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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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.
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.
How do I request my claim file after I've been denied long term disability?
Requesting your claim file after being 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.
Should I File for Social Security Benefits if I'm on Long Term Disability Insurance Claim?
What's the difference between Social Security benefits and Long Term Disability Insurance benefits?
There are several types of insurance that generally get lumped into the same lot: Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI) and Social Security Retirement Benefits. Most people only hear the term "social security" in the context of retirement and don't know that they may be eligible for other types of benefits if disabled.
Here are a few key differences between the different types of disability benefits:
Social Security Disability Insurance (SSDI): Pays benefits to anyone who qualifies as disabled and is funded by money that is paid into the social security system through paycheck deductions.
Social Security Retirement (Retirement Benefits): You can qualify for social security retirement benefits starting at age 62 regardless of your status (disabled or not disabled). The amount of your social security retirement benefits depends on how much you paid in during your lifetime. Social Security Retirement generally requires at least ten years of working.
Supplemental Security Income SSI: This is a benefit available to people who are disabled and it is a needs-based benefit, as opposed to the other types of benefits that are awarded based on what you've paid into the system (entitlement).
Long Term Disability (LTD) benefits generally come from an employer-sponsored plan and can be awarded alongside these other types of benefits, but the long term disability carrier will require a credit taken, or reimbursement, if the two types of benefits are being awarded at the same time.
Which we think is total B.S. - your employer paid your premiums on the long term disability insurance plan as part of your employee benefits so you should be entitled to the full benefit amount. But, unfortunately that's the law.
My long term disability claim has been approved. Will I have to pay back my social security disability?
Most of the time it will take longer to be approved for SSDI than it does for long term disability, unless your long term disability claim is denied after an appeal of the initial denial. If you are awarded SSDI after you have gone on claim with long term disability insurance, the LTD carrier will take a monthly credit for the amount you are getting under SSDI and will likely require a reimbursement for benefits paid if you are awarded a lump sum under SSDI. It gets complicated and frustrating for the claimant so if you have questions, you should give us a call at 202-393-3320 and we will get you started on the right path.
Most long term disability insurance carriers will require you to file for SSDI, which is another part of the B.S. that insurance companies get away with. You should be prepared for this if you are going on claim for LTD.
A lot of long term disability insurance companies will have you use a social security disability lawyer they recommend. Be careful on this - some conditions that may qualify you for social security disability may be excluded or severely limited under your long term disability plan (especially certain types of mental illness).
Like everything else, find a lawyer you trust for your social security case.
If my long term disability claim has been denied, what are my next steps?
If your claim is denied, send a copy of the denial letter to our Director of Client Services, Brooke Birkey, at [email protected] so we can review it for free and let you know what we think your next steps should be.
If you don't already have a copy of your medical records, you should request them immediately and start to index them, or have a family member help you index them if you have cognitive issues or chronic pain. You want to make sure your conditions are covered properly by your medical notes, and your doctor is consistently indicating that you cannot work due to your covered medical conditions. Your medical records will be the core of your appeal (but there is a lot more involved in this appeal), and if your case is ultimately filed in federal court, that appeal will be the administrative record the federal judge reviews to decide your case.
Don't wait - you likely only have 180 days to appeal, and if your medical records are not in order you need to get started right away. Give us a call at 202-393-3320 if you need help with your next steps.
Can You Get Long Term Disability Benefits in DC if You Have Coronavirus?
The short answer is yes.
Long term disability benefits usually pay benefits for almost any medical condition or injury that prevents you from working. Yes, these disability insurance policies have a number of exclusions (for example, many policies exclude work related injuries, certain types of mental illness, addiction, etc.) and there are a number of terms and conditions to fulfill, no matter what kind of injury or illness you have.
Plus, different conditions can combine to cause you to be disabled.
Coronavirus is just one example of how this works. For example, if you are a doctor or nurse, or had a job where you needed to travel, and contracted Covid-19, it can absolutely prevent you from working, especially if you have an underlying respiratory or immune system condition. It's really no different than if you had a heart condition or pulmonary condition and some event or illness exacerbated your underlying condition, making it worse and preventing you from working.
There are two things to keep in mind as well. First, if you can show that you contracted Covid-19 as a result of your exposure to work in the private sector in D.C., for example, you work in health care or had work related travel that exposed you, you may be able to get workers compensation benefits. Second, you may need to apply for short term disability benefits first - many companies in the D.C. area offer short term disability benefits as a way to bridge the gap before eligibility for long term disability benefits starts (and depending on your long term disability insurance policy, that may be 60 days or more). It's a similar process, but designed to be faster, and to provide benefits for a short period of time.
Trying to get long and short term disability benefits in D.C. depends on analyzing a lot of factors, no matter what the specific injury or illness. So get the information you need to make the best decision for you and your family.
So call us at 202-393-3320, or order our free consumer report to get started.
If Your Claim Has Been Denied, You Probably Need an Experienced Long Term Disability Insurance Lawyer
HAS YOUR ERISA LONG TERM DISABILITY INSURANCE CLAIM BEEN DENIED?
Here's the thing about ERISA governed long term disability insurance plans: they are usually going to be interpreted exactly as they are read. So you need to watch out for certain phrases that will make it very difficult to collect benefits should you ever actually need to use the policy.
Most people - yes, even lawyers, doctors and consultants - working in DC don't read through the long term disability policies they get as part of their employment benefits, and they make assumptions about what's in the policy. It's actually common sense, right? If your policy is called "long term disability," you wouldn't be crazy to assume that you are going to be covered in case you should ever have a disability that keeps you out of work long term.
I wish that it was that simple and reliable. But the reality is, many of the terms and conditions in the policy are actively working to exclude you from coverage, and the federal law that governs most of these policies (ERISA) makes it easy for the insurance companies to deny claims because they have "discretion." And though they should be looking out for your best interest (the premiums have been paid, after all) what they are most concerned about is their bottom line and reporting to their shareholders, who are also looking out for their bottom line.
It's not right. That's why, if your long term disability insurance claim has been denied, you should contact an attorney who understands ERISA who will know exactly what to do to give you your best chance at receiving benefits after an appeal. You should not try to handle an appeal on your own.
At this point you may be asking yourself: is having an ERISA long term disability insurance policy even worth it? The answer is, maybe, it depends on what's in your policy and the severity of the medical condition or injury you have. We like to advise people to buy supplemental insurance, just to cover all of their bases, with a non employee sponsored, non ERISA governed policy. But, if you already have a claim and need help getting benefits, you will want an attorney.
Here's what's great about having an attorney handle your ERISA claim:
- An Attorney knows how to put together what's called an Administrative Record (this is your appeal of the denial of benefits - and should contain everything you need to convince the insurance company to put you back on claim) - it is also what the federal judge will rely on when deciding whether or not to award your benefits;
- An Attorney will be able to help you navigate the medical community in order to get the proper documentation for your disability or illness. They will do this by working with your doctors or consulting physicians to review your case and making sure your medical records and reports give all of the proper information about your condition and how it affects your ability to work; and
- An Attorney will know how to argue your case before a federal judge (there are rules of the courtroom, a level of proficiency that comes with experience, and a knowledge of what the judge needs to hear in order to rule on your case).
You need a lawyer in DC who will listen to you and work with you to put you in the best position to receive benefits from your claim. Long term disability appeals are a lot more than filling out a form and sending it in to the insurance company.
Contact Our Experienced Long Term Disability Insurance Lawyers Today
Give us a call today at 202-393-3320 and we will review your denial letter for free and give you our analysis on what to do next. Don't wait - if you received a denial letter, you only have 180 days to appeal under ERISA. That's not a lot of time given the amount of work you have in front of you.
Why Do I Need An Experienced ERISA Attorney for my Denied Claim?
If your insurance policy comes through your employer, and your claim has been denied, your case falls under the federal ERISA code (The Employee Retirement Income Security Act of 1974). Ironically, this act was passed to protect the cash in your pension fund, but over time it has been used to protect insurance companies more than employees. And for some reason it covers employer-sponsored disability insurance plans in addition to dealing with pensions.
Ninety-nine percent of all disability insurance plans offered to employees are governed by ERISA. Under ERISA, you have the right to file suit in federal court if your claim for benefits is denied.
But, unlike almost any other legal proceeding, one side goes into court with all of the “good cards.” That side is the insurance company.
The most important card held by the insurance companies is something called a “reservation of discretion.” The reservation of discretion is something that the courts have given to the insurance companies – free! Here is what this “special card” means:
If your claim for benefits is denied, you will lose your lawsuit against the insurance company, even if you are right and it is wrong, if there is any evidence that supports the insurance company’s decision.
In any other legal proceeding, you can win if you have more than 50 percent of the evidence in your favor. Under ERISA, however, the claimant can have 85 percent of the evidence, and the insurance company can have 15 percent of the evidence, and if the insurance policy contains a “reservation of discretion,” they win!
If your claim has been denied, you'll need an experienced attorney to review your denial letter. We will review your denial letter for free. Contact my legal team at 202-393-3320 to take advantage of this incredible offer.
Why Does R.B. Ginsberg Call Long Term Disability Insurance Law Unjust?
Long Term Disability Policy Law is Unfair and You May Not Find Out Until Your Claim is Denied
Most people don't think about what's in their disability policy until they need to make a claim on it. Especially if you're young, you may be thinking "it's not going to happen to me." Here's some startling reality: According to the U.S. Census Bureau, you have a one in five chance of becoming disabled. A 1997 study released by the Census Bureau reveals that more than 152 million people between the ages of 21 and 64 — the prime working ages for most Americans — have some form of disability. According to the American Council of Life Insurers (ACLI), a person age 35 is six times more likely to become disabled than die before he or she reaches age 65.
It stands to reason that if you become disabled, you will need to make a claim against your long term disability insurance policy. You should be entitled to those benefits if the premiums have been paid. However, it's not always that simple. Over the years, many people have questioned whether ERISA (the law that governs long term disability claims) cases are "fair" for the employees when they take on the insurance company.
Supreme Court Justice Ginsberg Calls ERISA Unfair.
Here's an interesting case to review: Two people had sued their HMOs for failing to use ordinary care in making coverage decisions. The lower court had allowed the case to proceed. In Aetna Healthcare v. Davila, the Supreme Court struck down a Texas law that was designed to compensate people who had been injured by healthcare decisions made by their insurance companies.
The Supreme Court held that state consumer protection laws were completely overturned by the federal law of ERISA. This means that ERISA trumps state consumer protection laws that apply to other types of insurance coverage. Since, the Court said, the only remedy allowed under ERISA for a wrong overage decision is to force the insurance company to pay the benefit it should have paid anyway, a patient cannot sue the insurance company for a worsening of his condition, or for pain, suffering or death caused by the insurance company’s decision. And there is no incentive for insurance companies to deal fairly with their claimants.
Justice Ruth Bader Ginsburg, in a concurring opinion, said that she joined the rising judicial chorus urging Congress and the Supreme Court to revisit what is an unjust and increasingly tangled ERISA regime.” The problem, she says, is that through its decisions, the Court has made it so that virtually all state law remedies which would provide just relief are preempted, but very few federal substitutes are provided. She pointed out that a “series of the Court’s decisions has yielded a host of situations in which persons adversely affected by ERISA-proscribed wrongdoing cannot gain ... relief” and that the current situation needs to be remedied “quickly” because it is 'untenable.'
What Does This Mean for Long Term Disability Claimants?
This is just more bad news. This decision reaffirms that the insurance companies who make decisions for employer- sponsored long-term disability plans are immune from suit for anything other than the benefits they already owe and should have paid. Workers who have been wrongfully denied long- term disability benefits often suffer enormous emotional harm in their fight to have benefits reinstated, particularly if they are sick and without income replacement. The HMO case, however, gives insurance companies the green light to keep denying benefits, knowing that, on their worst day, all they have to do is pay what they owed anyway. We join with Justice Ginsburg in urging Congress to repair this damaged scheme and to restore ERISA to its originally designed purpose of protecting, not hurting, employees.
Contact Our Experienced Long Term Disability Lawyers Today
The next step in your case is to give us a call and see if you need an attorney. Don't let the insurance company bully you around with this. We've seen all of their tricks and are eager to reveal them to you: 202-393-3320.
How do I know the truth about ERISA long term disability claims in DC?
You would think that insurance would pay when you need it - that your long term disability insurance from your employer would be there for you if you were sick or seriously injured and couldn't work. That doesn't usually happen in ERISA long term disability cases, and here's why:
- Insurance companies exist to make money for their shareholders. They are private companies with a duty to those shareholders, not to you. They are not moved by your illness or financial hardship, so just writing a letter or asking for something you think is fair and reasonable won't get your benefits paid.
- Insurance company forms are not to help you win your appeal or get your benefits reinstated, instead many times they are asking for information they later use to deny or terminate disability benefits. So be careful how you fill out those forms.
- Even though most long term disability policies say you have to apply for social security disability, the insurance company can ignore the social security decision that says you are disabled.
- When they ask you for a list of activities, things you can and can't do, how you spend your typical days and send you a form to write all of that out, they often do that because they have had you under surveillance, secretly videotaping you and that form is then compared to the video
- When you write a detailed, lengthy statement yourself, the disability insurance company can use that as evidence you can work, especially if you had a desk job before your injury or illness.
- Very few lawyers have the training or experience to handle ERISA disability cases. Insurance companies take advantage of "pro se" (do it yourself) claimants and lawyers who don't understand this practice area.
- Put all of your evidence into your appeal - you only get one shot at this, because you will not get a trial under ERISA.
- It's not enough for your doctor to indicate just that you are disabled for you to get benefits - the doctor needs to know how that is defined by your policy, and back it up with support and medical evidence. Working with your doctors to get this right is critical.
- The appeal process after your claim is denied is biased in favor of the disability insurance company - you have to know this, understand it and deal with it in your appeal.
- Many federal judges have written that you are not on a level playing field with the insurance company in ERISA disability cases.
- Your employer really can't help (and they usually don't understand the policy either, or why the insurance company won't just pay you (because they know you have a legitimate injury or illness and can't work). But it's really up to the insurance company.
If your ERISA long term disability insurance claim has been denied, you only have 180 days to gather the evidence, medical opinions, records, statements, draft and file your appeal, and most policies only allow one appeal. Don't go it alone - your income is at stake. The insurance company has lawyers working for them around the clock, so don't try to handle this, as your first case ever, on your own. Call us at 202-393-3320 and you'll speak with someone who can get you started getting the information and help you need to make the best decision for you and your family.