Answers to Medical Malpractice, Workers Comp, Long Term Disability Insurance, and Car Accident Questions
Get The Help You Need Now
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.
- Page 3
My long term disability claim from my job working in D.C. was denied. Where do I file my long term disability appeal?
If your long term disability benefits were denied, you have the right to appeal.
If you were working for a private employer in Washington, D.C. and applied for long term disability benefits under a long term disability insurance policy, you have the right to appeal that decision.
If long term disability benefits were provided as an employee benefit from your company, the disability plan will be covered by a federal law, the Employee Retirement Income Security Act (ERISA) and there are certain rights and responsibilities ERISA gives claimants (claimant is the term for the person who is disabled and is making a claim for long term disability).
Your first appeal is to the insurance company that just denied your long term disability claim.
There are several basic rights under ERISA. First, you should request a complete copy of the claims file - everything that the insurance company considered in it's decision to deny your claim for benefits.
Second - you only have 180 days from the date you received the letter denying your benefits to appeal your case.
So request that claim file (or have an experienced DC long term disability attorney request it for you) immediately so you can begin to analyze the insurance company decision and the legal and medical basis for that decision denying your benefits.
An appeal after a denial of long term disability benefits is a lot more than filling out a form.
Many people make a critical mistake that can't be fixed later.
Instead of approaching the appeal and denial of benefits like an experienced long term disability lawyer, they just fill out a simple form or write a letter indicating they don't agree with the decision - just like the denial letter says they have a right to do!
Sometimes they will send in a few more recent medical records about their disabling condition.
But they won't schedule additional medical testing, or a Functional Capacity Examination, or a vocational rehabilitation specialist evaluation. They won't interview co-workers, conduct medical literature searches, perform opposition research on the physician who reviewed their medical records, review specific policy provisions with their doctor to generate highly specific, individual reports from the doctor.
There are 2 basic reasons why someone who is disabled should not file their own appeal.
- There is no way to understand ERISA law and procedure unless you have been in this field - you didn't ask for this and have never been through this before - how could you know whether you are making a mistake that ends your disability benefits forever?
- You have a disabling medical condition or injury that you need to focus on. You don't have the stamina, endurance or time to take on this kind of legal work.
Take it from an experienced long term disability attorney - you only get one shot at your appeal.
That's because if your appeal is denied by the insurance company, your next step is to file a lawsuit against them in federal court (since ERISA is a federal law).
So your case will be decided by a federal judge - there is no right to a jury trial under ERISA. And the judge will consider the administrative record of your appeal - all of the information, evidence and medical records you used to support the appeal will be part of that administrative record.
What do you think your chances of winning are if all you did was fill out a form or send in some medical records?
Call our experienced long term disability lawyers today at (202) 393 - 3320 to discuss your long term disability claim in DC. We offer a number of cost effective ways to help you get the disability benefits you and your family deserve.
Do you offer video appointments for car accident cases?
Experienced Car Accident Lawyers in DC Can Help You with Video Meetings
An accident that wasn't your fault in DC or on the Beltway in Maryland or Virginia can have serious consequences. A lot of the accidents we see cause serious injuries requiring surgery, hospitalization and extensive rehab. And our philosophy is simple - we want you to focus on getting better, getting the medical treatment and therapy you need. We eliminate the stress of dealing with the insurance company on your case - so you don't have to worry about getting taken advantage of or making a mistake that hurts your case.
Our DC Accident Attorneys Deal with Insurance Companies So You Don't Have To
Our accident lawyers have a process we've developed over 25 years to make sure you are taken care of - just check out some of our reviews. Whether you were just visiting when the accident happened or you live nearby, our lawyers can help you without you ever needing to come to our office. We are fully equipped to meet with you by video conference, sign all the paperwork digitally and get started helping you with your car accident case today.
We've already helped several clients who were injured and hospitalized during the coronavirus, so couldn't have visitors at the hospital, and it was too risky to meet with them personally in their homes - since they were in a potentially compromised condition after being in the hospital.
One of the Keys to a Successful Accident Case is Getting Started Right Away.
With any serious injury case in DC, there is a lot to do right away. You need to determine and coordinate all of the insurance coverage - health insurance, the other driver's insurance, your car accident coverage, any other insurance policies or benefits that may apply, like long term disability or workers comp (if the accident happened when you were working or in a work vehicle), investigate the scene of the accident, assess all of the damage to the cars, interview witnesses and first responders, and coordinate all of the medical care you need.
So don't wait - if you've been hurt in an accident, call us today at (202) 393 - 3320 for a video appointment so we can help take away the stress of dealing with the insurance company while you focus on getting better.
Can I work if I'm getting long term disability benefits?
Work and Long Term Disability Benefits
We fight insurance companies on behalf of people every day. If you were denied long term disability benefits for your injury or medical condition, you know how difficult that process is. Many long term disability insurance companies deny tons of people because they know that some people won't appeal at all.
It's an unfair strategy, but it works.
So once you are back getting benefits, is it OK to work?
Probably not. Here's why:
Insurance companies will use any activity related to work, including volunteer work (for people who work with us, we have an entire interview and assessment process that analyzes and explains this for your specific situation) as a basis to deny or terminate your long term disability benefits - many times before you are fully recovered or ready to return to work full time.
What if you're receiving long term disability benefits and want to return to work?
First, you'll need to thoroughly review your long term disability insurance policy.
Most long term disability policies have 2 terms and conditions you should be familiar with: "own occupation" and "any occupation." During the "own occupation" time period, you qualify for benefits if you cannot perform the primary duties of your own job. But after a period of time (your specific policy will indicate this) you qualify for benefits only if you can't work in "any occupation."
There are a few other terms and conditions in your long term disability policy to identify and analyze:
- How Total Disability and Partial Disability are defined
- Offsets for "other income" which allow the insurance company to reduce your benefits
- Vocational rehabilitation programs and incentives to work
Working with your doctor is critical to your long term disability claim.
You need to constantly educate your doctors on this process - they are busy and don't have the time or expertise to analyze the specific terms, definitions, conditions and law that apply to your long term disability benefits.
If you think you can return to some type of work, discuss it with your doctor and have him examine you first.
- Have your doctor thoroughly document any physical restrictions or limitations
- If your doctor agrees you can try to return to work, have the doctor write a detailed report that documents the exam findings, restrictions and limitations you have and indicate that you are approved to attempt to try to return to work for a trial period. If the trial period works, that is great, otherwise you can use it as evidence that you cannot work.
Be honest with the long term disability insurance company.
It's important to provide the insurance company with the medical records that document you can return to work for a trial period and disclose any income you receive.
And be upfront with your employer about your physical limitations and restrictions as well.
We hope these tips help with a healthy, long term transition back to work - one that puts you in control.
Questions about your long term disability plan?
Before taking action, call to schedule a flat fee strategy session with us. We'll review and analyze your policy and medical records and explain how the different terms, conditions and clauses impact your eligibility for benefits, and help you with a game plan so you can make the best decisions for you and your family.
Call us today at (202) 393 - 3320 to get started.
I was denied long term disability benefits from my job in DC. How do I write an appeal?
Appealing your long term disability denial is a complicated process.
There are several steps you need to take after you receive a denial letter from your long term disability benefits insurance company, and you need to act quickly. Under ERISA (the federal law that governs most long term disability insurance policies) you only have 180 days to file your appeal.
Here are some of the initial steps to get ready to write your appeal.
Remember - appealing your long term disability denial (to the same insurance company that denied or terminated your benefits) is a lot more involved than filling out a form or writing a letter. A lot of work and analysis will need to be accomplished before you draft the actual appeal.
After analyzing the claim file you've requested from the insurance company (we typically request 18 - 20 categories of documents and information, and claims files can be many hundreds or thousands of pages depending on the nature of your medical condition, the length of time on benefits and other factors), under most long term disability insurance policies, you need to gather and generate evidence that proves the insurance company denial was unreasonable.
That can mean working with medical and vocational specialists, getting additional diagnostic testing for support, undergoing a Functional Capacity Evaluation, getting statements from co-workers addressing your job duties, educating your physicians on the specific terms and definitions of your policy and integrating all of that new information into your appeal.
And you need to draft the appeal as if a federal judge were reading it, because under ERISA, if your appeal is denied, you must file your case in federal court, and the only information the judge will use to decide your claim is the administrative record - most of which is your appeal.
That's a lot of pressure on anyone, much less someone with a serious medical condition - and you only get one shot at the appeal.
A long term disability attorney in DC can help.
In our DC disability practice, we have an entire process for helping people appeal their long term disability denials. We want you to focus on getting better - your medical treatment and rehab.
We request your complete claims file to get started, analyze your claim, make recommendations, and communicate with you to keep you updated every step of the way.
You didn't ask to get sick. Let us help protect you from losing everything you've worked hard for.
Call our DC long term disability attorney today at (202) 393 - 3320 to get started.
Don't wait - if you received a letter denying or terminating your benefits, you want to get started right away - we'll evaluate the insurance company's denial without charge and give you our recommendations on what to do next.
Will it hurt my DC workers' compensation case to look for another job or take another job after my injury heals?
Will it hurt my DC workers' compensation case to look for another job or take another job after my injury heals?
Not at all. The way it works is your weekly workers compensation benefits should continue until you are released by your doctor to return to your regular job or you return to another job making more money than you were when you got hurt.
If you have a permanent injury to an arm, leg, hand, foot, etc. (sometimes called a scheduled loss or permanent partial disability based on the schedule) you can get those benefits after you reach maximum medical improvement whether you are working for the same employer or not.
Future medical treatment and ultimately settlement will not be affected by a job change, either.
When should I contact a D.C. medical malpractice attorney about a medical malpractice case?
The best medical malpractice attorneys are both selective in the cases they choose and busy. For example, we want to help people with certain types of medical malpractice cases such as cerebral palsy, injuries to children and babies, and wrongful death cases for adults. These are people who are worried about the future of their loved ones and family – how to take care of them. Those are the kind of people we serve.
So as soon as you are suspicious that a patient has been critically injured or has died due to medical malpractice by a hospital, HMO or doctor in D.C., Maryland or Virginia, you should call us and talk it through with an experienced medical malpractice lawyer. Starting the process of investigating and preparing a medical malpractice case earlier always helps the family - it is less stressful and time consuming and you don't have to worry about whether something was missed because you waited too long.
And with medical malpractice cases, the longer you wait, the harder it is to get an experienced medical malpractice lawyer to even talk to you about your case. The best lawyers won't take cases when the statute of limitations is near because there may not be enough time to really help someone. That's our policy.
Please give yourself and your family enough time to thoroughly investigate any medical malpractice issue. You can call us at (202) 393 - 3320 to set up a time to speak with you to see if we can help.
How do top D.C. medical malpractice lawyers decide whether to take a medical malpractice case?
Top medical malpractice lawyers in D.C., Maryland and Virginia (and probably everywhere else) are selective in deciding whether they can take a medical malpractice case. In our D.C. medical malpractice law firm, we decide whether to take a medical malpractice case after a thorough screening process. And we only agree to represent clients where the medical malpractice caused significant injuries such as paralysis or cerebral palsy, or death. The reason for that is simple. As medical malpractice lawyers for patients and families, we feel we can help people the most in those types of medical malpractice cases, and those patients and families usually need our help the most.
The process of investigating a medical malpractice case in D.C. starts with just a phone call. If you'd like us to investigate a medical malpractice case for you or your family, call us today at (202) 393-3320. We'll talk it through with you and hopefully get you some answers.
But don't delay - there are time limits to medical malpractice cases and if someone calls us too close to the statute of limitations (the deadline to file a medical malpractice case) we won't be able to help.
How Can I Get My Difficult Insurance Adjuster To Cooperate?
Workers Compensation Companies Employ Adjusters, Nurse Case Managers, Attorneys, Vocational Specialists and More to Fight Your Claim
If you're on workers compensation, you have probably already figured out it's not a fair fight. Your workers comp adjuster has handled hundreds, if not thousands, of workers compensation claims in D.C., Maryland and Virginia. Their job is to limit the amount the insurance company pays for medical treatment, testing, medications, therapy, benefits, etc. You name it, she will try to reduce it.
Remember, the adjuster works for the insurance company - not you and your family. In fact, your employer may have very little say in the matter of how you're treated, and often can't help you (other times they're upset because you got hurt on their job and may not even care).
Plus, these insurance adjusters handle hundreds of cases at a time and they really don't have time for you. They don't want to be bothered and you may notice that days and weeks have gone by while you are waiting to hear back from them on important issues like your paycheck and medical treatment authorizations. You might even be waiting to hear back on authorization for surgery - and your condition is getting worse while you wait for them.
You Need an Advocate on Your Side to Balance the Scales
Unless you have the experience and knowledge to deal with them, plus the time to devote to calling, writing, and faxing everything to get things done, it's never going to be fair.
With a minor injury that may not matter, but if you need significant medical treatment and will be out of work for an extended period of time because of your injury, you don't want to rely on the adjuster to do right by you. You will definitely need an attorney to advocate for your and your family.
Contact our Experienced Workers Compensation Lawyers Today
Call us today at (202) 393 - 3320 to discuss your options and we'll send you one of our free books, guides and reports that will give you the information you need now to take care of yourself and your family.
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.
But, what if your employer doesn't have light duty?
What should you do?
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).
Here's The Best Part - Where a Lot of People Get Mixed Up:
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.
I Hurt My Shoulder at Work and My Doctor Thinks It's a Torn Rotator Cuff. What Do I Do?
3 Ways to Avoid Messing Up Your Case After Rotator Cuff Tear
A torn rotator cuff (tears of the the tendons in one or more of the major muscles of the shoulder) is a painful, often disabling injury. Many times it requires surgery, especially if an MRI confirms a tear and physical therapy or injections haven't helped. If you are a heavy duty worker, you might be dealing with a permanent injury that will keep you from going back to work.
How do you protect yourself if this serious injury happens at work?
There are three essential things that you need to do when you're hurt at work in order to protect your legal case, your income, and your livelihood. First, tell your employer it happened on the job. We call this giving notice, and it should be done as soon as possible after the injury.
Second, be wary of doctors referred by the insurance company. The insurance company will be watching their bottom line, not advocating for your care. If the insurance company referred you a doctor ask yourself: is he going to order expensive tests, like an MRI, that the insurance company will have to pay for? Is he going to believe you when you say how much it hurts? Is he thorough and does he seem objective? You should not let the insurance companies' doctor manage your treatment.
Next, get to a specialist. This is not an injury that can be managed or treated by a family physician and maybe not even by a general orthopedic surgeon. Make sure you choose the best doctor to be your long term provider to deal with this injury. You could be looking at months or even years of rehabilitation and/or rotator cuff repair surgery, so you want to make sure you choose the best physician from the outset. If you don't, it can be very difficult to get the physician approved later on.
Finally, file your workers' compensation claim in the right jurisdiction.
If You Have a Serious Injury That Requires Surgery, You May Need Ongoing Legal Help to Protect Yourself and Your Family
These are the things you should do, but remember, there is a lot more to it. Making a mistake can cost you a lot of money in lost wages and a lot of time and treatment when it comes to your injury. In most cases, you should not go it alone. You may need an advocate to fight for your rights.
Before you make any serious and difficult decisions, read the free book offered by our offices and written just for workers hurt on the job in the D.C. area: Protect Your Rights: The Ultimate Guide to D.C. Workers Compensation. It's free to injured workers and their families in D.C., Maryland and Virginia. So order your free copy today - call us at 202-393-3320. And if you need help now, contact our experienced staff at 202-393-3320 and we will help you take the next right steps today.