lawyer, call us at (202) 393 - 3320 or contact us through the confidential website form and we'll call you. We'll give you an honest, down to earth assessment of what we think - and we promise we'll try to help you in some way, even if it turns out we're not the best lawyer for you and your family!
The call is free, confidential and helpful!
What do I need to do to get ready to file for Long Term Disability?
What To Do Before Filing for Long Term Disability
First and foremost, get a complete copy of your medical records from your physicians. Some doctor's offices will give you only the physician notes or reports, some will charge you or have some copy service charge you for this, some staff members don't want to deal with it. But whatever the situation, be assertive in getting everything in your medical chart - office notes, labs, orders, prescriptions, referrals, etc. You need to see these before the disability insurance company does, and you have to know what your doctors are saying about your condition or injury and your ability to work before you file for long term disability benefits.
You're injury or condition is legitimate - you're not trying to hide anything. But remember, the insurance company is going to do everything they can to deny or stop your disability benefits, construe everything that isn't 100% clear in their favor.
Here's just a few reasons why you need to review your medical records first:
- There is a mistake in the records (this happens frequently, and with electronic medical records and auto fill on the computer, the mistake gets automatically repeated in every office visit). Examples could be what your job is, how long you've had the injury or condition, what caused it, what your limitations really are.
- Your doctor may not know what "disability" really means under your long term disability insurance policy - in other words as it is defined in your specific policy - not the common, dictionary or medical definition.
- The records aren't complete - there are visits, labs, tests, etc. that are not in your medical chart.
- Your doctor isn't a specialist or doesn't have specific expertise with your specific injury or condition and some of his notes could be misinterpreted by the insurance company. It's not that he doesn't understand your condition and that you can't work, but that his notes are vague, general or not very specific.
Medical Providers and Insurance Companies Have Completely Separate Agendas
Keep in mind that none of this really matters as far as your medical treatment goes - and that is what your doctor is focused on. Many doctors are squeezed by health insurance reimbursements and view documentation as one more thing they have to do - but it's critical for your long term disability claim. Obviously, you want a copy of your records so you can identify if you have any of these issues before you file your claim, and so you can take steps to correct them by talking to the doctor, getting a follow up exam, a second opinion, etc.
In every case, the disability insurance company will review these records closely, looking for everything they can (any mistakes, inconsistencies, omissions, etc.) they can use to deny benefits. The insurance company will have their own medical consultants and experts review your records - and you can bet they are trained to look for every inconsistency, mistake, anything that is vague or doesn't specifically describe your injury, condition and inability to work. Your medical condition and inability to work is real and legitimate, so make sure your medical records are good enough to satisfy the insurance company under the policy and qualify for benefits.
You Stand to Lose a Lot if You're Not Careful About Managing Your Medical Records
If you don't review your medical records and just send them to the insurance company, you may set yourself up for a denial of your claim - that's what your long term disability insurance company is hoping for. If you want more information on how to prepare for your ERISA long term disability claim, or want to talk it through, just call us at (202) 393 - 3320.
How do I request my claim file after I've been denied long term disability?
After you receive a denial letter from your long term disability insurance company, one of the first things you should do is request a complete copy of your claim file.
Why you should request your claim file after your long term disability benefits were denied.
The claim file should contain all of the information the insurance company used to deny your claim for long term disability benefits - many times the claim file will be several hundred or more pages long. And it's a critical piece in the evaluation of your appeal - and remember, filing a well written, thorough appeal with additional medical records, reports from specialists and experts, research, medical literature, vocational information and persuasive evidence is absolutely critical. It will be used by the insurance company to decide your appeal, and then by a federal judge if your case is filed in court.
An appeal of the denial of long term disability benefits is not just filling out a form or writing a letter!
Since you only have 180 days to file an appeal, you should request the claim file as soon as you can, and the insurance company can not charge you for this, it is free of charge. Under ERISA, the insurance company has 30 days after your request to send the claim file to you.
How should you request your long term disability claim file?
First, carefully review and analyze the letter denying benefits that you received from the disability insurance company as to why they say you are not entitled to benefits for your injury or medical condition. Many of these will have an address you can write to with your request, but call the person who signed the letter for the insurance company - you may be able to email or upload your request instead of mailing it.
As long term disability lawyers in Washington, D.C., we draft a specific request for the claim information that requests 15 - 20 types of documents and materials, and we do this as soon as someone hires us to review their denial of long term benefits. We know the clock is ticking and we want to get to work on your appeal!
Get help with your long term disability claim in DC
As long term disability benefits lawyers in DC, we offer a range of services to help with your long term disability claim. If you've been denied long term disability benefits, call us today at (202) 393 - 3320 for a free, no obligation, confidential review of your denial letter so we can analyze your specific situation.
If you're thinking you should apply for long term disability but haven't yet, we offer consultations (now by video) to review your situation and provide a strategy to help you through the application process as well.
How can you tell if you have a legitimate medical malpractice case?
With a serious injury or death after surgery, anesthesia, delivering a baby or some other routine health care procedure, you should investigate whether the injury or death was due to medical mistakes, like the hospital's directions to nurses of how often to check on a patient, or a doctor's office system for telling patients about test results.
If you're left to care for a family member who had a life changing condition, like paralysis, brain damage, cerebral palsy, etc or if a family member died after medical treatment and now you have to provide for children, struggle with grief and worry about the future, it probably makes sense for you to investigate whether the injury or death could have been prevented and learn about resources and compensation that can help.
We try to get people answers. So they know. So they don't have to worry about whether they should have done something years from now, when its usually too late.
We try to take care of those worries for you.
If this is you, call us for more information at (202) 393 - 3320. Even if we can't help you, the talk will be confidential, helpful and free.
How Do I Know I'm Getting a Fair Settlement From the Insurance Company After a Car Accident?
Getting a Fair Settlement From the Insurance Company
Getting a fair settlement from the insurance company after a serious accident can be difficult - you really have to understand how insurance companies work and know the law on accident cases and insurance in DC, Maryland and Virginia.
Accident cases can be more complex in the DMV than in other areas of the country because we often have the accident occuring in Maryland, hospitalizations and medical treatment in D.C. and the driver who caused it (and his insurance company) being in Virginia.
But there are a number of critical things that go into getting a fair settlement for your accident case.
Settlement of an Accident Case
A good settlement will depend on a lot of factors. so there are a number of things an experienced lawyer who helps people with serious accident cases will need to determine (or you if you are trying to settle a case for minor injuries yourself - and don't believe what other lawyers tell you, ot the TV commercials - for some cases you don't need a lawyer).
Are there serious injuries caused by the accident?
We're a lot different than most lawyers. That starts with the first thing we want to talk to you about, evaluate and help you with - you.
We want to know how you're doing.
Are you still in the hospital or did you have a long hospital stay? Did you have surgery caused by the trauma of the crash? Do you need more surgeries in the future? Are you facing a long and painful rehab? Do you have to stay home or quit your job because you can't physically do it anymore? How has this affected you and your family? How are you paying for the medical treatment you need?
There is a lot to ask and find out about. And we want to help people who are the most severely injured - that's where we can really make a difference in someone's life.
How did the accident happen?
Were rear-ended? Did the other driver run a red light? Were you a pedestrian hit by a car?
The facts of the accident should be investigated immediately - getting the police report, talking to witnesses, going to the scene of the crash, taking photographs of the cars are all important steps in the process.
All three local areas in the DMV - DC, Maryland and Virginia have their own laws, courts and procedures, so where the accident happened may be a factor. But DC, Maryland and Virginia all are contributory negligence states, meaning that if someone is at all responsible for or at fault for (even 1% at fault) an accident that they are hurt in, they won't be able to win their case.
It's a harsh law, but the way it is. So insurance companies are always looking to blame you for the accident, or say that you were partially at fault (one of the reasons not to give a recorded statement to the insurance company without talking to a real accident lawyer first). They investigate the accident and try to blame you.
Is there enough insurance coverage for a fair settlement?
If you have serious injuries and the accident was clearly caused by the other driver, you need to make sure there is enough insurance coverage to get a fair settlement. In this area of DC, Maryland and Virginia, the policy limits for car insurance are relatively low - $25,000 (and Virginia doesn't require auto liability insurance).
If you've been hospitalized, had surgery, have permanent injuries and can't work, that $25,000 won't go very far.
So it's critical to determine whether there is additional insurance coverage available - was the person who caused the accident on the job at the time? If so, his employer may be responsible. Some people have umbrella policies - an extra liability insurance policy, usually $1,000,000.00 or more that will pay in very serious accidents - but you have to understand to ask for that.
And every driver should have Uninsured or Underinsured Motorist Coverage on his own insurance policy. This coverage protects you by providing additional insurance coverage over the limits of the person who caused the accident. UM and UIM is a little different in every state but is usually inexpensive and can really protect you if you're in a serious accident.
If you have serious injuries caused by an accident, talk to a serious injury lawyer
Let's face it, these are just basic tips and to make sure you don't make a mistake or get taken advantage of by the insurance company, reach out to us today at (202) 393 - 3320 or fill out our short contact form and we'll get in touch with you.
We know a lot about these cases, and we're happy to talk to you personally, confidentially and with no obligation to make sure you get the best information for you and your family.
What If My Doctor Recommends Surgery But the Insurance Company Says It's Not Necessary?
What Happens When Travelers or The Hartford Denies Surgery Recommended by Your Doctor?
The insurance company doesn't always go according to the recommendation of your treating physician. In fact, one of our clients had to have two surgeries because the first one resulted in a serious condition called frozen shoulder and he struggled to get the second surgery authorized.
If the insurance company is refusing to authorize the recommendation of your treating physician, you should call an attorney. Often the insurance company will hire their own doctor to examine you, who is paid by them and will most of the time find in favor of them. They call this exam an Independent Medical Examination, or IME. We call it what it really is - an Insurance Medical Exam paid for by the insurance company and for the benefit of the insurance company. You're not there for medical treatment and the doctor has no duty to you (most won't even talk to you - they'll say you just have to get the report from the workers' comp insurance company).
What Can I Do After My Surgery Is Denied By My Workers Comp Insurance Company?
Sometimes the only way to get your treatment authorized is through filing for an informal conference (mediation) or a formal hearing. The informal conference is non-binding but might help to reconcile the differences between the two sides. If that doesn't work or for more serious adjudication issues, a formal hearing will result is a binding decision from an adjudication judge.
At Donahoe Kearney we use all of the process to your advantage: to pressure the insurance company to do the right thing, or have a judge order them to do the right thing. There are no insurance company tactics, strategies, or tricks that we haven't seen (and we can see them coming and prepare you for them). We will do everything we can to make sure your treatment is authorized and that you are on the road to healing.
If you have been caught up in an IME battle or the workers' comp adjuster is denying or delaying your medical treatment after a serious work injury, give us a call at 202-393-3320 or email us at [email protected] to get a free copy of our report "Scheduled: A Guide to Appointments with the Workers Comp Insurance Doctor and How to Protect Yourself."
Ready to Hire an Experienced Workers Comp Lawyer Now?
Contact our experienced workers compensation lawyers at 202-393-3320 to get help now. You'll speak to a real person who can help you get started on your road to success.
How Can I Get From Short-Term Disability To Long-Term Disability Smoothly?
Going From Short Term Disability to Long Term Disability
Most people don't realize that short term and long term disability are totally different - different policies, administration, time limits, types of injuries and medical conditions, just to name a few. So even if both types of policies are provided by your employer, you may have very different benefits and claims policies available.
A lot of short term disability policies cover you if you can't work for anywhere from a few months to 2 years. They typically have a short waiting period, about 14 days, and require a less intensive application policy and review. Many times, these applications are granted quickly. They may have exclusions - for example, they may exclude injuries that happen at work.
So does getting approved for short term disability mean you will be automatically approved for long term disability? You would think that but it's not the case. Many times the short term disability is really the employer's money rather than the insurance company's money - the disability insurance company just administers the policy.
And you can be denied for short term disability and still get long term disability benefits.
Long term disability can cover you for many years if an injury or medical condition prevents you from working in your occupation, or after a period of time, any occupation, and typically these policies cover you until age 65. Like short term disability, there are usually exclusions, often for mental illness, for example, and the application and review process is more rigorous. These policies often require you to apply for social security disability (and take a credit if you're approved and getting social security disability).
Keep in mind - all long term disability insurance policies are written to favor the disability company, and the federal law that governs disability claims (ERISA) is much more favorable for disability insurance companies than it is for employees with legitimate, serious injuries or medical conditions that prevent them from working.
And the key is - if you've received a letter from the disability insurance company denying or terminating your claim for benefits, call us so we can arrange to review the denial letter (in confidence and free of charge) and give you our analysis of what to do to put your appeal in the best light. But under ERISA, you only have 180 days and that's not a lot of time for the amount of work involved.
Call us today at (202) 393 - 3320 to get started.
When someone dies and has a D.C. medical malpractice case, who does the money go to when the malpractice case settles?
Wrongful Death and Survival Action Claims
When a patient dies because of medical malpractice in the District of Columbia, the relatives and estate have both a wrongful death case and a survival action. In D.C., both are different in terms of who is involved and the damages to make up for the harms and losses caused by the malpractice.
Here's how it works. Say a wife and working mother of two young children dies because of an undiagnosed pulmonary embolism in the hospital or after leaving the E.R. and we can prove her death was caused by the hospital's malpractice, there are two components to the family's case. First, the children can recover for the harms and losses for losing their mother due to medical malpractice. The D.C. Wrongful Death Act allows the children to recover for the loss of care, guidance, attention, services, etc. the mom would have given them if she had been alive.
The mom's estate can also recover for her lost future income and her pain and suffering. The husband and possibly the children could also recover damages under her estate - that depends on a number of factors. These are just the basics - there are other elements of legal damages available. And there are different time limits for filing a wrongful death case (1 year after death) and a survival action (3 years).
To Learn More Contact our Experienced Medical Malpractice Lawyers Today
If you are facing this situation having lost a loved one, or if you know someone trying to get answers in the face of such a tragedy, don't delay. The sooner you call us to investigate a potential medical malpractice case, the sooner you will have answers, and we hope, peace of mind. Want more information? Give us a call today at 202-393-3320. We can't wait to hear your story.
Do We Have to Sue My Husband's Employer for Workers' Compensation in Washington, DC?
My husband was hurt at work in D.C. We don't want to sue his company, we just want fair compensation. What should we do?
We get this question all the time. Most people have never had to have a lawyer, have never gotten seriously hurt at work, have never gone through this before. Before you do anything - sign any forms, talk to the adjuster, go see the insurance company doctor - you need to get information. Get started by ordering a free copy of my D.C. workers compensation book.
If your husband has a minor injury and is back to work quickly, he may not need a lawyer. But if the injury is serious, if he is out of work for a long time, needs medical treatment, needs surgery, has an injury that will flare up in the future or is permanent, you should call us now at (202) 393 - 3320 so we can answer your specific questions based on your specific situation.
There is a big difference between filing for a workers compensation insurance claim and suing your employer. Filing for workers compensation is opening a claim with an insurance company- much like you would after a car accident or if someone was injured at your home. Your husband's employer may do everything they can for him but they have a workers compensation insurance company that is calling the shots. And the insurance company doesn't know or care about your husband or any injured worker - the insurance company is in business to make money for its shareholders and they make money by paying injured workers less.
How do they do that? They will never tell you all of the benefits you are entitled to under the law (because they don't want to pay for them). They will send you to one of their doctors for medical treatment for your injury (is an insurance doctor likely to recommend tests or specialists that the insurance company has to pay for). They may even send you to some type of "worker's clinic" they fund where you won't see a specialist (or even a doctor usually) for treatment. Don't get me started on these "worker's clinics" but I wouldn't send my dog there. If your husband was injured in DC, he has the right to choose his own doctor for independent treatment.
Choose the Right Lawyers for Your Husband's Work Injury Claim
An experienced workers compensation lawyer knows how to get benefits fors an injured worker and follow through on an eventual settlement of the claim. We don't get between an injured worker and his company - we only deal with the workers comp insurance company. And our goal is always to get fair compensation for an injured worker - and that includes everything - like compensation for time off work, proper medical care, and permanent injury benefits.
Give us a call today at 202-393-3320 to learn the realities about DC Workers' Compenation, and discover how to protect yourself and your family.