Virtually every long term disability (“LTD”) plan changes the definition of disability after a short period of time, which is usually two years. After that time, instead of having to prove that you are unable to do you own job, you now have to show that you cannot do any work for which you are reasonably qualified. The insurance companies that administer LTD plans frequently terminate monthly benefits when this change in definition occurs.
A claimant retained me after CIGNA terminated his LTD benefits and had denied his appeal twice. The claimant had submitted narrative reports and records from several treating medical specialists as well as a report from a vocational expert. Despite a claim file of nearly 1,000 pages, the question was a simple one: did he have the functional capacity to perform sedentary work.
Courts had specifically instructed CIGNA that sedentary work requires the ability to sit for at least 6 hours a day and walk and stand for two hours during a work day. The claimant’s pain management specialist completed a report specifying the claimant was limited to sitting for only 1-2 hours, and standing less than 1 hour. Nonetheless, CIGNA denied the appeal because the pain management specialist previously had said that the claimant had “5/5 motor strength.” Among the many things that I pointed out on appeal is that CIGNA had approved benefits despite that finding, which showed it was not a valid excuse for terminating benefits.
When the sole basis for a denial or termination of benefits is exposed as patently invalid, insurance companies frequently develop a new reason for their decision. To avoid CIGNA from concocting a new rationale, and because no new evidence could be submitted in federal court if the final appeal were denied, I had the claimant seek updated and additional reports detailing his functional capacity from seven different physicians. The goal was to overwhelm CIGNA with the new evidence and my 15 page letter demonstrating the flaws in the termination decision.
The strategy was successful. A week earlier, after having submitted my appeal three and a half months earlier, I faxed CIGNA a demand for an answer or advised I would proceed to federal court promptly. Apparently CIGNA was so overwhelmed by all the new evidence and the detailed attack of its decision that it sent a check for all retroactive benefits without any explanation.
Unfortunately, unless an LTD appeal is overwhelming, the insurance company will usually risk going to court, where it realizes that the deck is stacked against the claimant.
Monday, February 12, 2007
FAST SSD Hearing
One of the biggest problems with the Social Security Disability process is the amount of time it takes. The initial determination usually takes about 6 months. The decision is made by a disability analyst who is not a doctor and who ignores what the treating doctor says, so the decision is normally unfavorable. The next step here after a denial is waiting for a hearing before an administrative law judge. Unfortunately, according to government statistics, the wait for a hearing is usually about 1 1/2 to 2 years. Nonetheless, I have been able to take steps to shorten the wait for a hearing.
When a client of mine has been scheduled for a hearing, and a request for an on the record decision has been rejected, I institute Congressional Inquiries. The grounds for an inquiry vary, but it seems to be the one mechanism that hearing offices recognize for expediting a hearing.
Yesterday, I had a hearing for client who could no longer work because of Chronic Fatigue Syndrome and Fibromyalgia. Because I commenced a Congressional Inquiry, the hearing was scheduled only a couple of months after the initial denial. Moreover, the judge approved the application on the record during the hearing and issued a Bench Decision. Typically, even if a judge tells a claimant that the application will be approved, it may still take months to get a written decision. The Bench Decision avoids that delay.
When a client of mine has been scheduled for a hearing, and a request for an on the record decision has been rejected, I institute Congressional Inquiries. The grounds for an inquiry vary, but it seems to be the one mechanism that hearing offices recognize for expediting a hearing.
Yesterday, I had a hearing for client who could no longer work because of Chronic Fatigue Syndrome and Fibromyalgia. Because I commenced a Congressional Inquiry, the hearing was scheduled only a couple of months after the initial denial. Moreover, the judge approved the application on the record during the hearing and issued a Bench Decision. Typically, even if a judge tells a claimant that the application will be approved, it may still take months to get a written decision. The Bench Decision avoids that delay.
Welcome to The Law Offices of Jeffrey Delott.
Welcome to The Law Offices of Jeff Delott.
Our Long Island based law practice is limited to disability law. Because of our personalized and aggressive legal representation, we have successfully obtained disability benefits for over 99% of our clients, even those whose benefit claims were denied or terminated.
The odds of your needing disability benefits are greater than you may think. According to government statistics, one out of every 5 people has a disability, and a 20 year old has nearly a one out of three chance of becoming disabled before reaching retirement age. That is why some people purchase disability insurance. However, you may be able to receive disability benefits even if you did not purchase disability insurance.
If you became disabled after working, there are potential sources for benefits for those people who have not purchased disability insurance. First, many people do not realize that their employers or union provide group long term disability ("LTD") or disability retirement benefits. Whoever is responsible for handling your benefits at work, such as the people in your human resources department, should be able to confirm if the company or union has group LTD coverage or a disability retirement plan. Second, while many people are aware that they may be entitled to benefits from the Social Security Administration (the "SSA") once they retire, they are unaware that they may be entitled to Social Security benefits if they become unable to work.
Regardless of whether you are seeking benefits under your own disability insurance policy, your employer's or Union's group LTD Plan, the New York State or City Retirement System Disability Pension, the Federal Employee Retirement System or from the SSA, no lawyers will fight for your disability benefits more tenaciously than the Law Offices of Jeffrey Delott. We will get your benefits as quickly as possible. Your claim will receive personal attention from an attorney at all times. We help our clients prepare and file their disability applications, represent them before insurance companies and government agencies, and litigate their claims in court if necessary.
Our Long Island based law practice is limited to disability law. Because of our personalized and aggressive legal representation, we have successfully obtained disability benefits for over 99% of our clients, even those whose benefit claims were denied or terminated.
The odds of your needing disability benefits are greater than you may think. According to government statistics, one out of every 5 people has a disability, and a 20 year old has nearly a one out of three chance of becoming disabled before reaching retirement age. That is why some people purchase disability insurance. However, you may be able to receive disability benefits even if you did not purchase disability insurance.
If you became disabled after working, there are potential sources for benefits for those people who have not purchased disability insurance. First, many people do not realize that their employers or union provide group long term disability ("LTD") or disability retirement benefits. Whoever is responsible for handling your benefits at work, such as the people in your human resources department, should be able to confirm if the company or union has group LTD coverage or a disability retirement plan. Second, while many people are aware that they may be entitled to benefits from the Social Security Administration (the "SSA") once they retire, they are unaware that they may be entitled to Social Security benefits if they become unable to work.
Regardless of whether you are seeking benefits under your own disability insurance policy, your employer's or Union's group LTD Plan, the New York State or City Retirement System Disability Pension, the Federal Employee Retirement System or from the SSA, no lawyers will fight for your disability benefits more tenaciously than the Law Offices of Jeffrey Delott. We will get your benefits as quickly as possible. Your claim will receive personal attention from an attorney at all times. We help our clients prepare and file their disability applications, represent them before insurance companies and government agencies, and litigate their claims in court if necessary.
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