You receive a letter from your insurance company advising you that your disability claim is denied or terminated. After the initial shock wears off, what steps can you take to obtain your disability benefits? What you should NOT do is immediately write back, telling your insurer they have made a mistake, and ask them to reconsider your claim. You will eventually want to do so; however, there are several steps you need to take first.
If your disability policy is part of an employee benefit plan then it is probably governed by Federal Law known as the Employee Retirement Income Security Act (ERISA). Under ERISA, the insurer/plan must give you 180 days following a termination or denial of benefits in which to request an administrative appeal or review of your claim. However, most plans give you only one shot at an appeal. Thus, you must use this opportunity wisely.
The first thing you should do is request from the insurer, a copy of their entire file on your claim. They are obligated to provide it to you, without cost, within 30 days of a written request. Once you receive this file you should go through and organize it in some fashion, i.e, putting all the medical records together segregated by provider and in chronological order. Once you have organized the file it will be easier for you to see what is missing from the records. If they had your file reviewed by their own medical or vocational consultants, you will see their reports and have a better understanding of why they denied or terminated your claim.
You should also obtain, if you do not already have it, a copy of the plan or disability policy that sets forth all your rights and obligations. You should be able to obtain the policy from the administrator of the plan who is typically the employer. However, if there is a claims administrator, then they will most likely be able to send that document to you.
It is at this point I would strongly suggest you contact an attorney. An initial conference with an attorney should not cost you anything. However, make sure the attorney is experienced in handling ERISA benefit claims. The law applicable to these claims is unique and technical. If you have done your homework and have the claim file, the policy and your letter of denial, you should be able to answer many of the questions the attorney will have to help you evaluate your claim. You are most likely emotionally attached to your claim and getting input from an experienced attorney can often be enlightening. Remember, the fact that you are disabled does not guarantee that you will receive benefits. It does not matter how many times you tell the insurer that you are in pain and cannot work. What is important is the presentation of evidence that sets out your physical limitations associated with your illness or injury and how those limitations preclude you from performing the duties of a job.
If you want more information about ERISA or wish to talk to or email an expert about your claim, visit our website at www.StennettCasino.com.
Showing posts with label disability benefit denial. Show all posts
Showing posts with label disability benefit denial. Show all posts
Wednesday, July 8, 2009
Wednesday, May 14, 2008
HARTFORD RECIPE FOR LTD DENIAL
If you are receiving benefits under a Hartford disability policy then you should be aware of its recipe for denial. I have seen a consistent pattern of termination of benefits by Hartford. The strategy is to set a trap for the beneficiary that can be avoided if you are aware of the following.
Regardless of the form of your disability Hartford will send a functional capacity evaluation form to the treating doctor which will ask him/her to delineate the number of hours their patient can sit, stand, walk in an 8-hour work day. It will also ask many other questions regarding the patient’s functioning. Typically, the doctor will rely substantially on the patient’s statements of disabilities. The trap is this. The form typically does not conform to the individual disability that you may have. Thus though you may be able to sit for only 20 minutes in a work setting in front of a computer on a consistent basis, you may be able to sit for 2 hours in a car. Or, on a good day you may be able to do much more than on a bad day, which typically will follow a day of activity. Thus, the problem in a work setting becomes the inability to perform the same function day after day, 8-hours a day. The functional capacity form is typically filled out by the doctor and by the patient on the basis of the worst case scenario. Thus, the doctor may state that the patient can sit for only 20 minutes consecutively. What the doctor should be stating is that the patient is limited to 20 minutes sitting at a work station consecutively before their abilities to concentrate, etc. are interfered with by pain and discomfort. Or that their capacities vary and thus their limitations are based on an inability to perform consistent, day-after-day activities.
The trap is that once the physician sets out the limitations as being the ability to sit "only 20 minutes at a time," then Hartford sends a surveillance team to videotape the insured. Hartford will camp out at your residence at 6 a.m. and follow you for the entire day. They will do this for 2 to 3 days and if they are unsuccessful in finding you doing any activities they will come back another time and do it again. Inevitably, the insured will leave their home and perform errands such as shopping, going to the bank, going to church, etc. These errands will typically show the insured doing things beyond the limitations placed in the functional capacity evaluation forms completed by the treating doctor.
Once the surveillance is completed then Hartford will send an adjuster to the insured’s home for a 2 to 3 hour interview. During the interview they will obtain a signed statement from the insured listing all the limitations they have due to their disability. Then they pop out the video and ask the insured to identify themselves in the video and that indeed it reflects their abilities. The video will show the insured getting in and out of cars, driving cars, sitting in cars for extended periods of time, doing extended shopping for a half day or more. These will be perceived as inconsistent with the limitations the insured and the treating physician placed and thus makes the insured’s claim of disability appear to be false.
The reality is that an individual who is disabled from the grinds of a 40-hour work week is not necessarily disabled from life. They still have to perform activities of daily living that are required, whether one is working, or not. The abilities to go to the grocery store and the bank do not correlate with the ability to work a full time job. However, Hartford’s strategy is to get the insured to at least appear to overstate their disability and then discredit them with the video. If you understand Hartford’s strategy you can avoid the trap. Don’t place unrealistic, definite time limitations on any of your capacities. Concede your ability to do what you can do, with the important aspect being the things you cannot do that prevent you from returning to work.
For more information on how to protect your disability benefits visit our web site at StennettCasino.com.
Regardless of the form of your disability Hartford will send a functional capacity evaluation form to the treating doctor which will ask him/her to delineate the number of hours their patient can sit, stand, walk in an 8-hour work day. It will also ask many other questions regarding the patient’s functioning. Typically, the doctor will rely substantially on the patient’s statements of disabilities. The trap is this. The form typically does not conform to the individual disability that you may have. Thus though you may be able to sit for only 20 minutes in a work setting in front of a computer on a consistent basis, you may be able to sit for 2 hours in a car. Or, on a good day you may be able to do much more than on a bad day, which typically will follow a day of activity. Thus, the problem in a work setting becomes the inability to perform the same function day after day, 8-hours a day. The functional capacity form is typically filled out by the doctor and by the patient on the basis of the worst case scenario. Thus, the doctor may state that the patient can sit for only 20 minutes consecutively. What the doctor should be stating is that the patient is limited to 20 minutes sitting at a work station consecutively before their abilities to concentrate, etc. are interfered with by pain and discomfort. Or that their capacities vary and thus their limitations are based on an inability to perform consistent, day-after-day activities.
The trap is that once the physician sets out the limitations as being the ability to sit "only 20 minutes at a time," then Hartford sends a surveillance team to videotape the insured. Hartford will camp out at your residence at 6 a.m. and follow you for the entire day. They will do this for 2 to 3 days and if they are unsuccessful in finding you doing any activities they will come back another time and do it again. Inevitably, the insured will leave their home and perform errands such as shopping, going to the bank, going to church, etc. These errands will typically show the insured doing things beyond the limitations placed in the functional capacity evaluation forms completed by the treating doctor.
Once the surveillance is completed then Hartford will send an adjuster to the insured’s home for a 2 to 3 hour interview. During the interview they will obtain a signed statement from the insured listing all the limitations they have due to their disability. Then they pop out the video and ask the insured to identify themselves in the video and that indeed it reflects their abilities. The video will show the insured getting in and out of cars, driving cars, sitting in cars for extended periods of time, doing extended shopping for a half day or more. These will be perceived as inconsistent with the limitations the insured and the treating physician placed and thus makes the insured’s claim of disability appear to be false.
The reality is that an individual who is disabled from the grinds of a 40-hour work week is not necessarily disabled from life. They still have to perform activities of daily living that are required, whether one is working, or not. The abilities to go to the grocery store and the bank do not correlate with the ability to work a full time job. However, Hartford’s strategy is to get the insured to at least appear to overstate their disability and then discredit them with the video. If you understand Hartford’s strategy you can avoid the trap. Don’t place unrealistic, definite time limitations on any of your capacities. Concede your ability to do what you can do, with the important aspect being the things you cannot do that prevent you from returning to work.
For more information on how to protect your disability benefits visit our web site at StennettCasino.com.
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