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It can seem like disability insurance claims drag on forever. Sometimes delays are justified and inevitable—it can take time to collect and evaluate all of your medical records and other evidence. However, not all delays are so innocent. Occasionally, insurance companies hold off on approving undeniably valid claims for disability insurance benefits, hoping that you’ll give up, make a mistake, or accept an unreasonably low settlement.

When this happens, you have legal options. In Illinois, as in most other jurisdictions, disabled policyholders can sue their insurance company when it delays decisions about coverage, eligibility for benefits, or other issues in bad faith. In this article, we’ll help you identify possible insurance company bad faith.

What Does “Bad Faith” Mean in a Disability Insurance Claim?

In an insurance claim, there is an uneven balance of power. The insurance company has more information, financial resources, and the ability to approve or deny your disability claim. To prevent abuse of this power, Illinois law requires that they handle your claims in good faith. Otherwise, the insurer may owe you damages. This duty of good faith applies not just to the determination of whether to pay your benefits, but also to the speed of its claim handling.

Delays in the handling of a legitimate disability insurance claim can put a great deal of financial pressure on the policyholder. As you attempt to recover from your disability or adapt to new and unexpected limitations, you may not have consistent income and may feel financially vulnerable. The emotional and financial pressures can mount quickly. If the insurance company uses this vulnerability to take advantage of you—slowing down your claim, refusing to answer your phone calls, or providing you with false information, it may be liable for its misconduct.

If the insurance company uses this vulnerability to take advantage of you—slowing down your claim, refusing to answer your phone calls, or providing you with false information, it may be liable for its misconduct.

What Happens During a Disability Insurance Claim Investigation?

Once you submit a disability insurance claim, the company will assign your case to an insurance adjuster. This individual is responsible for evaluating your case and issuing a decision to either approve or deny your benefits. This investigation can take time, since the adjuster will likely:

  • Review your application and other forms that you complete
  • Request medical records and statements from your doctors and medical providers
  • Ask to meet with you and perform a field interview
  • Schedule an independent medical examination
  • Assess your work experience and ability to work
  • Consult with experts, including vocational specialists and physicians

If you have an employer-sponsored disability plan, this process typically cannot take more than 150 days. However, if you have a self-funded disability insurance policy, the insurance company doesn’t have a specific deadline. Instead, it cannot wait an unreasonable amount of time before it makes a decision.

RELATED: How Long Does It Take UNUM to Process a Claim? It Depends

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When Is an Insurer’s Delay Considered Bad Faith?

Let’s explore Section 155, the Illinois law that governs bad faith claims. Under state law, insurance companies can act in bad faith in many ways, including:

  • Failing to communicate promptly or regularly with you
  • Refusing to pay an acknowledged claim amount that owes you
  • Deliberately undervaluing a claim and pressuring you to settle
  • Issuing a decision without an adequate investigation of your claim

However, a bad faith claim may also arise when the insurer’s delay is “vexatious and unreasonable.” Determining whether a delay is reasonable or unreasonable is not particularly straightforward. The court must consider the total circumstances, including factors like the adjuster’s attitude towards you, the length of time you have to wait, and whether you had to pursue litigation to get the benefits you deserve.

For example, suppose you are a short-term disability insurance policyholder. You suffer serious back injuries in a car accident and cannot work for six months. You file a claim for disability benefits with your insurance company. While it’s clear that the company owes you benefits, the insurance adjuster decides to delay payment for three months, reducing your benefits. The adjuster hopes that you’ll think it’s too much of a bother to file a lawsuit and get full compensation.

In this case, a court is likely to find that you can sue and recover damages under Section 155 due to a vexatious and unreasonable delay.

RELATED: Will Illinois’ Courts Enforce a One-Sided Insurance Contract?

Bryant Legal Group: Experienced Chicago Bad-Faith Insurance Lawyers

If you have had your legitimate disability benefits claim unreasonably delayed (in processing or payment) by the insurer, you may have the right to sue and recover damages under Illinois’ bad faith insurance law. Successfully litigating bad faith disability insurance claims can be quite challenging. They demand an experienced team of attorneys who can fully investigate and prosecute your claims. At Bryant Legal Group, our bad faith insurance attorneys have decades of experience representing disabled claimants. We provide top-notch advocacy at every phase of litigation, from negotiating with the insurance company to trial and appeals.

To schedule an initial consultation, call us at 312-561-3010 or complete our online form.

References
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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Most people who suffer a mild traumatic brain injury or concussion heal quickly, often within a month. However, not everyone is so lucky. Approximately 30% of people with concussions develop post-concussion syndrome (PCS), which can last a lifetime.

If you live with PCS and can no longer work, you may be eligible for short-term or long-term disability benefits. In this blog, the experienced disability insurance lawyers at Bryant Legal Group discuss the essentials of a post-concussion syndrome claim.

What Is Post-Concussion Syndrome?

Post-concussion syndrome occurs when your mild TBI symptoms, like headache, ringing in the ears, blurred vision, and fatigue, continue for more than two months. While we don’t know what causes PCS, certain populations, including women, older individuals, and those with a history of mental health issues, are more likely to develop the condition.

Post-concussion syndrome can dramatically change your life, causing:

  • Migraine and tension headaches
  • Fatigue or insomnia
  • Depression, anxiety, and irritability
  • Memory and concentration problems
  • Dizzy spells
  • Ringing in the ears (tinnitus)
  • Blurred vision
  • Sensitivity to light and sound

Sometimes, post-concussion lasts for several months. Other times, symptoms persist for a lifetime.

Can I Get Disability Insurance Benefits for Post-Concussion Syndrome?

Some people with post-concussion syndrome continue to work. Others cannot manage their jobs amid their overwhelming headaches, dizziness, and other symptoms.

If it becomes impossible to work, you may be eligible for either short-term or long-term disability benefits. Unlike Social Security disability benefits, disability insurance policies are sold and paid by insurance companies. Many professionals either have employer-sponsored or privately purchased disability plans.

Disability insurance plans will pay a portion of your lost income if you meet their definition of disability. There are two common disability definitions in short-term and long-term disability policies:

  • Own occupation: You are disabled if you cannot perform your actual job or profession.
  • Any occupation: You will receive benefits if your post-concussion syndrome and other conditions prevent you from doing any type of full-time work.

If you need help understanding your disability plan’s definitions, refer to your Summary Plan Description or consult a knowledgeable disability insurance lawyer.

Insurance companies frequently deny long-term and short-term disability claims involving post-concussion syndrome. Insurance adjusters prefer objective, fact-based data, like an MRI study or bloodwork, to symptom-based diagnoses. PCS is often a diagnosis of exclusion — your doctors will rule out other conditions instead of ordering a single test that can confirm your post-concussion syndrome.

To fight back, you’ll need help from a law firm that understands the science behind PCS and the complex laws the control disability insurance claims. At Bryant Legal Group, we’ve helped people throughout Chicago and Illinois with their head injury claims. Our ERISA lawyers have recovered hundreds of millions in benefits for our clients, and we can help you evaluate your claim’s strength and your legal options.

Look Out for “Self-Reported Condition” Limitations

Many LTD policies limit benefits for “self-reported conditions,” where there isn’t an objective test that clearly diagnoses your condition. The insurance company may try to terminate your benefits for post-concussion syndrome after two years, citing these limitations. If the insurance company tries this tactic, it’s best to consult a disability insurance lawyer right away. Sometimes, insurance adjusters improperly apply “self-reported condition” limitations.

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Filing for LTD Benefits? Your Plan’s Definition of “Disability” May Change

If your post-concussion syndrome does not resolve within a year, you may have to file for long-term disability benefits. Many people with mild brain injuries are surprised when the insurance company denies their LTD claims, especially because their short-term disability claims were quickly approved.

Some of these denials are due to a change in your plan’s definition of disability. Many short-term disability plans use an “own occupation” definition, which is easier to meet. However, most long-term disability plans, especially employer-sponsored ones, apply the tougher “any occupation” standard.

People with PCS do receive long-term disability benefits under “any occupation” plans. However, success often requires extensive evidence, detailed legal analysis, and guidance from expert witnesses. A disability lawyer can help you navigate these hurdles, clarify your evidence, and connect you with the right vocational and medical experts.

Bryant Legal Group: Compassionate Legal Representation for People Living With TBIs

At Bryant Legal Group, we’ve built a reputation for our practical, compassionate, and client-focused approach. We help individuals with traumatic brain injuries and post-concussion syndrome get the short-term and long-term disability benefits they deserve.

Rather than struggle alone, contact our office for a free, no-risk consultation. Our team has recovered millions in compensation for our clients, and we can help you understand your options.

To schedule your free initial consultation, call us at 312-667-2536 or use our online form.

References
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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Whether you’re interested in submitting a claim for long-term disability benefits, are currently involved in a disability insurance dispute, or are already getting benefits, chances are you’ve at least considered the tax consequences. Unfortunately, there’s no simple answer to the question, “are short- and long-term disability benefits taxable?.” Instead, it depends on your circumstances.

At Bryant Legal Group, we’ve spent decades helping people navigate their disability insurance claims. In this blog, we’ll discuss the factors that will impact your long-term and short-term disability benefits’ taxability.

Basics of Long-Term Disability Income Taxation

The IRS addresses disability insurance benefit payments in Section 105 of the Internal Revenue Code. As with many tax laws, the taxability of both long-term and short-term disability benefits depends on a variety of factors. However, the most important factor is whether you paid your premiums with pre-tax or after-tax dollars.

  • Pre-tax dollars: If you paid your premium with pre-tax income, you’ll typically have to pay taxes on any benefits you receive from the plan.
  • After-tax dollars: If you made payments with after-tax dollars, you might not have to pay taxes on your disability insurance benefits later on.

It’s worth noting that your long-term disability benefit is already likely to be a percentage of your pre-disability earnings. Because your benefit payments are also taxable, you’ll get less money in your pocket. We encourage people, especially highly compensated professionals, to be wary before they purchase a plan with a pre-tax premium structure.

Most people with private or individual disability insurance plans use after-tax dollars when they purchase their plans. However, the story is much more complicated if you have employer-sponsored disability insurance coverage.

Are My Employer-Sponsored Long-Term Disability Benefits Taxable? It Depends

Many employees have a patchwork of disability insurance as part of their fringe benefits package. Your employer may offer you a limited amount of short-term disability and long-term disability coverage that is fully covered by the company. Or, you may pay a portion of your disability insurance premium while your employer subsidizes the rest. Each of these situations can result in different tax consequences.

Let’s walk through some common situations.

Your Employer Paid Some or All of Your Disability Insurance Premiums

If your employer pays your entire disability insurance premium, you’ll typically have to pay income taxes on any benefits you receive. However, if your employer pays just a portion of your premium, the taxability of your benefit payments will depend on whether you paid the rest of your premium with pre-tax or after-tax dollars.

You Paid Premiums with Pre-Tax Dollars

If your employer paid part of your disability insurance premium, and you paid the rest with pre-tax dollars, then your entire disability benefit payment is taxable income.

You Paid Premiums with After-Tax Dollars

If you paid your share of an employer-sponsored long-term disability premium with post-tax dollars, then only part of your disability insurance payments is taxable.

For example, suppose your employer pays 60% of your disability insurance premium. You pay the remaining cost with after-tax dollars. In this case, you’ll only have to pay taxes on 60% of your long-term disability benefit payments.

What Happens if I Get a Disability Insurance Settlement or Negotiated Buyout?

If you and your insurer negotiate a buyout of your long-term disability benefits, you’ll receive the agreed-upon lump sum amount at once. We recommend seeking the advice of an experienced tax professional regarding the taxability of payments beyond regular monthly benefits and potential deductions for attorney’s fees and associated expenses.

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Are Short-Term and Long-Term Disability Premiums Tax-Deductible?

You cannot deduct the cost of your long-term disability or short-term disability premiums on your taxes. The IRS does not consider the cost of disability insurance to be a deductible medical expense.

Similarly, self-employed individuals cannot deduct the cost of short-term or long-term disability premiums, although business overhead insurance (that covers business expenses rather than lost income) is deductible.

Have Specific Questions About the Taxability of Your Disability Benefits? Consult With a Professional

Navigating the U.S. Tax Code isn’t an easy process. If you need help selecting the right disability insurance plan or have questions about your policy’s tax consequences, you should consult both a disability insurance attorney and a tax professional.

At Bryant Legal Group, we help professionals, self-employed individuals, and entrepreneurs with their complex disability insurance issues. Whether you have questions about a private disability insurance plan you’re considering, need to apply for long-term disability benefits, or are facing an appeal, we can help you understand your legal options. We can also suggest reputable tax professionals who can address your specific IRS concerns.

Schedule Your Consultation With an Experienced Chicago Long Term Disability Attorney

Bryant Legal Group is a Chicago-based boutique insurance litigation firm that represents policyholders in their insurance disputes.  Our attorneys have decades of experience handling long-term disability disputes and have achieved significant case results for our clients.

We pride ourselves on our client-oriented legal representation, and we collaborate closely with clients throughout the dispute resolution process to ensure that we are up to date and are strategically aligned. Ready to speak with one of our disability insurance lawyers?

Call us at (312) 667-2536 or complete our online form to schedule your free initial consultation.

References
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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Many people receive variable income because they’re small business owners, salespersons, freelancers, or receive performance-based commissions or bonuses. If your income is variable on a day-to-day, week-to-week, or month-to-month basis, you may be concerned about the potential impact on your disability insurance benefits.

Insurers are always looking to minimize their costs, and if you have a variable income, they may try to underestimate your income to lower your benefits. As the insurance policyholder, however, you are entitled to challenge an insurer’s attempt to wrongfully deny, undervalue, and mishandle your claim.

In this article, our disability insurance lawyers at Bryant Legal Group explain how to calculate long-term disability benefits involving variable income.

Variable Income Means Something Different for Everyone

There are many different types of variable income earners:

  • Employees who receive a base salary but also get a significant, performance-based, year-end bonus
  • Employees whose earnings are primarily through commissions or customer tips
  • Independent contractors and self-employed individuals
  • Small business owners and entrepreneurs

No matter your circumstances, your priorities are clear. If you’re unable to work due to an injury or illness, you want fair compensation.

How Much Does Long-Term Disability Pay?

Most LTD policies pay monthly benefits to disabled individuals. Typically, the insurance company will pay you a percentage of your pre-disability earnings each month. This percentage can vary, but it is often between 50% and 80% of your earnings. Most policies also have a maximum benefit, so if you earn a very high income, your monthly benefit may be less than the standard percentage set out in your plan.

To calculate your exact monthly benefit, you’ll need to read your Plan Document or Summary Plan Description (SPD). These documents outline all the terms and conditions of your policy, including the formulas the insurance company will use to calculate your benefits. (If you need help interpreting your SPD or Plan Document, consult a lawyer who can help you fully understand its terms.)

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Will the Insurance Company Consider My Bonuses and Commissions When It Calculates My Benefit Payments?

Long-term disability plans vary dramatically, so the answer to this question will depend on the precise terms of your policy. Many policies calculate your monthly benefit payment based on your monthly salary, and this calculation does not typically include supplemental income such as bonuses, commissions, tips, and other compensation. 

However, some plans are intended for those who earn a variable income.  Many salespeople, independent contractors, and self-employed individuals purchase private disability insurance coverage that more broadly defines their pre-disability earnings, even if they already have an employer-funded policy. These private plans typically account for income earned through supplemental sources such as overtime, bonuses, commissions, and tips. 

How to Choose a Private Disability Insurance Policy if You Earn Variable Income

If you have variable income, it’s important that your plan average your earnings so that your monthly income is derived based on your total annual income.  For example, some plans will calculate your benefit by averaging your earnings over the year. However, this might also be a disadvantage if you’re a freelancer and you’ve had a down year. 

An alternative is to look for an insurance plan that will average your earnings over a longer time, giving you a more accurate evaluation of your monthly income. For example, some plans will average your pre-disability earnings over two years.

When you purchase private long-term disability insurance, make sure your agent understands that your income is variable. They can help you select a plan that meets your needs.

What Should I Do if the Insurance Company Undervalues My Income?

Sometimes, even if you were proactive and purchased private disability insurance that acknowledges your income variability, you may still run into issues. First, calculating your pre-disability earnings may be complicated, and even the most honest insurance adjuster can make mistakes. Second, some insurance companies intentionally try to undervalue people’s income.

In either case, if you think your long-term disability benefit payments seem too low, you should consult a disability insurance lawyer.

At Bryant Legal Group, we help self-employed and commission-based workers understand their long-term disability policies, properly calculate their benefits, and fight back against the insurance company’s tactics.

The sooner you consult with our team, the better. Strict appeal deadlines apply to long-term disability claims. If you miss these deadlines, you may lose out on benefits. And if you work with a skilled disability lawyer from the beginning of your claim, they are more likely to catch mistakes and miscalculations early on, potentially saving you from the hassle of prolonged litigation.

Bryant Legal Group: Chicago’s Trusted Long-Term Disability Firm

Here at the Bryant Legal Group, our attorneys have decades of experience representing people in their disability insurance claims. We have a fundamentally client-oriented approach to legal advocacy. Unlike many of our competitors, we work closely with our clients at every stage of a dispute to make sure we have all the information we need. Over the years, this aggressive and transparent approach to litigation has helped us recover significant benefits and compensation for our clients.

Ready to speak to an attorney about your disability insurance claim? You can schedule an appointment by either completing our online form or calling us at (312) 667-2536.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

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Chronic kidney disease (CKD) is much more common than you think. About 37 million people live with CKD, and many more cases are undiagnosed. Kidney disease is the ninth leading cause of death in the United States; every day, about 340 people start dialysis.

Many people assume they need to be in kidney failure before they qualify for long-term disability benefits. At Bryant Legal Group, we help people get the disability insurance benefits they deserve, even before they require dialysis or a kidney transplant. Keep reading to learn more.

What Is the Difference Between Chronic Kidney Disease and Kidney Failure?

Did you know that every 30 minutes, your kidneys filter all of your blood? These organs play an essential role in your body, filtering out excess water, waste, minerals, and salts. Your kidneys keep your blood cells and bones healthy.

When you have chronic kidney disease, these organs do not work effectively, and waste and toxins may remain in your body. Kidney failure occurs when your kidneys are functioning at less than 15% of their normal capacity. While you can experience sudden, acute kidney failure, most people’s kidney disease is progressive.

Doctors categorize chronic kidney disease into five stages:

  • Stage 1: Your kidneys are damaged but are still functioning normally. Many people with stage 1 kidney disease seem symptom-free.
  • Stage 2: You are experiencing a mild loss of kidney function. Most people remain relatively symptom-free. You may notice some mild swelling in your legs and increased urinary tract infections. You also may have abnormal urine test results.
  • Stage 3: You now have moderate loss of kidney function, and your symptoms are becoming more obvious. Many people start noticing pain, numbness, tingling, unexpected weight loss, and a feeling of being unwell.
  • Stage 4: Your kidneys are functioning very poorly. You may experience anemia, decreased appetite, increasing pain, bone disease, and other symptoms. Your doctors will start preparing you for dialysis.
  • Stage 5: Considered end-stage kidney disease, you will need dialysis or a kidney transplant to survive. You will likely experience pain, fatigue, shortness of breath, nausea, vomiting, and swelling throughout your body.

Because our kidneys are remarkably powerful and efficient (you can survive with one functioning kidney), many people don’t realize they have CKD until their disease is relatively severe.

What Is Polycystic Kidney Disease (PKD)?

Polycystic kidney disease is a form of chronic kidney disease. With this inherited medical condition, fluid-filled cysts grow in your kidneys. These cysts are different than simple kidney cysts.

Over time, PKD can change the shape of your kidneys and make it harder for them to function normally. About 500,000 people live with polycystic kidney disease in the United States, making it one of the most common genetic disorders.

Can I Get Disability Insurance Benefits for Stage 3 Kidney Disease?

Once you have end-stage kidney disease, you may automatically qualify for disability insurance benefits. For example, the Social Security Administration’s rules grant Social Security disability benefits to people who need dialysis, undergo a kidney transplant, or have very severe kidney disease symptoms. However, private disability insurance policies are different than Social Security, which is a federal benefit program.

Long-term disability benefits are either self-funded or an employee benefit. Your eligibility for benefits will depend on your specific policy’s terms and conditions. Typically, to prove that you are disabled, you’ll need to show that your medical conditions prevent you from doing your own occupation or any occupation, depending on your policy’s language. This will require strong evidence, including:

  • Medical records that clearly document your chronic kidney disease symptoms and treatment
  • Evidence from your employer and vocational experts about your work experience and transferable skills
  • Information about your daily activities and how they’ve changed due to chronic renal disease

While some policies may automatically qualify you for LTD benefits when your kidney disease requires dialysis or a transplant, you may be eligible for benefits much earlier.

Stage 3 kidney disease can involve a variety of disabling symptoms, including:

  • Malnutrition
  • Bone pain
  • Low blood cell counts
  • Malnutrition
  • Bone pain
  • Low blood cell counts

Combined, these symptoms may make it impossible to work.

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Should I Work With an Experienced Disability Insurance Lawyer?

Filing a short-term or long-term disability insurance claim requires attention to detail as well as extensive legal and medical knowledge. If you’re struggling with profound fatigue, the side effects of your treatment protocols, or an overwhelming dialysis program, it may be impossible to pursue long-term disability benefits on your own.

When you hire a disability lawyer, they will take on this burden and let you focus on your health.

At Bryant Legal Group, we understand the complexities of renal disease claims. We help our clients explain and document their CKD-related issues long before they require hemodialysis or peritoneal dialysis.

If you’re considering your long-term disability options, we can help you build a plan. Our team helps people navigate their kidney disease-related insurance claims, ensuring that they meet strict filing deadlines, build strong evidentiary records, and don’t get taken advantage of by unscrupulous insurance companies.

Bryant Legal Group: Respected Disability Insurance Lawyers in Illinois

Bryant Legal Group is one of Illinois’ premier disability insurance law firms. We help people get the long-term disability insurance benefits that they deserve. If you need help understanding the terms and conditions of your employer-sponsored or private LTD policy, we’ll help you evaluate your plan’s documents and suggest practical next steps.

To schedule your free no-risk consultation, contact us at (312) 667-2536 or use our online form

References
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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Dentists, orthodontists, endodontists, and other dental professionals often purchase long-term disability (LTD) insurance as a safety net. Many of these providers have built thriving businesses, and they know that an unexpected illness, injury, or disability can endanger everything they’ve worked for.

However, you may be surprised to discover that dentists, like many other professionals, have a hard time getting the disability insurance benefits they deserve. At Bryant Legal Group, we represent dentists and other medical professionals in their ERISA and private disability insurance claims. Here, we outline some important factors you need to consider as you prepare your LTD claim.

Dentists Have a High Risk of Disability

Most people don’t appreciate the physical demands of dentistry. Studies suggest that dental professionals have a one in four likelihood of filing for disability insurance during their careers. Cardiovascular disease is the #1 culprit, but there are other factors at play. Years of sustained standing, twisting, stooping, gripping, and grasping can cause degenerative changes in your hands, arms, shoulders, and back. In a 2015 study, more than 68% of the surveyed dentists reported ongoing neck, back, knee, shoulder, or arm pain.

Additionally, mental health issues are common among dental professionals. Dentistry is a high-stress profession, and many providers report ongoing problems with depression and anxiety. Sadly, dentists are twice as likely to attempt suicide than the general population, and three times as likely as most other professionals.

What Is Long-Term Disability Insurance?

LTD coverage pays a monthly benefit if you meet the policy’s definition of disability. Unlike Social Security disability, which is a federal benefits program, long-term disability insurance plans are sold by for-profit insurance companies. Dentists and dental professionals may either get this coverage from their employer or privately purchase it from an insurance agent or a professional organization. (Both the American Dental Association (ADA) and Illinois Dental Society partner with insurance agencies that offer these policies.)

Many dental professionals invest in long-term disability insurance. As a small business owner, you may be painfully aware that an unexpected disability could financially ruin you, especially if you have outstanding dental school debt, business loans, and other obligations. Long-term disability insurance can give you peace of mind.

However, to get that monthly income, you’ll need to file a claim, provide evidence that documents your disability, and meet other requirements. Before you start this process, it’s a good idea to spend some time reviewing your disability plan and building a comprehensive strategy for your claim.

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1. Determine Whether Your LTD Policy Is Private or Employer-Sponsored

Different rules apply to your long-term disability claim depending on whether it was privately purchased or employer-sponsored. A federal law, ERISA (Employee Retirement Income Security Act of 1974), covers most group disability insurance plans. If you have an ERISA claim, you’ll need to comply with a strict set of procedures and regulations.

However, if you purchased your LTD policy directly from the American Dental Association or an insurance company, state laws apply to your claim. In this case, you can file a lawsuit more quickly, present additional evidence at trial, and demand a jury trial.

Typically, your Plan Document or Summary Plan Description should outline which laws apply to your claims. You can request these documents from your insurance company. However, if you’re unsure whether you have a private or group disability insurance policy, it’s best to consult an experienced disability lawyer. When you meet with an attorney from Bryant Legal Group, we can help you interpret your Plan Document and explain your legal options.

 

2. Understand the Precise Terms and Conditions of Your Long-Term Disability Policy

In addition to identifying which laws apply to your claim, your SPD and Plan Document also contain essential terms and conditions that will impact your claim. They typically include:

  • Definition of disability: Your policy may pay disability benefits if you’re unable to perform your own occupation. However, most policies only consider you disabled if you’re unable to do any work.
  • Limitations: Most policies limit benefits for mental health issues, self-reported conditions, and substance abuse. Typically, your benefits will end after two years if your only disabling condition falls into one of these limitations.
  • Exclusions: Some policies will not cover specific medical conditions, self-inflicted injuries, or injuries related to a crime or conflict.
  • Filing and appeal deadlines: You’ll need to meet the exact deadlines in your policy if you want your benefits.

A single mistake or missed deadline can lead to a denial of benefits. Again, if you need help interpreting your policy, contact a disability insurance lawyer.

 

3. Look Out For Dual Occupation Defenses

As a dental professional, you may play many roles in your business: caring for your patients, managing your employees, evaluating the business’  finances, and engaging in long-term planning. You may even have other ventures, dabbling in real estate or property management. Sometimes, insurance companies will try to use your diverse job description against you.

In the “dual occupation defense,” insurance companies argue that while you may be unable to practice the art and science of dentistry, you are still capable of doing your other occupations (like managing your business).

For example, suppose you purchased an “own occupation” policy years ago. Since then, your practice has thrived. You now have offices in four locations, manage a large team of dentists and dental hygienists, and only treat a handful of your old patients.

During a car accident, you suffer a herniated disc in your neck that limits your ability to grip, grasp, reach, and perform essential dental services. Your doctor suggests you file for long-term disability. The insurance company quickly denies your claim, arguing that the bulk of your work has little to do with dentistry and that you can still perform your managerial work.

To fight back, you’ll need strong evidence documenting your physical capabilities, job requirements, and other information. Your disability insurance lawyer will likely consult with vocational experts and physicians to help document how your neck injury prevents you from performing your actual job duties.  

Bryant Legal Group: Fighting for Dental Professionals in Illinois

Dentists and other dental professionals face unique challenges in their long-term disability claims. If you have questions about your legal options, contact Bryant Legal Group today. Our Chicago-based legal team assists professionals throughout Illinois with their complex disability insurance claims. We offer free evaluations and can use video conferencing tools to help you maintain social distancing and stay safe.

To schedule your initial consultation with our team, call us at 312-667-2536 or use our online form.

References
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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An estimated 1.5 million people live with lupus in the United States, and roughly 16,000 more are diagnosed each year. If you’re living with this complicated disease, you know its challenges first-hand. Lupus is hard to diagnose and treat, and many people won’t understand how this “invisible” condition affects your life.

At Bryant Legal Group, we’re here to help. Our lawyers assist people living with lupus and other autoimmune disorders through their disability insurance claims.

In this article, we discuss the essentials of lupus-related claims and suggest some simple ways you can strengthen your application for benefits. (Please note that this article focuses on long-term disability (LTD) insurance and lupus, not Social Security disability insurance or SSI benefits.)

What Is Lupus?

Lupus is an autoimmune disorder. When you have lupus, your body’s immune system attacks healthy tissues. There are four types of lupus:

  • Systemic lupus erythematosus (SLE): You experience inflammation throughout your body, which can affect your organs, joints, skin, and nervous system.
  • Cutaneous lupus: Sometimes called “chronic cutaneous lupus” or “discoid lupus,” you only experience symptoms and inflammation in your skin tissues.
  • Drug-induced lupus: Some medications can cause lupus, although in these cases, the disease typically resolves once you stop using the drug.
  • Neonatal and childhood lupus: These conditions develop in utero or during childhood.

SLE is the most common form of lupus. When most people say “lupus,” they really mean systemic lupus erythematosus.

While women are more often diagnosed with lupus, the disease can affect anyone. Common symptoms associated with systemic lupus include:

  • Extreme, chronic fatigue
  • Headaches
  • Fever with no identifiable cause
  • Pain and swelling in your joints, hands, feet, and around the eyes
  • Chest pain, especially when you breathe deeply
  • Sensitivity to both natural and fluorescent light
  • A red, butterfly-shaped rash on your cheeks and nose
  • Raynaud’s disease, which can cause your fingers and toes to feel numb and turn white or blue
  • Mouth ulcers or sores
  • Unexplained weight loss or sudden weight gain

Over time, lupus can also damage your organs, cause inflammatory arthritis, and contribute to depression and anxiety.

Lupus symptoms tend to wax and wane. During a flare, you may experience very dramatic inflammation, fatigue, and other symptoms. When the disease is in remission, you may be relatively asymptomatic. You may even be able to perform your daily activities without any difficulty.

How Is Lupus Diagnosed and Treated?

Because lupus shares symptoms with many other conditions, it usually takes a long time to diagnose the disease. There is no single test that conclusively diagnoses lupus. Instead, you’ll probably undergo many blood tests, x-rays, and even biopsies. It can be an incredibly frustrating process.

There is no known cure for lupus, but there are many ways you can manage your condition. Depending on your unique symptoms, your doctors may prescribe various medications, like steroids, anti-malarial drugs like Plaquenil, and immune-suppressing drugs. Many doctors also recommend lifestyle changes such as quitting smoking, following a healthy diet, and getting regular exercise.

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Long-Term Disability Benefits for Lupus

Like any chronic condition, lupus can be disabling. However, you’ll need to carefully evaluate your LTD policy and circumstances before you apply for benefits. Because lupus symptoms vary from person to person, it’s a good idea to have a well-prepared application for benefits. Otherwise, you may face significant delays and difficulties in your long-term disability claim.

Identify Your Insurance Policy’s Disability Definition

Long-term and short-term disability plans will only pay benefits if you’re unable to work. Before you apply for disability benefits, you should carefully read your Plan Document or Summary Plan Description and identify your policy’s definition of disability. You may have an “own occupation” plan that will pay disability insurance benefits if you’re unable to do your current job. Alternatively, you may have an “any occupation” policy that only pays LTD benefits if you’re unable to perform any type of work.

Most long-term disability policies use an “any occupation” definition of disability, which makes disability harder to prove. However, if you a private disability insurance policy, you may have selected the more lenient “own occupation” standard. If you need help understanding your plan’s terms and conditions, contact an experienced disability insurance lawyer for help.

Watch Out for Limitations on “Self-Reported” Conditions

Most long-term disability insurance policies limit coverage for “self-reported condition” that cannot be substantiated by a diagnostic test. If your condition falls within this limitation, the insurance company may only pay your benefits for a limited period, often two years.

Unfortunately, many lupus symptoms, like fatigue, chronic pain, depression, and concentration difficulties, are “self-reported.” There is no MRI, CT scan, or blood test that can detect these symptoms and prove they are real.

To fight back against insurance company tactics, your long-term disability lawyer may consult with experts and specialists who can link your symptoms to your lupus diagnosis and other related health conditions.

Get Consistent Medical Care for Your Lupus

You’ll need clear and consistent medical records as well as strong testimony from your doctors and other experts to win your disability insurance claim. Our disability insurance lawyers always suggest that you follow up with your doctors during a flare and clearly explain your symptoms. This way, you’ll have an accurate record of your disease’s progression and the frequency of your flares.

Unfortunately, many people with lupus become so used to their chronic fatigue, joint pain, and inflammation that they stop mentioning it to their doctors. When this happens, the disability insurance company may argue that because your medical records do not consistently document your ongoing issues, you no longer experience these symptoms.

You may also want to keep a disability journal that tracks your daily activities, symptoms associated with your medical conditions, and side effects from your treatment.

Don’t Forget to Mention Medication Side Effects

Many lupus medications cause severe side effects, including an increased risk of infection, headaches, nausea, and blurred vision. When the insurance company evaluates your application for benefits, it should consider how these negative side effects limit your ability to work.

However, it’s also a good idea to report these issues to your medical team. Your doctors can help document your side effects and may be able to identify other treatment options.

Bryant Legal Group: Chicago’s Lupus Disability Lawyers

At Bryant Legal Group, we focus on complex disability insurance claims and guide our clients through their applications for benefits and appeals. If you have questions about lupus or another autoimmune-related disability insurance claim, contact our office today. We’ll help you understand your legal options and treat you with the respect you deserve.

To schedule your free initial consultation with an attorney from our team, use our online contact form or call us at (312) 667-2536.

References
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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If you have a serious medical condition, you may worry that you’ll soon be unable to keep up with the demands of your job. In fact, one of the most common questions we hear is, “Can I apply for disability insurance if I’m still working?” The answer is that you typically cannot receive disability insurance benefits before you leave your job — but you can start preparing your claim.

In this article, our disability insurance lawyers explain the basics of a disability insurance application. We’ll also give you a disability checklist that will help you prepare your claim.

Chronic and Progressive Conditions Can Make It Hard to Maintain Your Job

Many of our clients live with chronic, progressive, or recurring-remitting medical conditions that incrementally make it harder to work. Whether you have heart disease, multiple sclerosis, or an autoimmune disorder, the wear and tear of your condition can eventually become disabling.

Disability insurance plans typically define “disability” in two different ways:

  • Own occupation: You cannot perform your actual job, but you still may have the ability to do other work.
  • Any occupation: You are unable to perform any kind of work due to your injuries, illness, or chronic conditions.

If you meet your policy’s standard, you may be eligible for monthly benefit payments.

You Can Apply for LTD Benefits Before the Elimination Period Expires

Every disability insurance plan is different, but most of them have “elimination periods.” You cannot receive benefits until the elimination or waiting period expires.

While a short-term disability policy’s elimination period may be just a week, many long-term disability policies have a 90-day waiting period (although long-term plans also vary). Before you apply for disability benefits, it’s a good idea to read your Plan Document or Summary Plan Description. That way, you’ll know the precise waiting periods that apply to your claim.

However, an elimination period doesn’t mean you should wait to apply for disability insurance benefits. By the time that the insurance company investigates your claim and reaches a decision, the elimination period will likely be over.

Medical Evidence Is Critical to Your Short-Term and Long-Term Disability Claims

As you get ready to apply for short-term or long-term disability benefits, consistent medical care is essential. When an insurance adjuster reviews your claim, they will look for evidence related to your diagnoses, the severity of your conditions, and your prognosis. Medical records offer this information and much more.

If you’re struggling at work, the first step is to talk to your doctor. They may be able to identify treatment options that reduce your symptoms or suggest restrictions that improve your daily life. Additionally, if you decide you can no longer work, your doctor’s detailed notes will become powerful evidence during a disability insurance claim or lawsuit.

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Consult a Disability Lawyer Early On

Applying for long-term disability benefits is not a simple process. You’ll need to give the insurance company comprehensive information about your medical conditions, work and education, daily activities, and the severity of your symptoms. In turn, the company may demand more information and face-to-face interviews. They may even hire a private investigator to track your every move.

Many people can’t manage all of these demands while maintaining a focus on their wellness. We frequently meet with people who tried to handle their applications themselves and made costly mistakes. Sometimes, our legal team can address the errors and get these clients the benefits they deserve. Other times, it’s too late.

When you consult an experienced LTD lawyer at the start of your claim, you’ll know your case is built on a strong and solid foundation.

However, not every attorney who says they’re a disability lawyer understands how to pursue a long-term disability claim. Many disability lawyers focus their practices on Social Security disability claims, which involve very different processes and laws. The Social Security Administration manages all SSDI and SSI claims, and specific federal laws and regulations apply. However, long-term and short-term disability claims are much more complicated.

Depending on your policies, Illinois or federal laws may apply. And, you may face a multi-stage appeal process that involves insurance-company-level appeals and a lawsuit. There are also significant procedural hurdles.

For example, if you have an employer-sponsored LTD plan, you only have a limited amount of time to submit evidence supporting your claim. If you wait too long, you will be unable to present new information, no matter how important it is. If your “disability lawyer” only dabbles in long-term disability claims, they may make errors that cost you your LTD benefits.

To make sure this doesn’t happen, always work with a law firm that focuses specifically on disability insurance, not broader disability issues. At Bryant Legal Group, we primarily handle disability insurance claims, not Social Security cases.

Are You Ready to Apply? Use Our Disability Checklist

There are many essential steps to a disability insurance application. Here are some you should never ignore.

  1. Talk to your doctors and health care providers about your medical conditions and follow their advice to the best of your ability.

  2. Start a disability journal that tracks your day-to-day symptoms.

  3. Request a copy of your Plan Document and Summary Plan Description from your supervisor or human resources department. These documents outline your policy’s definition of disability and detail other terms and conditions.

  4. Consult an experienced disability insurance lawyer at Bryant Legal Group who can assess your eligibility for benefits. We offer free consultations.

  5. Keep track of all elimination periods and filing deadlines. When possible, mark them in your calendar. If you miss a deadline, you may lose your right to benefits.

  6. Create a list of all your medical providers’ names and addresses, including doctors, therapists, hospitals, and clinics.

  7. Collect your medical records and get detailed information about your physical and mental abilities from your treating doctors.

  8. Request a copy of the application form, sometimes called an Employee’s Statement, from the insurance company or your HR department.

  9. Complete your application for disability insurance benefits with help from your lawyer. This form will require extensive information, including:

    • Your Social Security number
    • Date of birth
    • Contact information, like your phone number and address
    • Your employer’s name
    • Information about your job and work activities
    • Your education and training
    • Your work history
    • Information about your medical conditions and providers
    • When you started noticing symptoms from your medical conditions
    • Your last day of work

  10. Make sure your employer completes their part of your LTD application.

  11. Promptly respond to the insurance adjuster’s requests for more information.

  12. Supplement your claim with additional medical evidence and information as your condition changes.

  13. Attend independent medical examinations (IMEs), if scheduled.

  14. Negotiate with the insurance company and insist that they follow the appropriate state or federal laws.

  15. If the insurance company denies your claim, discuss your appeal options with your disability lawyer.

This is not a complete list of all the actions our team takes when we represent a long-term disability client. However, the list does provide a general framework if you decide to represent yourself in a disability insurance claim.

If you’re unable to manage all the items on this checklist, that’s okay — but you must contact an experienced disability insurance lawyer for help as soon as possible.

Bryant Legal Group: Fighting for People With Disabilities in Illinois

If you’re considering a long-term disability application, the team at Bryant Legal Group can help you understand your legal options. Our lawyers focus on disability insurance claims and help people get the benefits and aid they deserve. Plus, your initial consultation with an attorney from our team is always free. We’ll listen to your story, review your claim, and give you practical advice.

To schedule your free initial consultation with our team, call us at 312-667-2536 or use our quick and convenient online form.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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When you live with depression, anxietybipolar disorder, or another mental health condition, it can be hard to maintain employment. At Bryant Legal Group, we know how frustrating it is to suddenly find yourself unable to control your symptoms, especially if you’ve worked hard to build your career. Insurance companies, however, take a different view. Because they’re for-profit companies, insurers see long-term disability claims for mental health conditions as an expensive burden.

That’s why insurance companies often add limitations and exclusions that can affect your ability to get long-term disability benefits for mental illness. Most (but not all) group long-term disability insurance policies limit payment on mental health claims to one or two years of benefits. In this article, our experienced disability insurance lawyers outline factors that may affect your depression or mental health claim.

Mental Illness Is a Top Cause of Disability

According to the World Health Organization, depression is one of the top causes of disability. When you add in anxiety, bipolar disorder, post-traumatic stress, and other mental disorders, mental illness is a factor in the vast majority of disability cases worldwide. In the United States alone, one in five people live with a mental health disorder, and about 4% of us have severe mental illness.

Our mental health also has a profound impact on our ability to work. Many mental health disorders cause symptoms that interfere with our jobs, including:

  • Poor attention and concentration
  • Memory difficulties
  • Anxiety and panic attacks
  • Feelings of hopelessness, helplessness, and worthlessness
  • Fatigue and sleep disturbance
  • Lack of motivation and follow-through
  • Crying spells
  • Impulsive behavior
  • Mood swings and personality changes
  • Problems with decision-making and executive functioning
  • Suicidal thoughts and self-harm

Globally, it’s estimated that we lose $1 trillion in productivity each year due to depression and anxiety.

Because our mental health issues are so profound and evaluating how severe a mental health condition can be very difficult, insurance companies have tried to lower their costs by limiting coverage of these conditions. Whether you have an employer-sponsored group disability insurance plan or a private policy, you need to understand insurance companies’ tactics and how to respond.

Look Out for “Mental and Nervous” Limitations

Unlike Social Security disability benefits, long-term disability insurance is offered by privately owned insurance companies. These companies can include a wide variety of terms, conditions, exceptions, and limitations to their plans. You should always carefully read your disability insurance plan’s documents before you file a claim for benefits.

Long-term disability policies often include a “mental and nervous” clause that limits the amount of time you can receive benefits for a mental disability. Policies vary substantially, but as a general rule, most “mental and nervous” clauses impose a one- or two-year limitation.

For example, if you are suffering from depression that is so severe that you cannot work, then you may be eligible for benefits under your long-term disability plan. However, if your plan includes a “mental and nervous” limitation, you’ll only receive benefits for a few years, even if your disability lasts longer. As soon as you reach your plan’s cut-off date, the insurer no longer has to pay benefits for your mental health claim.

There Are Exceptions to Most “Mental and Nervous” Clauses

It’s worth noting, however, that “mental and nervous” limitations have exceptions. For example, many long-term disability mental health limitations do not apply to organic brain disorders, like schizophrenia, Alzheimer’s disease, and other forms of dementia. Your disability lawyer can help you review your policy’s “mental and nervous” limitation and apply it to your unique circumstances.

However, be prepared for a fight. Long-term disability insurers sometimes try to redefine disabling conditions as mental health problems to cut costs. By categorizing your disability as solely a mental health condition, the insurer will try to avoid paying out significant lifetime benefits that they might otherwise owe. You and your lawyer will have to counter their tactics with compelling evidence and insight from your treating physicians and other experts.

Additionally, many people with depression and anxiety also have disabling physical conditions. According to the National Alliance on Mental Illness, if you have a mental health issue, you’re 40% more likely to have heart disease or a metabolic condition. If physical conditions, like heart disease, degenerative disc disease, or an autoimmune disorder, also prevent you from working, the “mental and nervous” limitation may not apply to your claim.

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Insurance Companies Misinterpret Medical Evidence and Policy Language to Their Advantage

When you apply for disability benefits, you’ll fill out a series of forms and provide the adjuster with medical evidence and other information. Then, the insurance company rep must review all the information, apply your policy’s terms and conditions, and decide whether you’re eligible for benefits. Insurers sometimes misinterpret policies’ language, gloss over your medical records, and deny long-term disability benefits.

For example, the insurance adjuster may try to argue that your depression is disabling, but that your physical conditions are not as severe. Suppose that you have coronary artery disease, diabetes, and depression. The adjuster may agree that your depression is disabling and apply your policy’s two-year limitation on mental illness. However, they may also argue that you’ve fully recovered from your heart attack and that your uncontrolled blood sugars are due to your poor diet and lifestyle choices.

Disability insurance plans often include vague limitations and poorly written definitions of mental health conditions. For instance, some insurers have (unsuccessfully) tried to argue that a policy that fully covers schizophrenia may not provide the same level of benefits for “schizoaffective disorder,” a condition that involves similar symptoms and limitations.

In a long-term disability claim, you’ll need to collect and interpret critical medical evidence that explains your conditions and their severity. Then, your disability insurance lawyer will take all of these facts and analyze them based on your policy’s language and the law. Fortunately, Illinois law ensures that courts must interpret all ambiguous provisions in private insurance in favor of you, the policyholder. 

Substance Use and Mental Health Are Often Linked, Bringing in Other Policy Limitations

More than 19% of people with mental illness also struggle with a substance use disorder. While our disability attorneys understand that addiction is a disease, insurance companies sometimes use people’s struggles with substance use against them. Many long-term disability plans limit addiction-related benefits to one or two years.

However, insurance adjusters will sometimes argue that overdoses and substance use are “self-inflicted,” and many LTD plans exclude injuries due to self-harm. Don’t fall for these tactics. Instead, consult an experienced disability attorney who can help you build your case and correctly interpret your policy’s language.

Some Private LTD Policies Don’t Include “Mental and Nervous” Limitations, So Review Your Plan Carefully

When you purchase a private disability insurance policy, you have more control over the terms and conditions. You and your agent may have considered a variety of plans that offered different levels of coverage, terms and conditions, and monthly premiums. Some of these private insurance policies do not include “mental and nervous” limitations. 

If you’re a business owner, professional, or another person who has private long-term disability insurance, you must carefully review your plan’s language. If you need help interpreting your policy’s dense and hard-to-read conditions, contact your attorney. They can use their years of experience and legal knowledge to help you navigate your Plan Document.

Bryant Legal Group:

Fighting for Disabled People in Chicago and Throughout Illinois

When your disability claim involves mental health issues like depression, anxiety, or affective disorder, the insurance company may try to limit your LTD benefits. At Bryant Legal Group, our team helps people get the compensation they deserve. For decades, we’ve fought for people with mental illness, giving them the information and support they need at every step, and we’ve won millions in benefits for our clients.

To schedule your free, no-risk consultation, contact us at (312) 667-2536 or use our online contact form

References
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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When you’re unable to work due to an injury, illness, or chronic condition, the last thing you want to do is wait for disability insurance benefits. Unfortunately, many short-term and long-term disability policies contain “elimination periods” that must pass before you can receive compensation.

What Is an Elimination Period?

Under most disability insurance policies, you must wait a period of time before the insurer will pay out your benefits. This waiting period is called the elimination period.

Most short-term disability policies have an elimination period of between 0 and 14 days. Long-term disability policies have varying waiting periods, but 90 days is the most common. You can also purchase LTD insurance with a much shorter or longer elimination period.

Many long-term disability experts compare an elimination period to a health insurance deductible, which is the amount of money you must pay before your insurance company starts to cover your health care. When you purchase health insurance, a policy with a larger deductible typically will give you a lower monthly premium. However, you’ll have to pay more money out-of-pocket for your care until your spending exceeds the deductible.

Similarly, in the world of private disability insurance, a policy with a longer elimination period will have cheaper monthly premiums. However, if you become disabled, you’ll have to wait longer before the insurer starts paying your short-term or long-term disability benefits.

Where Can I Find My Policy’s Elimination or Waiting Period?

When you purchased your long-term disability policy, you may not have paid much attention to the elimination period. However, this period becomes incredibly important when you need to file for disability insurance benefits. You can find your policy’s specific elimination period in both the Plan Document and the Summary Plan Description (SPD).

Both the SPD and Plan Document are highly technical documents. If you have a hard time reading and understanding them, you should call an experienced disability insurance lawyer. At Bryant Legal Group, we offer free consultations, and we can help you understand your policy’s precise terms and conditions. Then, we can help you build a legal strategy that focuses on both your long-term and short-term needs.

Should I Wait to Apply for Disability Benefits Until the Waiting Period Expires?

Many people assume they cannot apply for long-term disability benefits until their insurance policy’s waiting period expires. This is incorrect. Elimination periods are not “probationary periods” that prohibit you from filing a claim. Instead, you should apply for LTD benefits as soon as you meet your plan’s definition of disability, even if you won’t receive a check for a couple of months.

Our disability lawyers suggest this strategy for a few reasons. First, it takes time to process disability claims. You’ll need to fill out a variety of forms, the insurance company will request medical records, and the insurance adjuster may even schedule you for an independent medical examination with one of their company doctors. This process can easily take a few months. By the time the adjuster makes their initial decision, your policy’s elimination period may be complete.

Second, many long-term disability plans have accumulation clauses, which let you combine periods of disability over an accumulation period (typically a year).

For example, suppose you suffer a heart attack and cannot work for 45 days while you recover. You return to work for a month or two, but your fatigue, shortness of breath, and other symptoms make it too difficult. Your cardiologist takes you off work again and suggests that you apply for long-term disability benefits. If your policy has an accumulation clause and a 90-day elimination period, you’ll only have to wait 45 days before you can receive benefits (90 days – 45 days of disability = 45 days).

Finally, if you have a chronic, recurring health condition and already qualified for LTD benefits once before, your policy may waive the elimination period in subsequent claims. For example, suppose you have relapsing-remitting multiple sclerosis. In the past, you had to take a year off of work due to the severity of your symptoms. During this time, you received long-term disability benefits. If you still have the same insurance plan and you experience a significant MS flare, your elimination period may be waived.

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Will I Automatically Get Disability Benefits Once My Waiting Period Ends?

No. There’s a lot more to your long-term disability plan than just an elimination period. Your LTD policy includes a vast number of terms and conditions. Before you qualify for long-term disability benefits, you’ll need to satisfy them all.

Here are some of the most important policy requirements you’ll need to look out for.

How the Plan Defines “Disability”

Most LTD policies define disability in one of two ways. If you have an “own occupation” plan, you’ll need to prove that you cannot perform your actual job. However, most LTD plans are “any occupation” plans. That means you’ll need to convince the insurance company that you’re unable to do any type of work.

Limitations on Pre-existing Conditions

If you have an employer-sponsored disability insurance policy, it may include additional limitations and waiting periods if you have a pre-existing condition. For example, many group long-term disability plans will not cover a pre-existing or chronic condition if you reported symptoms in the six months before you enrolled in the plan and file a claim within 12 months of enrollment.

Other insurance policies may exclude or limit coverage of certain conditions, like mental illness, addiction, and self-inflicted injuries.

For How Long Will I Get Long-Term Disability Benefits?

Again, it’s important to read your long-term disability plan’s documents, like the Summary Plan Description. Most LTD policies will cover you until you reach retirement age or can return to work. However, insurance companies are for-profit businesses, and they often try to terminate their claimants’ disability benefits.

If you’re receiving long-term disability benefits and the insurance company schedules you for an independent medical examination (IME), the company may be building a case against you. IME doctors frequently find that disabled claimants’ abilities have “improved.” IME doctors make these findings because that’s what they’re paid to do.

If you’re concerned about an upcoming IME or suspect you’re under surveillance, call a disability insurance lawyer right away. You need to start building your legal claims and preparing for a fight.

Bryant Legal Group: Illinois’ Trusted Long-Term Disability Firm

At Bryant Legal Group, we help people across Illinois with their private and employer-sponsored disability insurance claims. If you have questions about your long-term disability claim, contact us today. We’ll help you understand your policy’s requirements, suggest ways you can strengthen your disability claims, and educate you about your rights.

To schedule your initial consultation with our team, call us at 312-667-2536 or complete our online form.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

Request Your Free Consultation

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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Let’s be clear: there is nothing “independent” about UNUM’s medical examinations. The disability insurer works closely with a network of doctors and medical providers whose primary goal is building cases against you and other UNUM claimants. If an insurance adjuster schedules you for an IME (independent medical examination), you need to be prepared.

However, you can beat a UNUM IME. As part of our UNUM series, Bryant Legal Group outlines the IME process, discusses some IME doctor tricks, and explains how you can protect your long-term disability claim from a damaging IME report.

What Is an “Independent Medical Examination?”

Most long-term disability plans say the adjuster can send you to an occasional IME. Insurance adjusters order IMEs for many reasons:

  • You haven’t seen a doctor or a specialist in a while, and they want an updated psychological evaluation or physical examination
  • There’s evidence that suggests your condition has changed or improved
  • They’ve noted “red flags” in your claim
  • They’re looking for a reason to deny your claim

While UNUM will assure you that the IME doctor is completely neutral, this is rarely the case. Most IME doctors don’t treat patients. Instead, these doctors make their living performing IMEs for insurance companies, who provide generous compensation for one-time examinations. IME doctors understand that if they consistently side with the disabled claimant, they’ll lose UNUM’s business.

Do I Have to Go to UNUM’s Medical Examination?

If UNUM’s insurance adjuster schedules an IME, you typically must attend the appointment. If you have a serious conflict, like a scheduled surgery, call your long-term disability lawyer; they may be able to reschedule your examination. However, if you refuse to attend the IME, you could lose your right to long-term disability benefits.

What to Expect During a UNUM IME

IME doctors vary in their approach. While some physicians perform very detailed, lengthy exams, most IMEs are relatively short. However, most IMEs follow a relatively similar format:

  • When you check in to the doctor’s office, they may ask you to sign a series of forms. If they want you to sign a medical authorization (HIPAA) form, politely decline.
  • The doctor or nurse will ask you some questions about your medical history, symptoms, and lifestyle.
  • The doctor will perform an examination, which may take a matter of minutes or hours.
  • Sometimes, the doctor will order diagnostic testing, like an x-ray, nerve conduction study, or pulmonary function test.
  • The doctor will thank you for your time and walk you out to the waiting room.

After your examination, the IME doctor will send a written report to UNUM that discusses your medical conditions, outlines their clinical findings and opinions, and explains your degree of disability. You typically will not get a copy of this report unless you receive a denial of benefits and file an appeal. However, UNUM’s IME reports tend to favor the insurance company and suggest that you’re malingering.

What’s Malingering and Why Does It Matter?

Insurance companies are always trying to damage claimants’ credibility. When a doctor says there’s evidence of malingering, they are implying that you’re exaggerating your symptoms for financial gain. In short, they’re saying you’re a liar.

However, there isn’t a test that objectively proves that someone is exaggerating their symptoms. Waddell’s signs, which are often used to identify “malingering” in orthopedic cases, are really a tool that helps determine when psychological and emotional issues are impacting someone’s recovery.

Don’t get upset if UNUM or their doctors suggest you’re malingering. It’s one (very biased) doctor’s opinion. And, your lawyer may be able to build a case that proves otherwise.

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5 Ways You Can Beat a UNUM IME Report

Even if UNUM denies your case based on an IME report, you can fight back. However, there are a few ways you can strengthen your claim from the very beginning.

 

1. Don’t Exaggerate Your Symptoms

As we mentioned above, UNUM’s IME doctors love to report malingering. If you exaggerate your symptoms during the exam, they will notice and report it. Instead, do your best and give an honest description of any pain you experience during the exam.

Similarly, you should answer the doctor’s questions honestly and respectfully, but only answer the questions you’re asked. For example, if the doctor asks you how far you can sit, answer the question — you don’t need to get into the details about how you suffered through a long flight to visit your sister.

 

2. Build Strong Relationships With Your Treating Doctors

When claims adjusters and judges review your long-term disability claim, they should consider all the evidence, not just a single IME report. Medical records are essential to every long-term disability claim. These reports can help establish the severity of your condition, your abilities, and the steps you’ve taken to get better.

When you see your doctors consistently and give complete and accurate information about your medical issues, the resulting records may counteract a report from a one-time examination. Your lawyer can also help strengthen your claim by consulting with their own medical experts and getting detailed statements from your treating physicians.

For example, suppose UNUM’s IME doctor reports evidence of malingering and suggests that you’re “drug-seeking.” However, your medical records show you’ve never gone to an emergency room to demand narcotics, and your doctors’ records and testimony verify that your pain complaints are consistent with their examinations and your MRI films. No one, other than a UNUM representative, is going to buy the IME doctor’s false allegations of malingering.

 

3. Assume You’re Under Surveillance Before and After an IME

UNUM loves surveillance. The insurance company frequently hires private investigators to track you before and after an independent medical examination. When they order this surveillance, they are hoping that your day-to-day routine will be inconsistent with your conduct and behavior at the IME doctor’s office.

Similarly, the IME doctor’s staff will probably watch you enter and exit the building. It’s not uncommon to see IME reports where the doctor implies that your gait and pain behaviors changed as soon as you entered or exited his building.

While you can’t stop a dishonest IME doctor from making false or unfair statements, it’s important that you act honestly and consistently before, during, and after your IME.

 

4. Bring a Trustworthy Witness With You

You have the right to bring a witness to your IME. We often suggest that our clients bring a trusted and reliable family member or loved one with them. That way, if the doctor makes false claims in their report, you’ll have another corroborating witness.

Ask your witness to sit quietly in the examination room and take notes, focusing on the following issues:

  • The time the examination starts and finishes
  • Any statements the IME physician makes about your condition or abilities
  • What activities the doctor asks you to do
  • Whether you report any difficulty or discomfort to the insurance company’s doctor
  • Anything that seems important or unusual about the examination

The person you bring doesn’t need to interact or participate in the examination at all. You also may be able to videotape the exam, but you should ask your lawyer beforehand.

 

5. Consult an Experienced Disability Insurance Lawyer

When UNUM schedules an independent medical examination, they’re getting ready to fight. So, it’s a good idea to start preparing your case for an appeal. When you consult with a long-term disability lawyer before an IME, they can help you fully prepare for the examination. They may even be familiar with the physician you’re seeing and can give knowledgeable advice about the IME doctor’s tricks and tactics.

Bryant Legal Group: Fighting for People With Disabilities

At Bryant Legal Group, we help people across Illinois with their UNUM long-term disability claims. If you have questions about an IME or your disability insurance claim, contact us today.

To schedule your free initial consultation with an experienced disability attorney from our team, call us at 312-667-2536 or use our online contact form.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

Request Your Free Consultation

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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“It’s easier if we talk this over face-to-face,” says your UNUM claims adjuster. “We’ll drive to your home to go over the paperwork.” They suggest an in-person meeting.

Unfortunately, UNUM’s field visits aren’t always designed for your benefit. Like many long-term disability insurance companies, UNUM uses these interviews as an opportunity to investigate claimants, and at times, discredit them. 

At Bryant Legal Group, we’ve handled many UNUM long-term disability claims that involve both employer-sponsored and private insurance plans. We’ve seen most of the company’s tactics firsthand, and we can help you combat them. In the second part of our UNUM series, we’ll discuss how UNUM uses field visits as a form of surveillance.

  • Related Article: UNUM’s Dirty Tricks: Tying Compensation to Denied Claims

What Happens Before the Field Interview or Visit?

Odds are very good that in the days and weeks leading up to your field interview or visit, the insurance company will conduct physical (video) surveillance of your daily activities. The purpose of the video surveillance is two-fold:

  • To observe the extent of your physical limitations
  • To potentially catch you in a lie during the field interview.

For example, before your field interview, an investigator may observe you taking out a garbage bag and placing it in a trash can. Then, during your interview a week later, the field rep may ask about your routine daily activities, such as sweeping, doing dishes, and taking out the trash. If you fail to mention taking out the trash, or say you do not do it (even if you only did it the one time), the insurance company will argue you are lying about the extent of your disability and may even accuse you of fraud. Therefore, it is very important to be accurate in your answers during the field interview.

What Is a Disability Field Interview or Visit?

A field visit occurs when a UNUM representative visits you, either at your home, a public place, or your office. That person may be a Unum employee or a hired private investigator. The purpose of the visit is to discuss your disability insurance claim. Adjusters often frame these meetings as a chance to discuss your claim and get to know you. However, it is important to remember that the insurance adjuster represents the insurance company, not you, and the insurance company increases its profits by denying claims.

Field visits are often a form of surveillance. The UNUM representative wants to examine your house, watch how you move about, and look for evidence that you’re not truthfully representing your disability. The field representatives typically have specialized investigative training, and their full-time job is interviewing disabled claimants. When the interviewer walks into your meeting, they already know a lot about you, and your claims adjuster may have given the interviewer specific directions about what they need to look for and ask you about.

Typically, a field visit involves the following activities:

  • The field rep will ask to take your picture and record your conversation. You do not have to agree to this. However, remember that recorded conversations can protect you as well. Non-recorded interviews are subject to the notes, report and memory of the field interviewer, which will likely not be framed in your favor.
  • The field rep will seem very warm and chatty; you should expect lots of personal questions about your family, activities, and lifestyle.
  • The field rep will ask you questions about your symptoms, your treatment, and your physical and mental limitations.
  • The rep may try to pressure you to sign forms or authorizations. Politely decline and ask for more time to read and review them.
  • The interview may take longer than you expected, since the field rep is trying to gauge your physical and mental abilities. If you are not physically or mentally up to an extended interview, tell the field rep you need to stop and continue on another day, do not try to tough it out.
  • The field rep will take lots of notes.

All of the information gathered by the field rep can help UNUM build a case against you. For example, if your home seems sparkling clean and you live alone, the insurance company will argue that you’re capable of doing more than you reported. Or, the representative will point out that you sat “comfortably” for hours, without needing to stand up, recline your chair, or shift positions. The interviewer will document anything and everything that could damage your credibility. They may even list good vantage points where an investigator could record your activities in the future.

What Happens After a UNUM Field Interview?

UNUM’s representative will compile their notes into a series of reports. You may get a summary report that outlines the information you discussed with the interviewer. UNUM will get an even longer, more detailed report that discusses your conversation, the representative’s observations, and suggestions about how UNUM should approach your disability insurance claim. You will not get a copy of this longer report unless you and your attorney request a copy of your insurance company file.

Based upon the representative’s report, UNUM may revise its approach to your claim. If they have not done so already, the insurer may hire a private investigator who will perform in-person and online surveillance. The company also may schedule an IME with an “independent medical examiner” who reliably sides with UNUM. Or, the insurer may simply deny your long-term disability claim.

Do I Have to Agree to a UNUM Field Visit?

Some long-term disability plans require that you participate in field visits. Newer policies often have stronger language that requires your compliance. You may even have to make a statement while under oath. However, you should never agree to a UNUM field interview until you review your Plan Document or Summary Plan Description.

If you need help understanding your rights, contact a long-term disability lawyer. Your attorney can help you review your long-term disability policy and determine whether you must attend a field interview.

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5 Ways to Protect Yourself During a UNUM Field Visit

Even though UNUM’s field visits are intimidating and invasive, there are steps you can take to protect yourself.

1. Meet in a Neutral, Public Place

UNUM’s representative wants to scope out your home, looking for ways to discredit you. However, you typically do not have to open your doors to their prying eyes. Instead, suggest that you meet in a public, accessible place. Many libraries have conference spaces you can use for free. If you already have a lawyer, they will typically schedule your field interview at their office.

2. Ask for Breaks and Change Positions as Needed

Don’t tough out the interview if you’re feeling uncomfortable. If you need to take a break, take medication, or adjust your position to stay comfortable, you should do so. While you should never exaggerate your pain and limitations, it’s also important that you accurately represent your symptoms during a field visit.

3. Be Prepared for Invasive Questions

UNUM’s field interviewers can be chatty, especially if you don’t have a disability lawyer. They’re hoping that you’ll open up and say something that damages your case. Expect open-ended questions like, “What’s your social life like?” or “How do you pass your time?”

When you answer these questions, make sure you don’t sugarcoat your abilities or talk about past hobbies. For example, if you loved to read, but now due to a traumatic brain injury, you can only focus on a page for a few minutes, don’t mention it as a pastime.

Additionally, don’t take the bait and go off-topic. If the UNUM representative asks you about your ability to walk, give them a short, honest answer. Don’t tell them about the time your dog ran off and you limped along for a half-hour looking for them, no matter how interesting the anecdote. The interviewer is not your friend.

Finally, if the interviewer asks something too personal, politely decline to answer the question. You can note that your favorite foods, best friends’ names, and the strength of your marriage are irrelevant to your long-term disability claim and then ask the field representative to move on. If you ever feel threatened or intimidated, you should politely end the meeting.

4. Expect Surveillance Before and After Your Field Interview

This advice also rings true for independent medical examinations (IMEs). UNUM is looking for inconsistencies in your claim. The company’s adjusters frequently hire private investigators to tail claimants before and after their interviews. They’re hoping that your behavior during the field visit is different than your daily activity level.

You don’t need to hide inside and close your curtains before and after a field visit. However, do your best not to push your limits during this time period. And if you see anyone on your property, you can ask them to leave.

5. Work With an Experienced Disability Insurance Lawyer

One of the simplest and surest ways to protect yourself and your long-term disability claim is to work with a respected disability insurance lawyer. When you have an attorney, they will typically prepare you for your field interview and attend the meeting.

Your disability lawyer will also help you navigate the visit and steer you away from potential mistakes and missteps that could cost you your LTD benefits.

Bryant Legal Group: Illinois’ Trusted Long-Term Disability Firm

Bryant Legal Group’s disability lawyers guide disabled individuals through their complex legal claims. We’re not afraid to stand up to big companies like UNUM and demand compensation for our clients. If you have questions about an upcoming field interview or a long-term disability claim, contact us today.

We offer free consultations for all disability claim. You can call us at 312-667-2536 or use our online contact form to schedule your appointment.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

Request Your Free Consultation

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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