Answers to Medical Malpractice, Workers Comp, Long Term Disability Insurance, and Car Accident Questions
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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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The workers comp insurance adjuster says I have to give a recorded statement before I can get D.C. workers comp benefits. Is this true?
You Do Not Have to Give a Recorded Statement to Get Workers Comp Benefits in D.C
Unfortunately, we hear this a lot from people who have been legitimately hurt on the job in DC and should be receiving DC workers comp benefits.
There is absolutely no requirement that you give a recorded statement to your adjuster in order to start your workers comp benefits in D.C. In fact, we don't let our clients give recorded statements.
Why Does The Workers Comp Adjuster Want You to Give a Statement?
Here's the deal - the insurance company adjuster has handled hundreds (if not thousands) of workers compensation claims in D.C., Maryland and Virginia. She knows how to steer people hurt at work to file in the wrong state, or go to an insurance company doctor, or twist their words when giving a statment, or get information they can use to deny or delay your legitimate claim for workers comp benefits...
You've had one work injury and its serious enough that you may need workers compensation benefits.
Who knows more about the laws, practice and procedures of workers compensation?
The Insurance Adjuster's Job Is To Make Money For the Insurance Company.
It's not to take care of you and your family.
You've worked hard for everything you've gotten your whole life. Don't let them take it away just because you don't know the workers comp law and systems (in addition to the D.C. Workers Compensation Act, there are 58 chapters of regulations that govern that statute, plus case law decisions interpreting it by both the Compensation Review Board (part of a D.C. agency) and the D.C. Court of Appeals (the highest court in D.C.))
You can bet the insurance company has training, seminars, and updates on the law, procedures and policies in effect for DC workers compensation. Plus they have an army of adjusters, lawyers, doctors, investigators, nurse case managers and others working to reduce the amount they have to pay you for benefits and medical treatment.
Who have you got?
Get The Attorney Who Literally Wrote the Book on D.C. Workers Compensation
If you depend on your income to feed your family and you can't work because of an on the job injury, don't take any chances against a workers comp insurance company that has absolutely no duty to you (their duty is to make money for their shareholders).
Mr. Kearney, a nationally recognized attorney, author and advocate for working people, who is Board Certified by the National Board of Trial Advocacy, actually wrote the only book for workers injured on the job in the DMV.
Here are some other things workers comp insurance companies tell people who were injured at work that are wrong and can hurt your case, so watch out!:
- That you had to sign some forms before she could send benefits check
- That you had to see a doctor on an approved list in D.C.
- That you should file your workers compensation claim in Maryland because you live there
You don't have to (and shouldn't do) any of those things. If your workers comp adjuster has told you this, you need to call us right away at (202) 393 - 3320 to get the right information so you don't get taken advantage of by the workers comp insurance company.
There Is Help Available. Contact Our Experienced Workers Comp Lawyers Today
Order one of our free guides to workers compensation, or better yet, read our book to find the answers to these and many more questions about what to do when you get hurt at work and need workers compensation benefits and stop you from making mistakes that will hurt you financially, medically and emotionally. And then give us a call at 202-393-3320. We are looking forward to helping you navigate workers comp - you don't have to do it alone!
My Father is in the Hospital After a Serious Car Accident and the Insurance Company Keeps Calling Him and Sending Forms. Does He Have to Talk to Them?
Don't Talk to the Insurance Company When You're Recovering From a Serious Car Accident.
Unfortunately, we see this all the time. After a serious car accident, especially when you or someone in your family is in the hopital or recovering from surgery, the other driver's insurance company wants you to give an interview or recorded statement, or fill out some forms, or provide authorization for your medical information.
Don't. Here's why:
The Insurance Company Will Use a Recorded Statement Against You.
Remember, their job is to deny or limit the amount they pay in damages. In a serious car accident, they want to do that - and they know if they get started right away, before you have an experienced attorney working for you, they have an advantage.
There is absolutely no requirement that you speak with the insurance company. What if you make a mistake or can't remember something because of your pain, medications you are on, or symptoms you are experieincing since the accident?
What if you're distracted by nurses and doctors coming in and out of your room and you forget to add a detail to how the accident happened? Or you forget to mention all of your injuries? Will they try to make it look like you were lying or hiding something?
What Will the Insurance Company Tell You to Get You to Talk to Them?
Remember, insurance claims adjusters and investigators for all of the major car accident insurance companies in the DC area - USAA, Geico, Travelers, Liberty Mutual and others - are experienced. They have handled hundreds, if not thousands, of car accident claims for the insurance company.
Who do you think has the advantage?
They may tell you that they need this information, or that if they don't get it by a certain date, they will "close" your claim. That sounds serious but it means absolutely nothing. That is just an internal term - in our car accident cases, we've had people come to us, worried about high medical bills and the effect of permanent injuries from an accident, who have had their claim "closed" but the insurance company.
Once our accident lawyers got involved, the insurance company opened the claim the next day.
The point is - you control this process (that's one of many things we do for the people we work with, our clients don't have to worry about this), not the insurance company.
As long as you are within the statute of limitations for filing a lawsuit against the other driver, you are ok. But don't take this to mean you should wait until the statute of limitations is about to expire before contacting the insurance company or trying to get an experienced attorney - the best lawyers won't take cases that are close to the statute of limitations. We won't be able to help.
Get The Best Lawyer For Your Accident Case in the DMV.
Remember, this is a process. We want to be able to help you through every phase without having to worry about the insurance company or your case - we handle all of that so you can focus on your recovery and on getting better.
We can only help people with very serious injuries - that is who we focus on.
If you or someone in your family was hospitalized after an accident caused by another driver, call us today at (202) 393 - 3320 and talk to us before you talk to the insurance company (or sign any of their forms).
We'll get you started by talking with you and getting you all the information you need to make the best decision on your car accident case and how to take care of yourself and your family.
The Long Term Disability Claims Rep Says I Have to Show Proof of Disability to Continue Benefits. What Does That Mean?
Proof of Disability in Long Term Disability Claim
After you have been awarded long term disability benefits, most long term disability insurance companies require you to show proof of ongoing disability, and sometimes it is called "proof of loss". Some of that will depend on your specific long term disability policy, but there are some common requirements, such as:
- the long term disability company (Mutual of Omaha, Hartford, Guardian, Reliance, etc) will have internal guidelines for reviewing your claim.
- the insurance company can require you to provide proof of disability at certain points (usually every 45 - 90 days or so)
- the insurance company can require that you are under the care of a physician
- the insurance company can send you to one of their doctors for an evaluation
How Do You Prove Disability in Your Long Term Disability Claim?
The first thing to do is to make sure your doctor understands the physical and mental aspects of your job, so that your doctor can address all of the relevant restrictions and limitations from your medical condition or injury. Its a common misperception, but your doctor doesn't necessarily have to say you are "disabled" or that you can't work at the job.
But the doctor does have to provide the limitations on your functioning (and those limitations or restrictions should lead to the conclusion that you can't do that job). Here's an example of how restrictions and limitations match up with your job duties:
As a bank manager, your duties may include things like supervising employees, verifying cash counts, making decisions, using judgment, interacting with the bank's customers, scheduling deposits. But a severe concussion has impacted your ability to think clearly, to make decisions, to process information quickly, to remember things clearly and to follow directions.
The physician treating you for post concussion syndrome should be able to address whether you are able to make decisions at a pace appropriate for a bank manager, whether you have memory loss, altered or affected judgment.
Usually your long term disability insurance company will have a form for the doctor to complete. And its important that you meet with your doctor to make sure the doctor understands all of your symptoms and problems with functioning. And that should also appear in your doctor's records.
Is Proof of Loss Different than Proof of Disability?
That really depends on your long term disability policy. Some insurance companies use the terms interchangably, or as an initial determination of whether you are disabled according to the policy. So proof of loss may require you to provide:
- Evidence of your income, such as tax returns or W-2s
- Medical information - doctor's reports, diagnostic tests, treatment notes, etc.
- Evidence of Other Income Benefits (social security disability for example)
- Most policies will also require you to apply for Other Income Benefits like social security disability because they can use those to reduce the amount of long term disability benefits thay have to pay.
In addition, the long term disability insurance company can have you examined by a physician or other specialist of their choice (such as a vocational rehabilitation counselor or functional capacity evaluator) or interview you, as part of the Proof of Loss determination.
How Can a Long Term Disability Attorney Help You Prove You are Disabled?
As long term disability attorneys based in Washington, D.C., we talk to people who are struggling with keeping up with the insurance company's endless demands on them and their doctors to continue to prove they are disabled - often a consulation with a long term disabilty attorney can get you on the right track.
And a common way to deny long term disability benefits is for the insurance company to say you do not have sufficient limitations or restrictions, so aren't disabled as defined by the policy.
If your long term disability benefits are denied or terminated by the insurance company, you only have one chance to appeal - getting a long term disability attorney, one experienced with working with physicians and other experts you'll need to prove your claim, is a smart choice.
Call us today at (202) 393 - 3320 with your questions on long term disability benefits in D.C. We're here to help.
What will I have to do to investigate my child's medical malpractice case and how much time will be required?
What will I have to do to investigate my child's medical malpractice case and how much time will be required?
Caring for a special needs child is a 24/7 job - we've said that over and over. If you come to us and ask us to investigate whether your child's cerebral palsy was caused by medical malpractice, we will take care of you and your child.
We understand the demands on your time and the time, energy and money you devote to your child. So we don't ask you to take away from time with your child by getting medical records, doing our legwork or paying for evaluations.
We make it as easy as we can for mothers, fathers and caregivers. But we will take the time to explain the process of investigating the cause of your child's cerebral palsy and give you our straight up opinion of how long a case will take and what you'll need to do.
We will need to meet with you and your child. And there will be appointments and meetings to take your child to, but we do everything we can to let you focus on caring for your disabled child.
Watch this story of LaTonya and Jeremiah to learn about how Donahoe Kearney does cases for children and families.
Need Help Now? Call us at 202-393-3320.
My Long Term Disability Benefits Were Denied and I Need to Appeal. Should I Get an Attorney to Appeal?
Get the Right Lawyer to Appeal Your Long Term Disability Denial
Do you need a lawyer for your long-term disability appeal? The answer is almost always yes.
If you have been denied long term disability benefits or your benefits have been terminated, and you have a serious medical condition or injury that prevents you from working, you probably have too much to lose by trying to appeal yourself.
And under ERISA (the federal law that governs most long term disability plans provided as an employee benefit through your job) your appeal is the most critical component. Here's why your appeal is so important:
- The appeal goes to the disability insurance company that just denied or terminated your benefits (that sounds crazy that the same company gets your appeal, but that is the inital step).
- You can add evidence - medical records, opinion letters, reports from experts and specialists, diagnostic test results, etc. that supports the fact that you cannot work due to your illness or injury, and that the insurance company will have to consider.
- You need to argue your case in your appeal, based on the law and the analysis of the insurance company's decision to deny benefits under the policy and their denial letter.
- You can add witness testimonials from people who know your condition, what you are going through, and what your job requires
- You can rebut the evidence the insurance company used to deny or terminate your long term disability benefits - did they have a physician review your records, do they have surveillance video they say shows you can work, do they think your job is physically less demanding than it is, or that you could work in another, similarly defined job?
- Your appeal is part of the administrative record that a federal judge will use to decide your case for long term disability benefits if your case goes to court.
There are certain types of cases that people can handle on their own, especially if they have a minor injury (and we tell people that every day). But this isn't one of them.
If you have a medical condition, illness or injury that is severe enough that you can't work for 6 months, it is probably permanent and may prevent you from working for the rest of your life, even with good medical care and treatment.
That is a lot of income to replace - which is why you have long term disability insurance that you either purchased or were provided by your company as part of your employee benefits and compensaton package.
And most people don't know how complex and difficult long term disability cases are (most lawyers won't even handle these cases). But don't risk everything you've worked hard for on a system that combines law, medicine, regulations, and insurance - get the right lawyer to help you and your family, so you can focus on getting better.
Get The Information and the Help You Need Today
You're making a big decision for yourself and your family, and we are here to provide the information you need to make the right choice. Download our free report Claim Denied: The Ugly Truth About Long Term Disability today at no cost or obligation. After reading this free report you will be 100% more prepared to navigate your future with a long term disabilty claim.
Ready to Speak to An Attorney Today?
We're here to help, so call us today at (202) 393 - 3320 to talk about your long term disability issue. We have a number of options to help you wherever you are in the process, even if you're just applying and have questions or concerns. And if you received a letter from your insurance company denying or ending your long term disability benefits, send that to us at [email protected] and we will review it at no charge, in confidence and with absolutely no obligation. We'll give you options and what we think your next steps should be based on the specifics of that denial letter.
What If My Company Doesn't Have Light Duty Work For Me?
What Is Light Duty When You're On Workers' Comp in DC, Maryland Or Virginia?
Before going back to work, the doctor can put you on light duty. Basically, he gives you restrictions that say you can do some activities, but not everything your job requires. Usually your doctor will say you can't lift over 20 pounds after a back injury, or no overhead work after a torn rotator cuff surgery, or no climbing ladders after a knee surgery. If you have any type of restriction from your work injury that prevents you from doing your regular job, and your company offers you work within those restrictions, that's light duty.
Did you know that sometimes light duty can actually help you recover more quickly, and get you back to work in shorter time? See how light duty can help you here.
What Is Light Duty?
Remember,light duty means that you're at work performing some duties (not the full duties of your job) and you are being paid accordingly. Also, remember, if you are earning less money than you were at the time you got hurt (and that's per week, not just your hourly rate) you should be getting workers comp checks to make up the difference while you're on light duty.
The simple way to calculate it is this:
If you are getting paid the same per week (with overtime and bonuses calculated for your weekly wage) you will get a paycheck from your company again and you won't get any further workers' comp benefit.
Here's how it works:
If you're making less money on light duty because you are working less hours or can't do overtime like you used to, your workers comp benefits would be 2/3 of the difference between your wages at the time you got hurt and the new light duty job. These benefits are called Temporary Partial Disability benefits.
Light duty doesn't stop you from getting your disability benefits, but if you're offered light work duty work within your restrictions and you turn it down, the workers comp insurance company can stop or reduce your benefits. (And you should bet they will).
But, What Should You Do If Your Employer Doesn’t Offer Light Duty?
If your company doesn't offer light duty work, they have to continue to pay your full workers compensation rate.
Many construction companies do not have light duty in the trade. So, even though a doctor may say you can return to some work with restrictions, until you are cleared to return to full duty, your workers' comp benefits should continue at the full rate. So it is really important to get a note or disability slip from your doctor indicating any restrictions or limitations you have because of the work injury.
Workers' Comp Check Coming Late?
Click here to see what to do. We know that just because the workers' compensation check is late, it doesn't mean that you can pay your bills late, so make sure you contact an experienced workers comp lawyer right away if your checks are coming late
Contact Our Experienced Workers Compensation Lawyers Today!
You're probably under a lot of stress due to the uncertainty - most people are - because how can you know what or how much you should be getting, or how to get the best medical care for your injuries, or what type of benefits you can get in the future? Don't worry -we help you with all that.So just call us at 202-393-3320 and you will speak with a real person who wants to hear your story. We make time to answer questions about work injuries in D.C., Maryland and Virginia every week and we'd love to hear from you.
If I Appeal My Long Term Disability Case, Or If It Goes To Court, Will I Have to Testify in Court?
You Probably Won't Have To Testify In Court If Your Long Term Disability Appeal Is Denied.
Most long term disability insurance policies provided by an employer as part of your employee benefits or compensation package, are governed by a federal law, ERISA (Employee Retirement Income Security Act), so if there is any litigation on your claim for long term disability benefits, it will be in federal court.
Here's how it works:
If Your Claim For Long Term Disability Benefits is Denied or Your Ongoing Benefits Are Terminated, You First Have to Appeal That Decision.
Appealing a denial of long term disability benefits is difficult, especially for someone who can no longer work and is dealing with the effects of a serious injury or medical condition (which the disability insurance company doesn't believe or doesn't believe prevents you from working).
Your appeal to the insurance company is the most critical step in the process.
It is much more than completing a form or sending in some medical records from your doctor. You need to analyze your long term disability policy - the definitions, terms and conditions, exclusions and limitations, etc. - will help you get started on what you need to prove.
You need to analyze the denial letter and request a complete copy of your claim file from the insurance company (which may be hundreds and hundreds of pages - make sure you specifically ask for everything).
If your long term disability insurance policy is an ERISA policy, there are regulations that govern how the insurance company evaluates and decides your appeal. As you know, the insurance policy is written by the insurance company - not only does the policy favor the insurance company, federal courts have routinely ruled in favor of disability insurance companies based on a number of factors set forth in the policy, including the standard of review the Court uses.
If Your Appeal To The Insurance Company Is Denied, You Can Sue The Insurance Company In Federal Court.
Once your appeal is denied, you can file a lawsuit to get the long term disability benefits you are owed. But there is a critical difference between an ERISA disability lawsuit and a case involving any other serious injury or medical condition - a medical malpractice case or trucking accident case, for example.
Under ERISA, the federal judge who decides your case will decide it based upon the administrative record - that is, everything your long term disability insurance company had when it denied your appeal. There won't be any discovery, depostions or additional evidence. You won't have a jury trial.
That record will include everything you submitted as part of your appeal - so you have to make it count. That's why we focus on the appeal, on generating all of the medical, vocational and other evidence necessary to prove that you are disabled as defined by your specific policy. While this would not include testifying in court, we interview you (and others with knowledge of your medical condition and job) extensively to prepare a powerful statement as part of our evidence.
Unfortunately, we've turned away people with legitimate, serious medical conditions who are ready to file their case in court because they did not properly and thoroughly file an appeal - and there won't be enough evidence, or the right kind of evidence - for the judge to rule in their favor.
If Your Long Term Disability Insurance Policy Is Not Governed By ERISA, You May Be Able To Testify in Court.
Again, most policies fall under ERISA but some are private, state law contracts. If you have an disability insurance policy that isn't covered by ERISA, you may be able to sue the insurance company in state court, like almost any other case and have discovery, including your deposition. And if the case goes to trial you may testify in court.
Download Our Free Report To Get The Information You Need Now
If you're just getting started in the process, you need the right kind of information to make good choices for yourself and your family. We have a free report you can download and read to better understand what will happen if your claim is denied and the dangers of handling the claim on your own. Download this free report now.
Talk To A Long Term Disability Attorney in DC
If your long term disability benefits have been denied or terminated, fax us your denial letter from the insurance company. We'll review it for free, in confidence, and with absolutely no obligation. Just send it to [email protected] We'll give you or thoughts on what you should do next.
And we offer different levels of service depending on your needs - maybe you are just applying for long term disability and only need to consult with us for an hour or two, or you've been denied and need to research, draft, prepare and file an appeal.
We're happy to help. Call us today at (202) 393 - 3320 to get started.
How do the smartest executives working in DC get long term disability benefits when they can't work?
Getting Long Term Disability Benefits After A Serious Illness or Injury.
If you're like most executives working in DC you've worked really hard for your entire career to make a difference and provide for your family.
You had absolutely nothing given to to you. You paid your own way. You earned it.
But what happens when a medical condition or serious 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. Don't give the insurance company the opportunity to deny or terminate your long term disability benefits because you don't know any better.
You don't want to get taken advantage of. You don't want to lose everything you've worked hard for.
How Do I Appeal a Denied Long Term Disability Claim?
If your claim for long term disability was denied, you need to formulate evidence and write your appeal as if a federal judge was deciding your case based on the appeal and the 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 by your insurance company (that's who the appeal goes to), 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 and to build your case at the appeal stage.
If a lawyer tells you to wait until you file the case in court, so the other side doesn't know what is coming, or to wait and take the depositions of your doctors, or that you have an aooprtunity to develop your case during discovery - then that lawyer doesn't know ERISA disability cases.
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 Our 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?
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.