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I frequently get calls from long term disability claimants wanting to know if their disability insurance company can get all their social security back benefits. Often they recall some discussion with the insurance carrier about coordination of benefits, but fail to fully appreciate what it meant. In a nutshell, most group disability policies have a provision that allows the insurance company to offset other income benefits. This means they take credit for the income the disabled individual received from other sources of income such as social security disability, pension, retirement, worker’s compensation, or even settlement from an accident that resulted in the disability benefits. In some cases they can take credit for the social security income that their children receive…Read More

This past weekend, my single goal was to blog. Instead my husband surprised me with tickets to the Caribbean festival in Marion Oaks at Champaign’s farm. What an awesome weekend we had! It was great seeing old friends like Dr. Pam Lewin and Heather-Dawn, as well as meeting new friends and acquaintances. But who can talk about a Caribbean festival without talking about the food? Food was provided from morning until night. Breakfast included ackee & salt fish, green banana and fried dumplings. For lunch there was fish, jerk pork, chicken, run down and festival. Then there was dinner and supper with all the great island food including curried goat, gungu pea and red pea soup and much, much more.…Read More

Some Disability policies blatantly discriminate against the mentally ill. Many policies set limits on the amount of benefits they will pay if mental illness plays any part in a person’s disability. Some will even terminate benefits after 24 months if mental illness is the reason the person is unable to work. It should be no surprise that even our government discriminates against the mentally ill by the amount they pay for medical services for mental illness. Currently, Medicare recipients pay 50% co-pay for mental health services. Therefore, the Medicare Improvements for Patients and Providers Act of 2008 was a welcome reprieve for patients with mental illness. Under the new law, Medicare recipients will eventually pay the same 20 percent co-payment…Read More

Do you want to know a secret? Every day, millions of people pay good money for a disability policy that limits or terminates benefits for disability caused by pain, fatigue, or fibromyalgia. What is even more amazing is that the law allows it. This is OUTRAGEOUS! The insurance company will whine that there is no objective evidence that you are in pain, or that you are tired and fatigued. When you send them your medical records with these symptoms - which your doctor used to treat your condition- they say it’s based on your own reports of pain or fatigue. As a result, they will either not pay benefits, or will severely limit your benefits. You should know that there…Read More

Every year thousands of people are wrongfully denied long-term disability benefits from their insurance company. Often, these individuals will take early withdrawal from their retirement plan in order to meet basic living expenses while appealing the denial of benefits. As a result, they are left with nothing to fund their retirement and because of the disability, no means of ever earning that income again. To add insult to injury, once the disability carrier decides that they were wrong and should not have denied benefits, they also take credit for the income received from the individual’s pension, IRA or other retirement plan. The net result is that the insurance companies get a free ride. Not only do they get away with…Read More

Pain and depression are among the leading causes of long term disability. According to a literature review, on average 63 % of patients with depression experience one or more pain complaint and depression is present in 5% -85% (depending on the study setting) of patients with pain conditions. [Matthew J. Bair, MD, MS; Rebecca L Robinson, MS; Wayne Katon, MD and Kurt Kroenke, MD Arch Intern MED/Vol 163, Nov 10, 2003] Insurance carriers love to see these conditions in your medical records because those conditions allow them to limit or deny benefits caused by self reported symptoms. You should know there are ways to objectify your complaints. Therefore, you must seek legal representation should your insurance claim be denied based…Read More

Unfortunately, Congress did not offer this protection to individuals injured by their group disability insurance company. The insurance company can wrongly deny your claim; make you retain and pay a lawyer and if they lose in court, their only obligation is to pay you what they should have paid you if they didn’t wrongly deny your claim. That’s outrageous! My best advice is to do your homework. Know the reputation of the insurance company before you purchase your disability policy. If you already purchased a policy, become familiar with the terms before you file a claim. Get an experienced ERISA lawyer before filing your claim. They can help you understand what you need to do to establish entitlement to benefits…Read More

Sometimes individuals are unaware of how their conduct may affect the entitlement to benefits that they have secured for their loved ones. I continue to encourage everyone with a group disability policy or group life insurance policy to get a copy and read it. Know what is covered and what is excluded. Recently, I was asked to evaluate the case of a young man who died as a result of participating in a street race. The widow’s attempt to collect the life insurance proceeds was met with denial by the life insurance carrier on the basis that he was engaging in a criminal offense (2nd degree misdemeanor in the state of Florida). The policy excluded coverage for loss caused in…Read More

It’s a fact that most Americans are only a few paychecks away from financial disaster. Disability Income insurance offers some protection by protecting a portion of your income. Most disability plans will only cover up to about 2/3 of your gross income. However, I’ve seen some plans that cover only 40 % of your income. In an ERISA plan where the premium comes out of your paycheck, you’ll want to have your employer deduct the premium after taxes, or out of your net paycheck. The reason is that if you deduct the premium before taxes are taken out, when you have a claim, your benefit will be subject to income taxes. As you can see, if you had to pay…Read More

The answer to this question is yes. However, the real question is Should you? That answer is a resounding NO! I am often contacted by people who have exhausted their administrative remedies and needed someone to file the lawsuit. It pains me to say no, especially to someone who I truly believe is disabled. But where that individual fails to develop the record, often there is nothing that can be done to prove their disability once the case goes to trial. Remember, in ERISA disability claims, at the end of your appeal, the record is closed. Once the record is closed, you cannot introduce new evidence into the record. Therefore, the only evidence the court will see is what is…Read More