D.C. Maryland and Virginia medical malpractice, accidents and work injuries questions answered by D.C. injury attorneys.
Here are some of the questions people have when they first contact us about D.C., Maryland and Virginia medical malpractice, serious car accidents 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 and based on representing many hundreds of people who have been injured in accidents or at work in D.C., Maryland and Virginia.
Here are the basics:
Patients permanently injured by medical malpractice, or the families of patients killed because of medical negligence, when a hospital, HMO or healthcare corporation doesn't follow basic patient safety rules deserve justice - resources to help with the harms and losses due to the injuries or death of their loved one.
Drivers who don't follow the rules of the road, driving recklessly, driving drunk, speeding, and texting should be accountable for the harm they cause when their actions cause a car accident or wreck.
Workers hurt on the job deserve workers compensation benefits for lost wages, medical treatment and permanent injuries. If a worker is killed on the job, his family deserves workers compensation death benefits - to at least help with the financial loss of a loved one.
But 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.
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What is a Recorded Statement for a Long-Term Disability Company?
After an injury at work or a serious car accident, the insurance company will have an insurance adjuster call or sometimes come to see you in person to get your recorded statement. A recorded statement is essentially a recorded interview and can be used as part of the adjuster’s investigation.
Should you give the insurance adjuster a recorded statement?
NO—at least not without an experienced lawyer representing you or without knowing your rights.
Remember, insurance adjusters work for the insurance companies and their job is to limit and even deny the amount of money the insurance company has to pay you. So they WILL use the recorded statement against you if it is inconsistent in any way. You can tell the adjuster the same situation ten times but if there’s something slightly different about how you explain the situation on the tenth time, the adjuster can and will use that against you.
That is why it’s important to either get all of the information you need to help yourself or if your injury is serious, have an experienced attorney to guide you through this process. Insurance companies will use any little trick or tactic they can think of to limit, delay and even deny your legitimate claim.
Download the report "Claim Denied - the Ugly Truth About Long-Term Disability" or call us today at (202) 393-3320 to learn about the other different resources we provide to make sure insurance companies don’t force you to make a mistake that hurts you and your family.
What Role Does My Doctor Play in My Long-Term Disability Claim?
I've been on long-term disability for a full year and they are just now telling me I don't have proper documentation of my injury and medical treatment. What am I supposed to do?
Yes, we are very familiar with this type of situation. Many times, people on disability just go along getting treatment and hoping to recover and go back to work. All the while, nobody tells them that the insurance company is looking for very specific medical records, will require certain times of tests, and will nitpick over language: all to find ways to deny your claim.
It doesn't seem fair, does it? Of course, it's not but you do still have power. You can discover the truth about ERISA long-term disability insurance and set yourself on the right path.
Most people have short-term disability claims first, and they never intend on going on long-term disability. They hope to recover and go back to work; and so their sights are set, as they should be, on recovery instead of preparing themselves for a successful long-term disability claim.
Here are some quick tips we can give you to get started.
1. Ask your doctor if he or she is familiar with "Objective Medical Evidence." These are the types of evidence-based tests that are famously cited by insurance agents looking to deny your claim. Use these type of diagnostics whenever possible to document your illness or injury.
2. Index your own copies of your monthly progress notes and disability slips. Don't ever leave your doctor's office without an updated disability slip, and follow up with your doctor's front desk to get copies of your progress notes a few days after your appointment.
3. If your progress notes don't fully describe your treatment and connect it to the injury you are claiming on disability (and they should be), ask for edits from your doctor. Your doctor can do this (and should).
4. Don't do anything at all, publicly or privately, that is outside of your doctor's restrictions. If surveillance is taking place courtesy of your insurance company, you can get kicked off your claim.
5. Stay away from social media; don't post anything related to your doctor's appointments or treatment, and keep all of your social media settings on private.
Want more? Securing a consultation with attorney Frank Kearney can keep you from making the kinds of toxic mistakes that will set you up to have your claim denied. Call us today at 202-393-3320 to get started on your road to success.
What Do Long-Term Disability, Workers' Compensation, and Serious Car Accidents Have in Common?
All insurance companies have one thing in common; they want to minimize their number of claims and pay out as few claims as possible. It would be a ridiculous business model if they didn't.
All business seek to maximize their profits, but it shouldn't be at the expense of making good on the promises you make to good people paying their premiums.
There is no exception for ERISA long-Term disability, workers' compensation and serious car accident claims in Washington, DC, Maryland, and Virginia.
Here are a five things that these types of claims all have in common.
1. The insurance companies are always protecting their bottom line, and usually not looking out for your interest;
2. Generally, insurance adjusters are trained to find ways to limit your claim;
3. You can be scheduled for an independent medical exam in all types of claims (though it's far more common in long-term disability and workers' compensation).
4. You can settle your case at the end of the medical treatment for a lump-sum.
5. Donahoe Kearney, LLP can help you maximize your benefits and settlement value on all of them.
Should I Avoid Posting on Social Media if I Have a Disability Case?
Should I Avoid Posting on Social Media if I Have a Disability Case?
The Answer Is a Resounding YES.
Consider this scenario. A new client comes on board with an experienced ERISA attorney like Donahoe Kearney. The attorney does initial research on his case file, which includes reports that the client has received from the insurance company.
What do they see? A lengthy investigative report completed by the aces at the insurance company. It starts with screen shots of him wake-boarding in Cancun. How did the insurance company find these pictures? They didn't have to work very hard for it.
They just searched his name and the town where he lives, and there it was, in all its glory, on his public Facebook page.
So much for his long-term disability claim!
Social Media scouting is just one of the tricks of the insurance company. The insurance company will also do surveillance - by phone and video.
The insurance company chatted up his neighbors, called him directly and and made "discreet inquiries" to fish out whether he was running a business on the side or had any type of "side hustle."
They even hung out on his block, trying to catch him on video doing something that they can use to say he can go back to work.
What most people don't know (but any insurance attorney worth their salt will tell you) files are often filled with surveillance video that insurance companies have gotten from unsuspecting claimants.
Many times you might hear the claimant (client) expresses outrage:
"How dare they sit on my street and video me. It's an invasion of privacy for them to follow me to my doctor's office."
Here's our reply: "Don't lie to the insurance company. What were you thinking?"
You don't HAVE to kill your disability claim with social media. Here are some tips to help you out.
Cheaters always get caught. Be honest and straightforward when talking to the insurance company about what you can and can't do.
The insurance company probably knows when your next doctors appointment is. Be aware of that fact- they will likely be videotaping your trip. Don't stop at Home Depot on your way.
Be smart about Facebook and Instagram. Don't post stupid stuff to Facebook (if you think it might be inappropriate, it probably is). Update your social media privacy settings.
An experienced long-term disability lawyer will be your best investment with an ERISA claim, but they cannot work miracles. They cannot make "discovered" social media disappear. There's a lot an experienced firm can do to improve your chances of winning but changing the reality of a video or photo or Facebook comment isn't one of them.
If you have questions about your ERISA disability claim, or have received a denial letter from your employer’s insurance company, give us a call at 202-393-3320.
Please tell me the Top 5 Tricks of an Insurance Claims Adjuster.
Who is your insurance adjuster?
The insurance adjuster is the representative of the insurance company that communicates most frequently and directly with you or your attorney.
The whole reason they are employed is to help the insurance company make money - that's what insurance companies do.
Think about it -- simply by the name "adjuster." They adjust your claim to try and save money -- simple as that.
Many times adjusters do this by trying to delay and deny your legitimate claim. They receive training on how to minimize the benefits you should get, and they are often so overworked, handling so many cases, that they can't even get to yours. They are there to save the insurance company money, and if that means you get less in benefits and medical treatment, that's just the way it is.
We don't let our clients get taken advantage of by adjusters.
There are some tricks that we see often that you might be experiencing while dealing with your adjuster. Watch out for them.
Here's a list of the top five adjuster dirty tricks.
1) Recording a statement while you are in pain or under the influence of strong pain medications. After a serious work accident, of course you are in pain due to your injury, plus you're probably uncertain, stressed out and not sure what you need to do in the system. You are not alone. Many adjusters know this is the worst time (for you - but its the best time for the workers comp insurance company) to get a recorded statement, knowing that you are now more likely to say something that they can use to delay or even deny their claim. Don't let this happen to you.
2) Misrepresenting the benefits you can receive under the law - this is a big one. Because they know some injured workers don't have an attorney (or worse - have the wrong attorney), they make it seem like you can't get certain benefits when they know you can, or they never tell you about the workers comp benefits you are entitled to.
Protecting you and providing for your family IS NOT not the insurance company's job. Educating you on the workers comp system (there are 58 chapters of regulations interpreting the statute) IS NOT their problem. You may not know what to ask for, and they won't tell you.
3) Intentionally not returning your calls - Not hearing back? It's a tactic to make you frustrated. They ignore you or play phone tag as a way to delay and deny your medical treatment and benefits. We have professional, full-time staff to make sure your adjuster is not ignoring you.
4) Wanting to settle too quickly - some adjusters, if they have a sense that the injury is serious but there isn't enough documentation readily available, will try to settle your case before you know the extent of the injury and what you're entitled to, just so that they can "low-ball" you. Be wary if they offer you money but don't know everything that happened. You may be taking way less than you deserve. An experienced attorney will be able to evaluate your claim and project the type of settlement you may be entitled to.
5) Advising you not to get an attorney - this one we see often, and can be the most damaging. Imagine being questioned without having a lawyer present - it makes it easier for them to take advantage of you if they know you don't know the law and don't know how much you deserve. They can more easily (and legally) give you less than what you rightfully deserve under the law if you don't have a lawyer. Insurance industry studies routinely show they pay more on cases to people who have lawyers.
Don't make these mistakes! If you've been seriously hurt, get all the information you can before trying to handle your claim by yourself. Make sure you contact us at 202-393-3320 so you can begin the process of getting representation if you truly need it.
Now that you know some of the common traps, tricks and strategy they use against you, you'll be ready if they ever happen to you. And remember, when we talk about your adjuster, he/she has a whole team of insurance company lawyers, doctors, nurses, case managers, and other specialists. They've handled thousands of cases just like yours for the insurance company. You may not realize it, but they are there, working against you, literally from the moment you get hurt. That's a lot to go up against.
The best way to protect yourself is to know the system, and have someone fighting on your side. The first thing you can do is order our free book on long-term disability.
Should I Accept a Lump-Sum over Long-Term Benefits for My Long-Term Disability Plan?
One of the ways insurance companies will "get" you -- they know that you need cash, now.
If your long-term disability insurance company (the Hartford, Guardian, MetLife, MetMutual) determines that they may be on the hook for your benefits for a long time, they may offer to "buy out" your policy by paying you a big payment all at once (lump-sum). If you were to accept the lump sum, you would no longer have to provide continued proof of disability. On the flip side, they no longer have an obligation to pay you.
Generally speaking, the insurance company is going to save money by giving you a lump sum if you are going to be out of work for a long time. Accepting a lump sum makes sense only if one out of the four following conditions apply to your situation:
You truly have to have the cash, now.
You know that you are going to die soon, and the insurance company doesn't know this.
You are almost recovered and will soon be able to return to the workforce.
You have learned make money in a different occupation and/or:
You need the lump sum payout to "bridge the gap" while you are working on getting your earnings up.
If none of these conditions apply to you, then it is generally not in your best interest to accept the buyout offer.
Give us a call to see if your offer is reasonable. We’re happy to help.
How Do I talk to my Doctor About Long Term Disability?
How Do I talk to my Doctor About Long Term Disability?
Your treating physician, or any doctor who has treated you for the injury or illness that caused your disability, is critical to a successful ERISA long term disability claim. But how and when do you get your doctor involved?
First - you have to read the disability insurance policy (this is the answer to a lot of long term disability claim questions...) to determine exactly how it defines disability. Chances are, your doctor has a different definition of disability or thinks of the term "disability" differently.
Does disability mean you can't do any work at all? Does it mean you can't do critical functions of your job? Does it mean you can't do the essential functions of your job? How long does it have to last? Is there a medical condition that may be excluded?
We talk to a lot of physicians and experts for our clients, and most treating physicians do want to help their patients.
But they don't know the answers to these types of questions. And without knowing that, they can actually hurt your case, even though you are legitimately disabled and can't work due to a serious injury or medical condition.
There are several things to keep in mind when talking to your doctor:
1. Doctors are busy - really busy. You may need to request and pay for extra time to see your doctor and discuss your condition because a routine visit may not give you enough time.
2. You need to give your doctor all of the important information (obviously this includes telling him the complete truth about your condition and limitations you have, but it's more than that). This may be reports of other doctors you've seen, Functional Capacity Evaluations, testing results, physical therapy evaluations. You can't assume that your doctor has seen these records or has all of this information.
3. Your doctor may need your job description - you can't assume he or she knows all of the physical aspects of what you do at work. Here's an example: Are you a security guard? Does that mean you sit at a fancy D.C. office lobby watching people swipe their fobs when they come back from lunch? Or does it mean you are a security guard at a place where you break up fights, apprehend suspects, detain people and carry a firearm? Don't let your doctor guess about this.
It's hard to talk to doctors and medical specialists - they're busy and would rather be practicing medicine than filling out forms and writing reports. But it's important to get your doctor all of the information, so it's in your medical records and you can use it in your long term disability claim.
And remember – our How To Talk to Your Doctor Tips apply to all kinds of cases and situations! Just ask.
I'm Young and Fit -- Why Should I Worry About Long-Term Disability?
Long-Term Disability (LTD) plans are not just for people who are older, or have a history of illness in their family. Other types of insurance won't cover you if medical disaster strikes, and people on LTD are generally those who have serious illnesses or are catastrophically injured and no longer have the functional capacity to work in a meaningful way.
Maybe that's not you at all....right now. But what happens if you are in a horrific car accident. Or you get cancer? None of us want to think about these things but consider this- if the unthinkable happens, do you want to be also plagued with trying to figure out how you are going to pay your mortgage and eat?
We don't sell these insurance policies and quite candidly, we know that on a large scale, ERISA plans difficult to administrate for a number of reasons. But if you need to appeal a denied claim and you have a serious injury or illness, we can help you.
You're going to need our help.
If you claim has been denied, we will review your appeal letter for free and let you know what we think your next steps might be. If you just want to have your policy reviewed for telltale signs of typical insurance loopholes, we can help with that, too.
So, even if you are young, fit, healthy, and have no history of serious illness in your family, it will be worth it for you to your policy reviewed in advance to determine where the insurance company might try to stick it to you in the event you really are hurt or seriously ill.
If you want to error on the side of safety, we will review your Long-Term Disability plan for you at a deeply discounted rate - so you can have peace of mind knowing whether or not your plan has those telltale signs -- the signs that indicate the claims will probably be denied due to the ERISA "discretion" given to insurance companies to deny claims based on "reasonableness."
That's an entirely different conversation but what you really need to know is, you will need an attorney if you have to appeal a claim because you only get one shot.
Give us a call at 202-393-3320. We have a flat fee to review your policy, a fee that will be credited toward assisting with your initial filing should you ever need to do so. And at the very least, you can have peace of mind knowing that you have the right next steps to take if you are ever caught in a catastrophic situation - that you won't be fighting tooth and nail to prove your disability to a group of people who are inclined to deny your claim and have the authority to do so.
Do I need a lawyer for my long term disability case in DC?
Yes. If your long term disability benefits are provided by your employer, they are probably governed by a federal law called ERISA. And there are a number of requirements under ERISA and your insurance policy that you need to understand, comply with and work through to give yourself the best shot at winning on appeal.
Because of that, this is one area of the law where it is very difficult to appeal your case after you get a letter denying benefits from your disability insurance company.
You need a lawyer who really understands how the appeals process works, the medicine, can work with experts and (most important) can work with you to help you tell your story.
Here are 5 red flags that tell you your lawyer doesn't understand long term disability cases:
1. In your first meeting or phone call, he needs to do some research (and may want to bill you for this) to explain how the process works, from the time you get the letter denying or terminating your benefits through the mechanics of what filing an ERISA disability lawsuit looks like.
2. He does not mention ERISA (the federal law that employer sponsored disability plans fall under) or doesn't know what it stands for.
3. Talks with you about whether to file a lawsuit in Superior Court (in D.C.) or some other state court, whether you will have depositions, be able to develop your case through discovery and go to "trial" and thinks you can sue the disability insurance company for bad faith or punitive damages to increase the amount of your award.
4. Doesn't tell you how and when to get the entire claim file from the insurance company, and why that is critical.
5. Doesn't tell you his plan for filing your appeal - what it should contain, how long it will be, how it will be developed and drafted, and how long it will take - or leads you to believe it is a simple matter of writing a letter saying you disagree with the insurance company's decision denying or terminating your disability benefits.
Don't risk everything you've worked so hard for because of a serious injury or illness - if you received a denial letter from the disability insurance company call us so we can review it for you and give you our thoughts on how to get started (this is both free and confidential).
Remember, under ERISA, you only have 180 days to appeal after you get the denial letter. So call us today at (202) 393 - 3320 to get started.
My ERISA Long-Term Disability was Denied by Unum. If I Win My Case, What Damages Can I Get?
What does winning your long term disability claim mean?
Usually, long term disability insurance policies are purchased by your employer and provided to you as an employment benefit. And any claim under the policy is covered by a federal law (ERISA - the Employee Retirement Income Security Act).
And the policy is supposed to provide coverage, or a benefit, usually 60% of your income, if you can't work because of a medical condition or injury. As a practical matter, ERISA and the court decisions on ERISA long term disability claims, favor the insurance companies, and this leads many of them to deny your claim for benefits, or terminate your benefits before you can go back to work.
So you may have to appeal your case. And if that appeal (which is decided by the same insurance company that decided to terminate or deny your long term disability claim) then your next step is to file a lawsuit in federal court.
And if you win your case in federal court, it could be a couple of years later, and you haven't been receiving benefits during that time. What if you had to cash out investments, liquidate your 401K, or sell your house? You certainly have other losses besides what the disability insurance company owes you.
So can you recover those other items of damage in a case against the disability insurance company?
Unfortunately, the answer is that under most group long-term disability insurance company policies, you cannot recover anything other than the past-due benefits you have been fighting so long for. In some cases, you may be able to recover attorney's fees (if the judge agrees to award that). But you can't get damages like you can in other cases - for pain and suffering or emotional distress for example.
So why are we telling you this? Sounds like bad news.
Well, this gives the disability insurance company a powerful incentive to deny your claim. They know that there are no punitive damages the judge will award, and even if they lose, they won't have to pay you anything other than what they owe you.
Sometimes, this attitude leads disability insurance companies to drag things out - so you settle your case for a lot less. And that's one of the reasons it is critical to focus on your appeal with your long term disability lawyer - that appeal is the critical step in your case.
If you’ve received a letter denying your long term disability benefits call us at (202) 393-3320 to see if we can help. We'll start by reviewing that denial letter, in confidence and at no charge, and give you our thoughts on your next steps.