plans are controlled by ERISA—the Employee Retirement Income Security Act of 1974. If your plan is an insurance policy, then you're
dealing with an insurance company. Although the insurer must comply with ERISA
and may have to disclose information that might help you with your claim,
you may also have time periods to meet, and other obligations under the plan.
This is why you may wish to contact a qualified attorney to review your rights
and obligations under your healthcare policy.
are you're here, now, because your Long Term Disability ("LTD")
or Short Term Disability ("STD") claim was denied. The first and
most critical thing you need to know is:
have time limits—and the clock is running!
have a limited amount of time to prove to the insurance company (or Disability
Plan) that you're disabled.
Your doctors may have sent letters to the insurance company insisting that
you are totally disabled. But the insurance company continues to deny your
I understand what you're going through. I was an insurance company employee
for 10 years. As house counsel I tried cases for those insurance companies.
I learned how insurance companies work and do business. I use this experience
every day now as I focus my efforts for individuals who find themselves on
the other side of these enormous bureaucracies.
As I said, when your benefits are denied, time periods begin to run. The correct
information must be sent to the insurance company within these time periods.
Once these time periods run out, it becomes very difficult to obtain your
benefits even though you are disabled and you and your doctor may have told
the insurance company this.
For this reason, I encourage you to pay close attention to these time periods
and visit with an attorney who handles these types of claims.
SHORT TERM DISABILITY
When you are no longer able to perform the duties of your current job, you may be entitled to disability benefits under a disability plan or insurance policy. You must prove that you are disabled to obtain your benefits. You prove your disability by:
- Obtaining and organizing all of your medical records.
- Analyzing these medical records to determine why you are disabled.
- Analyzing the provisions of your disability plan or policy to understand what documents and information you must produce to prove your disability.
- Combining and emphasizing all of the necessary documents and information under the correct provisions of your disability plan or policy to prove that you are disabled.
If you can't or don't want to do all of the above by yourself, call me
Not only is it important to do all of the above correctly to obtain your short term benefits, it is important for another reason—properly proving that you are disabled in the short term is often extremely helpful for you to prove that you qualify for long term benefits when your short term benefits run out.
LONG TERM DISABILITY
When you are no longer able to perform any job that you are qualified for, you may be entitled to long term disability befefits under a disability plan or insurance policy.
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You must do the same four things that I listed in the short term disability section, PROVIDED that you must prove that you can't perform any job (not just your current job) that you are qualified to do. Generally, this is more difficult to do. But, properly proving that you are disabled in the short term normally makes it easier to prove that you are disabled in the long term because you have already organized all of your medical records.
And, as with short term disability proof, if you can't or don't want to do it, call me.