The DeHaan Law Firm, P.C.

02/01/2022

https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/guidance-long-covid-disability/index.html

Although many people with COVID-19 get better within weeks, some people continue to experience symptoms that can last months after first being infected.

08/02/2021

HOW INDEPENDENT ARE INDEPENDENT MEDICAL EXAMINATIONS?

It is common when and if you become disabled for insurance carriers to compel you to submit to an Independent Medical Examination (IME). Although the language suggests this examination is objective (using the word, “independent”), nothing could be further from the truth. Actually, one might call this an Insurance Medical Examination since the examiner likely is working for the insurance carrier.

The medical examination is conducted on behalf of the insurance carrier, and the insurance carrier has little to no motivation to find you disabled. On the contrary, it benefits the insurance carrier when they deny you disability benefits; that is money saved and more money for their share holders.

For a little perspective, consider that most medical professionals who perform IME’s work for insurance carriers on a steady basis, either directly or through “consulting firms” who cater to insurance carriers. It stands to reason that an “employee” or contractor who has a business arrangement with an insurance carrier would have a vested interest in finding disabled or injured claimants to be healthy and capable of working. If these examiners were to find claimants “disabled” frequently, it would lead to less repeated business from the insurance carriers.

What Happens During An IME?

This process usually begins with a review of your records before you have even met the IME doctor. The insurance carrier first combs through your medical records usually cherry-picking specific records to give the IME doctor. Too often, these records are taken out of context, and the IME doctor looks for accidental omissions which then can be presented as evidence that you really are not that disabled.

Then, typically, the insurance carrier gives the IME doctor a list of questions to answer, so he or she knows, in advance, the direction of the inquiry. And when the IME actually takes place, it generally is a brief, superficial examination, lasting no more than a few minutes. It is this type of examination that the insurance carrier will base its decision on, in deep contrast with the type of examination you receive when you are examined by your own treating physicians.

Other Problems With The IME

This one-sided process is further aggravated by the fact that some IME doctors may have their own biases, especially against conditions which cannot always be detected on diagnostics such as fibromyalgia, for example. Unlike your own doctor who treats and examines you over a long span of time and knows your symptoms, an IME doctor simply reads a record and conducts a brief examination – that does not provide the whole picture. The most an IME doctor can do is comment on that one brief examination, and usually finds in favor of the insurance carrier.

While you cannot refuse to go to an IME, you can be prepared. It is allowable for you to retain a registered nurse to accompany you to the exam. At The DeHaan Law Firm we often make arrangements for a nurse to be in the room with you because that tends to relax our clients, and sends an important message to the IME doctor that your attorney is paying attention.

08/02/2021

THE IMPORTANCE OF MEDICAL TREATMENT WHEN YOU ARE ON DISABILITY

Whether you receive your disability benefits as a result of a private policy, an employer-sponsored plan, or from the Social Security Administration, it is as important to continue medical treatment after you are awarded benefits as it is when you first apply for them.

First, consistent and continuing medical treatment is good for your health. To try to improve, you should always see your doctor(s) on a regular basis, and continue to follow their advice.

Second, those who receive disability benefits, know that periodically, every other year or every year, insurance carriers ask for updates on your medical condition. They often ask for treatment records from your physicians. If you cannot submit updated medical records or your doctor refuses to fill out that Attending Physician’s Statement because it has been 3 years since he/she has seen you, you are giving the insurance carrier a green light to investigate further; or, to terminate your benefits, outright.

I have had clients who have told me that their medical conditions are permanent and will not change, and they see no need to continue treating with their doctors. That could not be further from the truth. Even if your impairments are likely not to change (or even if they are likely to get worse), you still need a qualified doctor to attest to that fact, periodically. No insurance carrier will take your word for it.

Of course, there are many people who simply cannot afford the proper medical care, and therefore do not see their doctors (or any doctors) because they haven’t the proper medical insurance (or none at all). In that instance, it makes more sense to financially plan for a medical visit at least once a year. Even if that visit is out-of-pocket for you, that one visit literally can save your benefits from being taken away, which is especially a concern if your disability benefits are your only source of income.

07/27/2021

"The Biden administration announced Monday that long Covid, a condition where people experience long-term Covid-19 symptoms long after clearing the actual virus from their system, could be considered a disability under civil rights laws.

The White House announced the new long Covid guidance on the 31st anniversary of the Americans with Disabilities Act, a civil rights law that protects people with disabilities from discrimination."

The White House released new guidance on the anniversary of the Americans with Disabilities Act.

07/26/2021

https://thehill.com/policy/healthcare/564795-biden-admin-says-long-covid-could-qualify-as-a-disability-under-federal-law

The Biden administration on Monday released new guidance to support those experiencing long-term symptoms from COVID-19 as part of a broader effort to recognize the 31st anniversary of the Americans with Disabilities Act.

04/20/2021

https://californiahealthline.org/news/article/covid-long-haulers-disability-benefits-hurdles-frustration/

Early in the pandemic, many patients couldn’t be tested. The lack of a covid diagnosis complicates disability insurance for those whose illness continues.

04/20/2021

Before You Buy That Private Disability Policy . . .

Those people who are in business for themselves or are professionals such as doctors, lawyers, dentists, accountants, should consider purchasing a private (individual) disability policy. A private (individual) disability policy is added protection for you and your family should you become disabled and unable to continue working.

But, not all private (individual) disability policies are equal, and the amount or type of coverage they offer depends upon the type of policy you purchase, the amount you spend, and the insurance carrier you purchase it from. Making the purchasing decision requires a good deal of research, as well as determining the specific needs of you and your family.

Unfortunately, many of my clients are at a loss when it comes to fully comprehending exactly what type of policy they have. Some have never read it carefully enough, and others do not bother to review it periodically for changes in eligibility or limitations. If and when they become disabled, too many are surprised when they learn about what these policies, often expensive, actually do cover.

Things to think about before purchasing a private (individual) disability: plan:

Make sure to read any policy carefully (especially the fine print)
When purchasing private (individual) disability insurance, make sure you have the right coverage as well as the right amount of coverage.
Always plan ahead; keep your changing personal and professional needs in mind.
Consider purchasing a Premium Waiver Benefit on your Life Insurance Policy. This means that your Life Insurance Policy will continue to cover you at no charge during your disability.
Consider purchasing a Business Overhead Policy. A Business Overhead Policy will cover your business expenses such as rent/mortgage, salaries, equipment, etc., during the time of your disability.
Review your policy (or policies) regularly for changes in eligibility and limitations.
I often consult with clients before they make the decision to purchase a private disability policy, and handle their applications should they suffer a debilitating disability.

04/19/2021

Often, as a part of an employee benefits package, an employer may provide long-term disability insurance. That employer-sponsored plan is governed by the Employee Retirement Income Security Act of 1974 (ERISA), which is a federal statute.

Typically, if the insurance carrier approves the claim for disability, these plans pay a monthly disability benefit of between 50% and 66% of your income, MINUS other disability benefits you may be entitled to such as Social Security Disability, Workers’ Compensation, and No-Fault, etc. At first glance, while an employer-sponsored long-term disability plan seems to cover you in the event of a disabling injury or illness, often they have specific restrictions and/or limitations.

For example, the monthly benefit you will receive through an ERISA plan is based solely on your base salary/income. Therefore, if you are a salesperson and you rely on commissions to make a living, you need to understand that your disability benefits ARE NOT based upon your total pay that includes these commissions. Rather, your disability benefit is a percentage of only your base pay. The same applies for other occupations such as hairstylists and restaurant employees who may rely on tips. Tips are NOT considered your base pay.

In addition, many of these disability plans define your disability eligibility as “Own Occupation” for the first two years. “Own Occupation” means that you cannot work in your own job or in a job with similar responsibilities, and is a simpler threshold to over come. However, after two years, the requirement becomes “Any Occupation,” meaning, you cannot work in any job, at all. And that is when it may become much more complicated. For instance, while you may not be able to do your job as a plant manager, where you may move around a lot throughout the course of the day, you may be able to do a job that requires little or no moving around, a sedentary position.

The change from “Own Occupation” to “Any Occupation” is where most people will experience difficulties with the insurance carrier.

It is prudent to get to know your employer-sponsored long-term disability plan (ERISA) so you know what to expect in the event you become disabled. Call us for a case evaluation. 631-582-1200

03/15/2021

Policy/Plan Reviews

Many of our clients have disability insurance, yet they often do not know the terms. At The DeHaan Law Firm, we will review your policy/plan to determine its specifics (benefits, requirements, limitations, etc.) before you file a claim to see whether it covers you adequately.

Although disabled and eligible for disability benefits, many clients find the process of applying for those benefits overwhelming. We can handle that for you. On your behalf, we will submit notice of claim, obtain necessary proof of claim forms, and work with you and your doctors to gather documentary proof of your disability. Additionally, we will pinpoint any ambiguous language in your policy claim forms that could cause potential problems for you in the future.

If you need assistance managing your disability claim, contact us at 631-582-1200.

03/01/2021

That Long-Term Disability Plan Your Employer Provides . . .

As I’ve said before, the Long-Term Disability Plan (LTD) provided by your employer likely is governed by the Employee Retirement Income Security Act of 1974 (ERISA), a federal statute. The standard of review, or what you have to prove to the court, in an ERISA case either is arbitrary and capricious or de novo.

The arbitrary and capricious standard of review simply means that the plaintiff (or, you, the claimant) must prove that the insurance carrier (or the plan administrator) acted in an unreasonable manner, without respect to the evidence.

In a de novo standard of review, the Court sets aside the decisions of the insurance carrier (or the claims administrator), and then evaluates your claim strictly based on the evidence before it. This levels the playing field just a bit for you.

02/26/2021

You May Have A Disability Plan You Don’t Know About

If you are one of the many millions of Americans who works for someone else, your employer may provide you with a benefits package that includes an Employer-Sponsored Disability Plan.
That employer-sponsored plan is governed by the Employee Retirement Income Security Act of 1974 (ERISA), a federal statute.

In general, most of these plans pay you a monthly disability benefit of between 50% and 66% of your income, MINUS other disability benefits you may be entitled to such as Social Security Disability, Workers’ Compensation, and No-Fault, etc. At first glance, while an employer-sponsored long-term disability plan seems to cover you in the event of a disabling injury or illness, often they have specific restrictions and/or limitations. You should be aware of them.

First, the monthly benefit you will receive through an ERISA Long-term Disability Plan (LTD) is based solely on your base salary/income. Therefore, if you are a salesperson and you rely on commissions to make a living, you need to understand that your disability benefits ARE NOT based upon your total pay that includes these commissions. Rather, your disability benefit is a percentage of only your base pay. Tips are NOT considered part of your base pay, either. Too often, clients are disappointed at the amount of their benefits because they were not aware benefits are based on base pay.

Second, there is a waiting period, called the elimination period, between the time you stop working and are assessed to be disabled and the time you are eligible to begin receiving disability benefits. It varies, but generally this period is between 90 and 180 days.

Third, as I’ve said many times before, the insurance carrier is not your friend. Quite often, no matter your disability, the insurance carrier will deny your claim. However, that doesn’t mean it’s all over. Generally, you are entitled to an administrative appeal, meaning, you present your appeal to the insurance carrier or plan administrator. It is only after you’ve exhausted the administrative appeal process (which may differ among insurance carriers) that you may sue in court.

Fourth, pay attention to the details. You may obtain benefits, initially. But, some plans will change the definition of disability after a 24-month period. The plan may first specify that you are disabled relative to your job, and after 24-months may change that to disabled to do any job. The latter classification is more limiting and more difficult to prove. That means it is possible that after receiving disability benefits for two years, the insurance carrier may terminate those benefits if you cannot prove yourself unable to work in any occupation, not just your own.

Fifth, remember that offset! Most insurance carriers or plan administrators will compel you to apply for Social Security Disability for a good reason. If and when you are approved for Social Security Disability, they will offset your monthly Social Security Disability benefits against your Long-Term Disability benefits - the money THEY pay you. So, you can expect a decrease in your monthly LTD benefits once you’ve been approved for Social Security Disability benefits.

Navigating through this process can be confusing, frustrating, and a losing proposition if you don’t know what you’re doing or you don’t really understand your Long-Term Disability Plan. At The DeHaan Law Firm, disability is all we do. We offer a case assessment, free-of-charge, to see if you have a viable claim for disability.

02/26/2021

Covid-19 And Coping With Stress

Symptoms, testing, what to do if sick, daily activities, and more.