By Peter Casciano, Esq., 301.563.6685
During these difficult times, folks are exploring all available options to protect their financial security. Disability insurance is a natural place to look, and we are receiving lots of inquiries about if their disability protects them.
First, it’s essential to know that you cannot file a claim unless a medical condition is preventing you from working. At this point, there are so many reasons why folks are not working. They have been laid off, furloughed, are on administrative leave, or they are using paid time off. Those folks would not be able to file for disability on those facts alone. Your employer must be requiring and allowing you to work, and your medical condition must be preventing that to have a successful claim. Others are working in a diminished or accommodated capacity. Significantly reduced hourly and telework are some examples of that. The threshold issue to keep in mind regarding your disability policy is whether your medical conditions are keeping you from working. One example is that your co-morbid conditions don’t allow you to go to work because exposure to COVID-19 is too risky. In other words, you do not need to have been diagnosed with the Coronavirus to file a disability claim related to this pandemic. The diagnosis could result in a successful claim, but the critical issue at the outset is whether your medical condition prevents you from working.
Connected with this issue is whether your disability insurance policy currently covers you. Many plans cease coverage, even if you are technically still on the rolls if you fall below a certain amount of hours provided for in the policy. A typical minimum amount of hours required to have disability insurance coverage is 30 hours per week. Said another way, that means that you must allege you became disabled during a time when you were still working more than the required amount, as outlined in your policy. What I find to be complicating matters for some claimants is that many employers feel terrible for what is happening to the average worker right now. On more than one occasion, I have heard the employer tell an employee that their disability coverage is extended while furloughed or working reduced hours. Technically that’s poor advice and not correct. It depends if there is an “Active at Work” requirement in the policy and what it says. As best you can, it’s essential to verify what your HR department or supervisor is telling you. If you cannot do that or don’t know how, please reach out to an experienced attorney for assistance.
Second, assuming your medical condition is impairing your ability to work, you must have medical information supporting that claim. Many clients are struggling to generate the documentation that they need to support their claim because doctor’s offices are closed or are only treating emergent situations. You must ask your doctor about telemedicine. Can we have our appointment by video or phone? That is an excellent question to ask your doctor’s office because telehealth appointments should generate records just like in-person appointments. Is it preferable to have your consult in person? Yes, almost certainly, but don’t give up on generating evidence just because the doctor’s office is closed or operating on an abbreviated schedule.
Third, you should be asking your insurance company for more time assuming you have reached the deadline imposed by the carrier, and you still don’t have the evidence they are demanding. Sometimes the carriers require information from your doctor, your employer, your accountant, a federal agency like the Social Security Administration. Each of those businesses is significantly hampered right now during the pandemic. None of the SSA offices are open to the public. Many employers are closed completely, or their employees are teleworking with little to no access to crucial documents. It is normal and natural right now for you as the claimant to struggle to locate the documents you need. It is advisable that at each deadline imposed by the carrier, you contact them in writing and request an extension. An extension is a far better option compared to just missing the deadline and hoping your claim gets approved.
Fourth, it would be best if you also remembered that the insurance companies are also working with a smaller staff, telework challenges, and less support generally. Decisions may occur more slowly. The carrier may demand from you the information they already have. These mistakes seem to be happening a bit more frequently now. The bottom line is that getting angry or (worse) ignoring the error by the carrier will not help you. What will help your claim get processed faster is your clear and concise communication with your representative explaining the issue and helping to get it resolved. I have found that a bit more patience with the carrier is required when working on STD and LTD claims during the pandemic.
Surprisingly, I have worked several disability benefits cases during the pandemic where carriers are still attempting to schedule Independent Medical Examinations (IMEs) and in-person interviews of the claimant by an investigator. While the carrier does have the ability to require your participation in these events, you should ask for a postponement if you are not comfortable. A request for an extension should be accompanied by medical support if you can obtain it. Currently, I take the position that it is inappropriate to schedule an in-person evaluation right now. However, as States begin to re-open and phase in returns to normalcy, it will be less and less obvious that an IME should be delayed. This is a sensitive issue that may require the advice of an experienced attorney because what you do not want is to appear non-compliant with the clauses of the LTD or STD policy.
In pre-COVID-19 times, protecting your benefits can be complicated. During this global pandemic, we strongly recommend that you obtain experienced counsel to assist you through this process. At Andalman & Flynn, we have helped workers successfully through this process for over 20 years. We know how to maximize your chances of winning.
Andalman & Flynn, P.C. serves clients throughout Maryland and the District of Columbia, offering compassionate, quality service and results-driven representation across a broad range of legal areas. With a concentration on disability benefits law and family law, the firm focuses on cases that impact the rights of everyone, and they are there for clients when responsive legal help is most critical. For more information about Andalman & Flynn, please visit our website or call 301.563.6685.