Answers to Medical Malpractice, Workers Comp, Long Term Disability Insurance, and Car Accident Questions
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 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 serious car accident or car 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.
If you're on a long term disability insurance claim and your claim has been denied, you probably need an attorney to do the appeal. Insurance companies will use every trick in their aresenal to deny or limit your benefits. Don't try to handle an appeal on your own.
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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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.
Do you need a DC Lawyer for Your ERISA Long Term Disability Insurance ?
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:
1. 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;
2. 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
3. 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.
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.
What if my claim is not governed by ERISA?
If your disability claim is not covered by ERISA
In a Non-ERISA covered disability claim, the person who is disabled and can't work due to an illness or injury (usually called the claimant) basically has no rights. What does that mean? Well, the insurance policy specifies everything involved in the claim, all of the rules, definitions, terms - everything.
That usually means:
You usually have 45 to 90 days to appeal;
There are no standard review timelines;
Your appeal has no rules governing how it is reviewed -
the insurance company can pretty much do this how they want to;
If you lose your appeal, you have to file a lawsuit in state court
and can get a jury trial;
In state court, the case is analyzed under standard contract law rules, it's really a breach of contract case. If you have a problem with getting claims paid out in a non-ERISA policy, you should contact an attorney who deals with contracts.
I Hurt My Shoulder at Work and My Doctor Thinks It's a Torn Rotator Cuff. What Do I Do?
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.
How do you protect yourself if this serious injury happens at work?
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.
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.
Third, 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.
Finally, file your workers' compensation claim in the right jurisdiction.
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.
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.
My child had a serious injury in the hospital. How much will a lawyer cost?
First, children's medical malpractice is a specialized area of law and you've come to the right place.
Medical malpractice cases against hospitals require the lawyers to investigate the cause of the injury, your child's medical condition, the medical records, review medical literature and studies and review the information with experts in different fields - doctors who specialize in pediatrics, pediatric neurology, hospitalists, neuro-radiologists, and other specialists depending on the child's condition.
Once we agree to investigate a medical malpractice case, we'll do that for free and share the results of the investigation with you. If our investigation tells us that we can prove a case and help your child, our fees are contingent - meaning you pay only if we win, there is no fee if the case is lost.
If you're thinking about talking to a lawyer about any serious medical mistake, order a copy of our Medical Malpractice Lawyer Evaluation - there are a lot of lawyers who advertise for these cases but don't be fooled by slick ads. This form is designed to help you find the right lawyer for your medical malpractice case, someone with the right experience, training and resources and its also FREE.
Just call us at (202) 393 - 3320 or order it through the website and you'll get it today.
What's Really in My Long Term Disability Insurance Policy?
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 insurance claimants? It’s 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.
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.
What if someone is paralyzed by medical malpractice?
Medical mistakes like misdiagnosis, not ordering the right treatment, delaying treatment, not ordering a consult with a specialist, system errors and other negligence can cause serious injuries, like paralysis.
We've seen it and helped people who became paralyzed.
If someone is paralyzed due to a medical mistake by a hospital, doctor or HMO, they will need care, treatment and support they never thought they would. Future medical care and treatment, transportation, home modifications or a handicap accessible home, job re-training, access to technology that can help someone adapt - these are just some of the things needed to help.
But the biggest need we see - and what we strive to do for people we help - is get your independence back. And take the stress off of your family members.
Sometimes that is learning to drive a modified car or van to go where you want when you want. Sometimes it is an extra nurse or companion to help you with mobility - getting out and around. Sometimes it is a modifying your home or buying another that is accessible and right for you. Sometimes it is the latest technology to help you do more.
Like every malpractice case, every person we help is different. You are different.
Honestly, we're different too. If we can help you or someone you know get their independence back, call us at 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.
Why Are ERISA Long Term Disability Insurance Claims so Difficult?
We hear all the time from people who are on ERISA disability claims that they are frustrated, they don't understand why their claim has been denied, and they really need the money they assumed would come when they filed a claim. After years of helping clients with their disability cases, I am sometimes asked, "are there easy disability claims?"
It is logical to believe that if your doctor, employer, and the Social Security Administration recognize that you are disabled, then your disability insurance company must agree that you are entitled to disability benefits.
Unfortunately, this is NOT the case.
Once upon a time, disability insurance companies offered policies that actually helped the people who paid their policy premiums. They provided clear explanations and definitions, and required the insurance company to pay benefits within 30 days of approval. Sounds exactly like how it should be, doesn't it?
We don't see policies like this anymore. Most disability insurance policies are designed to help the insurance company reject disability claims and provide as little coverage as possible. It's a big problem, but under the current law (ERISA) it's easy to get away with this type of practice.
These thin, ambiguous policies ensure that there is never an "easy" disability insurance claim. That is why a federal judge said, "claimants not able or aware enough to hire legal counsel before the administrative process is complete, likely enter into judicial review facing a loaded deck."
Now if a judge thinks that these claim are difficult, you may want to think twice about handling your own ERISA long term disability insurance case.
If you have been denied disability benefits by your individual or group disability insurance policy, such as AFLAC, Guardian, or Unum, Donahoe Kearney will review your denial letter for free. Call 202-393-3320 and we will help you move forward.
Give us a call today at 202-393-3320 to figure out your next steps, and if we can help you. But don't wait. You only have 180 days to appeal a denied long term disability insurance claim.