Disability Claim FAQs
As long as my doctor and I properly complete the disability application forms will I receive benefits?
No. Disability benefits are not usually approved based solely upon submission of application forms.
Why should I use a lawyer?
While a lawyer is not required, your chances of securing disability benefits increases significantly if you are represented by an experienced disability attorney. The sooner you retain an attorney, the more time the attorney will have to obtain the medical and vocational evidence to prepare your claim. An attorney should help you avoid making statements at interviews and in writing that can be misconstrued, and how to address evidence that may appear to hurt your claim for disability benefits, such as reports from doctors paid by insurance companies and the Social Security Administration (the “SSA”).
What materials should I have if interested in hiring an attorney?
You should have a copy of your claim file. If your claim is for long term disability (“LTD”) benefits, then you can request the records from the insurance company. You should also get your Summary Plan Description from your employer, union or the insurance company. If your claim is for Social Security Disability (“SSD”) benefits, then you can get a copy of your file from your local Social Security field office or Office of Disability Adjudication and Review.
If my doctor or I send a letter saying that I cannot work will my appeal be successful?
No. Both medical and vocational evidence is almost invariably required in order for an appeal to be successful.
If I am receiving LTD benefits will I automatically get Social Security benefits, and vice versa?
No. Approval of disability benefits by an insurance company or the SSA is not binding on the other.
Do I need to be concerned about a doctor selected by an insurance company or the SSA examining me?
Yes. A so-called “Independent Medical Examination” by a doctor paid by an insurance company is rarely independent. Similarly, a Consultative Examination by a doctor paid by the SSA is normally unfavorable to the claimant. Those doctors know who is paying the bill and they aim to please in order to get more work. Surprisingly, those doctors frequently do not specialize in the area of medicine that is relevant to the claimant’s impairments. Furthermore, because those doctors only get a “snapshot” of your condition from their one examination, they often fail to observe or understand the problems you experience intermittently or in varying degrees of severity.
What are my costs other than attorney fees?
You are responsible for the cost of securing and submitting medical and vocational records and reports. You are also responsible for the costs of litigation if the matter goes to court.
What do I do if I can no longer work?
Send a certified letter to your employer or union asking for a copy of the Summary Plan Description for your disability plans and every other health and welfare benefit plan that may cover you.
Will my disability claim be reviewed in fair manner?
Some insurance companies and Administrative Law Judges (“ALJ’s) have a history of evaluating disability claims in a biased manner. For example, your doctor’s treatment notes could indicate your condition was improved the day of the exam, which would be intentionally misconstrued that you have recovered. If you lost the ability to walk in a car accident, your overall condition may have improved, but that improvement does not mean that you completely recovered or can return to work. Alternatively, disability benefits may be denied or terminated for a lack of “objective” evidence for a condition like chronic fatigue syndrome or depression, which cannot be confirmed by a diagnostic test.
Can any attorney handle my disability claim?
Disability law is a specialized and complicated field and you should make sure that your lawyer has expertise in the field. For example, ask the attorney that you are considering retaining how many disability cases he has handled. From our experience with disability claims, we know what medical and vocational proof is needed and how to present it.
Is there more than one type of Social Security disability benefit?
Yes. Disability Insurance Benefits goes to individuals who have worked in recent years (five out of the last 10 years in most cases) who are now disabled. Disabled Widow’s and Widower’s Benefits are paid to individuals who are at least 50, and have become disabled within a certain amount of time after the death of their husband or wife. The late husband or wife must have enough work credits to be insured. Disabled Adult Child Benefits go to the children who became disabled before their 22nd birthday, whose parents are deceased, or drawing Social Security disability or retirement benefits. Supplemental Security Income benefits are paid to individuals who are poor and who are disabled. SSI child’s disability benefits are a type of SSI benefit paid to disabled children under the age of 18.
Why are so many so many claims for disability benefits rejected?
Many people who are disabled suffer from pain or fatigue, and it is difficult to determine the severity of another person’s pain or fatigue. The SSA and insurance companies have become more concerned with making sure that everyone who is receiving disability benefits is “truly” disabled. Insurance companies and Congress believe that many people will “fake” disability in order to get benefits.
What should I do if the SSA says it is terminating my disability benefits?
If you appeal within 10 days after being notified that your disability benefits are being ceased, you can ask that your disability benefits continue while you appeal the termination decision.
Can I get disability benefits because of a mental illness?
Yes. Even if there is nothing wrong with you physically, mental illness is a valid basis for obtaining disability benefits.
Can I get health care coverage if I become disabled?
Many employers’ health plans provide that your health insurance premium will be waived if you become totally disabled. If you are approved for any kind of Social Security disability benefit other than SSI you will get Medicare after you have been entitled to SSD benefits for two years. If you are approved for SSI you will get Medicaid.
Is there anything that I can do besides suing an insurance company if my benefits were denied or terminated?
Yes. You can file a complaint with the State Department of Insurance. In many States, including New York, you can download a complaint form from the Insurance Department’s web site.
How long do I have to wait after becoming disabled before I can file for SSD benefits?
Not even one day. You can file for SSD benefits on the very same day that you become disabled. Many individuals make the mistake of waiting months and even years after becoming disabled before filing a SSD claim. There is no reason to file a SSD claim if one has only a minor illness or one which is unlikely to last a year or more. However, an individual who suffers serious illness or injury and expects to be out of work for a year or more should not delay in filing a claim for SSD benefits. People are led to believe that they need to be disabled and out of work for a year before applying for Social Security Disability (“SSD”) benefits. The regulations actually state that you must have a condition that has lasted or can be expected to last for at least 12 months in a row which is why I always advise potential claimants to file as soon as possible.
I got hurt on the job. I am drawing worker’s compensation benefits. Can I file a claim for SSD benefits now or should I wait until the worker’s compensation ends?
You do not have to wait until the worker’s compensation ends and you should not wait that long. An individual can file a claim for SSD benefits while receiving worker’s compensation benefits. It is best to file the SSD claim as soon as possible because otherwise there may be a gap between the time the worker’s compensation ends and the SSD benefits begin.
Can I get both worker’s compensation and SSD benefits?
Yes. There is an offset, which reduces SSD benefits because of worker’s compensation benefits paid, but in virtually all cases, there is still some SSD benefits to be paid. In a few states the offset works the other way – – worker’s compensation benefits are reduced because of SSD benefits.
Has Cigna denied cases in bad faith?
Yes. Cigna has a history of denying cases in bad faith. They were the subject of a segment on Good Morning America for this specific reason. They were also targeted by the Maine Superintendent of Insurance and the Massachusetts Commissioner of Insurance for unfair and deceptive handling of claims, which resulted in a Cigna being instructed to come up with a plan of corrective action to address those concerns.