By Molly Friedman, (301) 563-6685
Lack of Information About Your Policy and Application Process
Most employer-sponsored long term disability benefit plans are governed by the Employee Retirement Income Security Act of 1974, known as ERISA. Under such plans, insurance companies are required to provide clear instructions for applying, as well as information about eligibility and procedural protections for participants. The best source of this information is your Group Insurance Benefits Policy. As helpful as your human resources department may be, always request a copy of your Group Insurance Benefits Policy, review it carefully, and check with your insurance company to ensure that you have the complete application forms. You should also confirm that your policy is governed by ERISA.
The application process for long term disability benefits generally includes forms and documents for you to complete and forms for your employer to complete. Make sure to follow up with your human resources department or whichever individual is designated to assist with the process to confirm they have completed and submitted necessary documentation.
Assuming Eligibility
Another mistake that applicants make is to assume that they are eligible for benefits. Assuming you’ll be approved for long term disability benefits makes you less likely to take the time to gather sufficient medical evidence to support your application. Reassurance from HR that you are “disabled” does not always equate to eligibility for long term disability benefits. Similarly, a doctor’s comment that you are disabled or a finding that you are eligible for Social Security Disability (SSD) benefits does not alone mean you qualify for long term disability benefits. Of course, eligibility for Social Security Disability benefits and a supportive physician are beneficial for your claim. However, it is ultimately the insurance company’s decision to award benefits based on the specific definition of disability located in your LTD policy.
Failing to Communicate Appropriately with Insurance Carriers
It is essential to read and answer every communication from your carrier carefully. Most important communication from insurance companies comes via postal mail. Letters often contain deadlines, forms to complete, and other crucial information. Ignoring a letter or even delaying checking your mailbox means that you may miss critical deadlines, potentially leading to the denial of your claim or termination of benefits. Your carrier may also reach out via telephone to discuss your application or set up a more detailed interview. Always return these calls. Be truthful in your conversations, but also be measured and careful with your responses. The individual on the phone may try to trip you up — stay cool, calm, and collected, and don’t be afraid to tell the caller when you do not know a specific date or piece of information. If the insurance company insists on a telephone interview with you, that may be a good time to hire a lawyer if one isn’t already retained. An experienced attorney will prep you for the interview and be on the line with you to ensure the questions are appropriate.
When the carrier does ask you to complete forms, the temptation is to fill them out as quickly as possible and get them back to the carrier. It’s essential to be thoughtful and take the time to fill out documents accurately. Before completing any documents, make extra, clean copies. Prepare drafts of forms before finalizing them, especially for questions that require more in-depth answers.
Not Accurately Portraying Your Medical Condition
This can be the biggest flaw in an LTD case. It’s a delicate balancing act of providing information that is both succinct and sufficiently detailed.
When describing your symptoms and limitations, provide a realistic description of an average day. It’s important to be accurate and honest when describing your limitations to your medical providers and in documentation to your long term disability insurance company.
However, this does not mean you should underreport or downplay the severity of your disability and resulting symptoms. Our clients often express discomfort with expressing the full extent of all the challenges they face. Frequently, our clients have been dealing with limitations for years, struggling to push through while remaining in the workforce. This may lead to the temptation to downplay symptoms, as being “not that bad” or “something you can deal with.” Even if you feel your primary disabling condition is migraines and severe headaches, for example, if you are also limited by rheumatoid arthritis, your application should reflect that.
Ignoring Medical Advice and Standards of Care
When reviewing your claim, the insurance company will not simply look for what your official diagnoses are and if you are taking actions following the treatment recommendations and stated limitations of your physicians.
- Failure to Treat: Consistent, clinically appropriate treatment is essential. Failing to treat regularly is problematic, not just for your ERISA claim but your health. Many policies contain provisions requiring that individuals seek clinically appropriate care. Failing to follow through with a referral and non-compliance with treatment all reflect poorly on the applicant.
- Acting Inconsistent with Claimed Limitations: Acting in ways that seem to contradict your claimed disabilities and limitations can be a huge mistake. Carriers often will hire investigators to perform surveillance and note actions you take — from how often you leave the house to the amount of grocery bags you carry. Insurance companies put a lot of weight on the reports from investigators.
Posting on Social Media
Be very careful with your social media presence. During your application process for disability benefits for your chronic severe back pain, it’s not the time to post pictures of a hiking vacation. The carrier will look not just at what you post but pictures you are tagged in as well. If there are older images online of you engaging in activities that could be detrimental to your claim, make sure it’s clear when the picture was taken.
Not Knowing Your Appeal Rights!
A denial from an insurance carrier is discouraging. You’ve provided deeply personal information about the very real difficulties you experience, only for someone you’ve never met to tell you it’s not good enough. The biggest mistake you can make is giving up on your valid claim. Don’t take no for the final answer! ERISA includes protections and rights for appealing a denial of a disability benefits claim. If your claim is denied, insurance carriers for ERISA disability policies are required to clearly outline the appeal process and the reason for a denial.
It’s important to follow the correct procedures, which generally require an administrative review. Failing to complete the required steps and rushing right to file a lawsuit can be a costly misstep. However, ERISA also includes provisions allowing individuals to file a lawsuit in federal court if your appeal is unfairly denied.
Failing to Seek Assistance from an Attorney Who Works with ERISA-Governed Plans
Applying for long term disability benefits is not a straightforward process. Working with an attorney experienced in ERISA disability benefits can help guide you through. At Andalman & Flynn, we have extensive experience dealing with ERISA-governed plans from insurance companies. We’ve worked with clients applying to receive benefits from dozens of carriers and will prepare you for what to expect every step of the way. Call us for a free consultation to discuss your disability benefits claim.
Contact Molly Friedman at (301) 563-6685.
About Andalman & Flynn, P.C.: Founded in 1998 in downtown Silver Spring, Maryland, Andalman & Flynn has forged a distinguished reputation for legal excellence. The firm represents individuals seeking disability benefits throughout the country and practices family law throughout Maryland and the District of Columbia. The firm focuses on cases that impact the rights of everyone and is there for clients when responsive legal help is most critical. The firm has provided legal analysis on national and local television and radio, and their attorneys often testify before legislative bodies and are routinely invited to contribute to prominent legal publications. For more information about Andalman & Flynn, please visit the website at andalmanflynn.com or call 301.563.6685