Bryant Legal Group

Substance use affects every social, economic, and demographic group. According to the Substance Abuse and Mental Health Services Administration, approximately 19.7 million people (aged 12 and above) struggle with some form of substance use, including addictions to alcohol, opioids, prescription medications, and illicit drugs.

When substance abuse limits or eliminates your ability to work, many professionals turn to their short-term disability and long-term disability policies for help. However, these people often find themselves battling their insurance company rather than focusing on their recovery. In this article, Bryant Legal Group’s disability professionals explain how you can get the help you need.

The Science of Addiction

Some people still believe addiction stems from a lack of willpower. However, scientists now understand that drugs can change how your brain functions. Most addictive substances affect your reward system, which is the instinctual part of your brain that helps you find and seek food, drink, and other sources of please and satisfaction. When you smell a barbecue and your mouth starts to water, your reward system has kicked in.

Addictive substances flood parts of your brain with dopamine, a chemical that gives us a feeling of euphoria. Over time, your brain will rewire itself to demand this feeling, which it now associates with the substance. Addiction can essentially reconfigure your mind to prioritize substance use over your work, family, and health and wellness. This process can change the way you think, remember, react to stress, and make decisions. It also makes addiction incredibly difficult to overcome.

Addiction is clearly an illness, not a moral weakness. That’s why the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the gold standard of mental health diagnostic tools, includes “substance use disorder” as a treatable medical condition.

What Is a Substance Use Disorder?

Based on our new understanding of addiction, physicians now treat it as a disease. According to the DSM-5, a substance use disorder diagnosis involves:

  • Taking a substance in larger amounts or for a longer period than intended
  • Unsuccessful attempts to cut back or stop using the substance
  • Significant time dedicated to getting, using, and recovering from the substance
  • Cravings and urges to use
  • Failing to meet your major work, school, and home obligations
  • Continuing to use even when your substance use harms your relationships
  • Giving up your hobbies, work activities, and social engagements because of substance use
  • Using in situations that put you at risk of physical harm
  • Using even when you realize it is harming your mental and physical health
  • Increased tolerance to the substance’s effects
  • Withdrawal symptoms

If you have two or three of these criteria, you have a mild substance use disorder. Six or more symptoms suggest that your substance use disorder is severe.

Unfortunately, it’s all too easy to develop a substance use disorder. Many people take opioid or narcotic medications while recovering from surgeries or dealing with chronic pain. Our bodies can quickly become dependent on these medications, leading to addiction.

People With High-Stress Jobs Have Higher Rates of Substance Abuse

Approximately 10% of all adults qualify for a substance use disorder diagnosis, although the vast majority never get treatment. Many professionals in high-stress fields report especially high levels of alcohol and drug use. For example, in a 2017 survey, performed by the Hazelden Betty Ford Foundation, about 15.4% of surgeons reported unhealthy drinking. A shocking 36.4% of lawyers had a recent history of unhealthy alcohol consumption.

It can feel hard to step away from your job and income when you’re in a high-profile position. However, without treatment, your addiction or alcohol dependence can take control, leading to life-changing losses. To help provide financial stability while you focus on your health and sobriety, you may be able to turn to your disability insurance policy.

RELATED ARTICLE: When Should I Speak With a Disability Insurance Lawyer?

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Does Short-Term Disability Cover Substance Abuse Treatment?

Typically, your healthcare insurance will cover some or all of your inpatient or outpatient substance abuse treatment. However, your healthcare plan won’t offset your lost income while you’re in rehab. For financial support, many professionals turn to their disability insurance policies.

Short-term disability insurance is supposed to step in and provide monthly benefits if you’re unable to work due to a chronic condition, injury, or illness. While some policies exclude claims that solely involve substance use, most disability insurance policies cover disabilities due to substance use and addiction.

To receive short-term disability benefits, you’ll need to prove that your alcohol or drug addiction is disabling. Depending on your policy’s terms and conditions, “disability” will be defined in one of two ways:

  • Own occupation: Your substance use disorder prevents you from doing your actual job.
  • Any occupation: Due to addiction and your other medical conditions, you cannot perform any type of full-time work.

If you qualify, your insurance company will pay you a monthly benefit while participating in therapy and addiction rehabilitation.

However, you’ll need to substantiate your claims. It’s best to provide a clear medical diagnosis along with documentation from a licensed doctor, psychologist, or therapist that details your struggles with alcohol dependency or addiction. (The insurance company will not pay your short-term disability benefits if you simply claim that you’re struggling with addiction and take time off to go “cold turkey.” You’ll need to show that you’re undergoing substance abuse treatment with a medical professional.)

Will I Lose My Job if I Seek Substance Abuse Treatment?

Under certain circumstances, the Family Medical Leave Act (FMLA) and Americans with Disabilities Act (ADA) will cover your fight with addiction. If you’re a covered employee, you can qualify for up to 12 weeks of unpaid leave during the year. Similarly, you may be entitled to reasonable accommodations and other protections under the ADA. However, these laws are remarkably complex, and you should always consult a lawyer if you have questions about your employment rights.

Can I Get Long-Term Disability for Alcohol or Drug Addiction?

Unlike the Social Security Administration, which will not cover substance use if it’s material to your disability, you may be eligible for employer-funded or private long-term disability benefits. However, there are usually limitations to this coverage. For example, many insurance companies limit LTD benefits for substance use disorder to two years of benefit payments.

Before you apply for long-term disability benefits, you should carefully review your current policy documents. This will help you understand whether you’re likely to face benefit limitations or exclusions. If you need help interpreting your plan’s terms and conditions, you should schedule an appointment with an experienced long-term disability lawyer. 

RELATED ARTICLE: Common Insurer Justifications for the Denial of Private Disability Benefits

4 Ways Insurance Companies Try to Deny Claims Involving Substance Use

Even if your policy offers broad benefits for substance use claims, insurance companies will frequently fight against paying those benefits. Some common reasons insurance companies deny substance use claims include:

  • Claiming your substance use is a preexisting condition.
  • Minimizing your other disabling conditions, especially physical disabilities.
  • Arguing that your disability is “self-inflicted.”
  • Deciding that you’re non-compliant when you relapse.

To counter these arguments, you’ll need help from an experienced disability lawyer who understands how to interpret long-term disability policies, evaluate substance use claims, and analyze your complex medical history.

The team at Bryant Legal Group takes a practical and sophisticated approach to claims involving alcoholism or drug addiction. We’ll carefully review your medical records, consult with experts, and review the relevant policies line-by-line. Then, using our extensive knowledge and experience, we’ll build a plan that focuses on getting you the support you need.

Bryant Legal Group: Fighting for Disabled Workers and Their Families

At Bryant Legal Group, our disability insurance lawyers have decades of experience handling claims involving substance use disorders. We apply this experience on behalf of our clients with the goal of supporting their ongoing recovery.

If you have questions about disability insurance and addiction, our lawyers can help you understand your options. We treat all of our clients with the utmost respect and offer practical solutions to their disability-related matters.

To schedule your free consultation, call 312-561-3010 or use our quick 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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When you’re in the middle of a long-term disability (LTD) or ERISA dispute, the insurance company might offer you a settlement or buyout. While this offer might seem generous (and tempting) at first, you should be cautious. Insurance companies rarely offer a fair settlement in their first offer — and you could lose out on valuable compensation if you accept.

In this article, Bryant Legal Group outlines the essentials of disability insurance settlements and when it’s best to accept a lump-sum payment.

What Is a Long-Term Disability Settlement or Buyout?

When the insurance company approves your LTD claim or a court grants your benefits, you should receive these payments on a monthly basis. If your condition does not improve, these benefits might continue until you reach retirement age. That’s a significant financial obligation for the insurance company, and they’d love to cut these costs.

When you settle your ERISA claim, you give up your right to ongoing benefits in exchange for a lump-sum payment. Once you accept a buyout and the insurance company issues you a check, you will no longer receive any disability insurance benefits — and, if you change your mind, you cannot go back and demand more compensation at a later date.

When Should I Settle My LTD Claim?

Every ERISA claim is different, and there are no simple cookie-cutter answers to when you should settle. Instead, you should consider a series of factors and priorities:

  • Age and life expectancy
  • Financial security and other sources of income
  • Likelihood of returning to work
  • The strength of your claims (if the company is disputing your eligibility for benefits)
  • Whether the offer is reasonable

At Bryant Legal Group, we guide people with disabilities through this analysis, focusing on their unique situation and goals. We believe that you should only settle your ERISA claim when it’s in your best interest and you fully understand the complications of a buyout.

We provide our clients with the time and information they need to make sound decisions. We also fiercely advocate for them, fighting on their behalf to ensure a fair lump-sum payment.

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4 Considerations Before You Settle Your ERISA Claim

While everyone should consult with an ERISA lawyer to get a personalized analysis of their claim, there are a few key considerations in any disability insurance settlement.

1. What Is Your Age and Life Expectancy?

Because you might receive disability insurance benefits for a lifetime (or until you reach retirement age), your age and life expectancy will significantly impact the value of your LTD claim. When you die, your benefits will end.

If you are a younger person with a high life expectancy and you cannot return to work, your lifetime of benefits will carry a significant value. For example, suppose you become disabled at age 45 and remain eligible for LTD benefits for 20 years. If your LTD benefit is $2,500 per month, you would get $600,000 in total LTD payments. Unless the insurance company offers you a large buyout, it will likely be in your best interest to receive ongoing benefits.

However, if you’re an older person or are facing a terminal or life-threatening condition, a lump-sum settlement might provide you with a nest egg for your loved ones after your death.

2. What Is Your LTD Claim’s Present Value?

While your LTD claim might be worth $600,000 over 20 years, that is not its “present value.” Money is worth more today than it will be in 10 years — due to inflation and other factors.

Suppose you win $1 million in the lottery. You get two options: receive payments over time or take a lump sum. If you choose monthly payments, you’ll receive $4,000 per month for 20 years. However, if you accept the lump sum, you’ll get a check for $700,000 because when you add in interest and inflation, those monthly payments have the same value as $700,000 today.

When actuarial scientists and banks calculate present value, they must identify the appropriate rate of return and your expected duration of benefits. It’s a complicated process that is best left to the experts.

However, don’t assume that the insurance company’s present value calculations are accurate. Insurers frequently undervalue claimants’ benefits, trying to convince them to take a smaller lump sum. An experienced ERISA lawyer will consult with financial specialists who can properly calculate your claim’s present value and respond to the company’s offers.

3. Will You Pay Taxes on Your Buyout?

A settlement from some disability plans, such as those you pay for with after-tax dollars, are not taxable. However, you might end up paying the IRS and Illinois Department of Revenue after settling certain ERISA claims. If your settlement is taxable, your lump sum could be reduced by more than one-third (depending on your tax bracket).

Before you settle your LTD claim, you should consult with an experienced disability lawyer who can help you understand the tax and financial implications of the proposed buyout.

4. Do You Have a Financial Plan for the Future?

A $300,000 settlement might seem like a financial windfall. However, if you’re unable to work, this amount will quickly disappear as you pay bills, receive medical care, and tend to your family’s needs.

Before you settle your ERISA claim, ask yourself:

  • Do you have other sources of income?
  • Are you receiving Social Security benefits?
  • Do you have a clear understanding of your future medical and long-term care needs?
  • Are you comfortable managing your settlement and following a budget?

If you don’t have good and carefully considered answers to these questions, accepting a lump-sum payment might not be a good idea.

Bryant Legal Group’s Practical Client-Focused Approach to Disability Law

At Bryant Legal Group, our top priority is our clients. That’s why we work closely with them at every step of the way throughout their claim, helping them make informed decisions that benefit them and their families. While we’ve built a reputation for working with professionals with disabilities in and around Chicago, we proudly serve the entire state of Illinois.

To schedule an appointment with one of our skilled and experienced long-term disability attorneys, please either complete this brief online form or call us at (312) 561-3010.

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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During a long-term disability (LTD) claim, your medical records and history get a lot of attention. Your lawyer and the insurance company will pore over every diagnosis, test, and recommendation in your files. However, there’s more to an LTD claim than medical evidence.

Your vocational experience and skills can also dramatically impact your eligibility for LTD benefits. That’s why our experienced disability insurance lawyers frequently work with vocational experts.

Why Does the LTD Insurance Company Care About My Work and Education?

Disability insurance pays benefits when your medical conditions, illnesses, and injuries prevent you from working. There are two primary considerations in an LTD claim:

  • Do you have serious medical diagnoses?
  • Can you work?

While these questions may sound simple, the insurance company won’t be satisfied with simple answers. They will perform a detailed evaluation of both your medical and vocational information.

Let’s dig deeper into how insurance companies define “disability.” Your LTD plan probably includes one of two definitions:

  • Own occupation: You cannot perform your own job due to an illness, injury, or chronic condition.
  • Any occupation: You cannot perform any job that you’re qualified for due to an illness, injury, or chronic condition.

While it may be relatively easy to determine whether you can do your own job, most LTD policies apply the more complicated “any occupation” definition.

With an “any occupation” policy, the insurance adjuster will assess your education, work experience, and skills to look for possible jobs that you can do. If they find even one position that you’re capable of, they will deny your LTD claim.

What Does a Vocational Expert Do?

Vocational experts (VEs) are specially trained professionals who help people understand their abilities, their wage-earning capacity, and whether they can transition to other work. Most VEs are not medical professionals. Instead, they have backgrounds in human resources, rehabilitation counseling, or social work.

Typically, a vocational expert’s evaluation will involve several steps, which include:

  • Reviewing your resume and job descriptions
  • Interviewing you about your abilities, skills, and background
  • Considering your doctors’ recommended restrictions
  • Identifying skills and experiences that may transfer to other jobs
  • Determining whether you can compete with other applicants for a job given your combined abilities and limitations

A credible VE’s opinion can strengthen your LTD claim and provide essential insight into your capabilities.

For example, suppose you receive a cancer diagnosis and file a long-term disability claim. Initially, the insurance company approved your short-term disability benefits. However, when you applied for LTD, the company denied your claim because the policy included an “any occupation” definition. The adjuster argues that you could do simple, unskilled work, such as greeting customers at a grocery store.

To fight back against this argument, your attorney hires a VE. During their evaluation, the vocational expert notes that while you have good days, you often experience severe nausea and flu-like symptoms for a week after each chemotherapy treatment. They also note that you’re experiencing severe fatigue and “chemo brain,” which makes it difficult for you to concentrate on even simple tasks. Finally, the expert notes that your doctors suggest you avoid contact with large groups of people due to your compromised immune system.

Based on these challenges, the VE determines you could not maintain a job due to absenteeism, health risks, and excessive time off task. While the insurance company and federal courts will not be bound by the vocational expert’s opinion, they must consider this powerful evidence as part of your claim.

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Are There Other Ways I Can Avoid Vocational Issues in an LTD Claim?

While vocational experts are sometimes necessary, there are other simple ways you can reduce vocational issues in your claim.

Don’t Overstate Your Credentials

Perhaps you’ve learned to reframe your job titles and duties on a resume to make them sound prestigious and impressive; most job seekers do this to some extent. However, the same skills that can help write a standout resume can hurt you during an LTD claim. The insurance company may use your flattering descriptions of your job duties and responsibilities against you. Instead, outline what you did at each of your jobs in the most straightforward terms possible.

Get Clear and Detailed Work Restrictions From Your Doctors

A note from your doctor that simply says “disabled” or “no work” may not be as convincing as a detailed list of limitations. Insurance adjusters typically dismiss blanket statements about disability from treating physicians.

Instead, ask for specific information about your ability to lift, walk, stand, and concentrate as well as your need for breaks. Alternatively, your medical and legal team may consider scheduling a functional capacity evaluation.

Consult an Experienced LTD Lawyer

Without guidance from a knowledgeable disability insurance lawyer, it’s easy to make mistakes that can endanger your LTD benefits. Rather than navigate the disability insurance system alone, it’s best to work with a lawyer who can oversee the details of your claim, manage your filing deadlines, and document your complex vocational issues.

Bryant Legal Group: Discover Our Sophisticated Approach to LTD Claims

At Bryant Legal Group, we’ve been helping people with disabilities for decades. We use our combined knowledge and experience to build effective and practical legal strategies for our clients, which is why we frequently consult with vocational experts.

If you have questions about an LTD claim, we can explain your legal rights and options. To schedule your consultation, either complete our brief online contact form or call us at (312) 561-3010.

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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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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Insurance companies and their insureds do not interact on a level playing field. The balance of power favors big business. However, when these companies unreasonably deny healthcare claims, they can put you in a precarious and vulnerable position. That’s why insurers owe their policyholders a duty of good faith and fair dealing.

At Bryant Legal Group, we help people when their health insurers deny legitimate claims, improperly delay benefits, or otherwise act in bad faith. In this article, we outline everything you need to know about health insurance bad faith claims.

When Does a Health Insurer Act in Bad Faith?

Under Illinois law, insurance companies cannot unreasonably delay or deny your healthcare claims on “vexatious and unreasonable” grounds. An insurer could be acting in bad faith if they:

  • Deny a valid health insurance claim without a legitimate reason
  • Intentionally misrepresent the facts or the policy’s terms and conditions
  • Fail to communicate with the insured
  • Improperly investigate a claim
  • Refuse to pay part of a claim that it acknowledges is due
  • Deny a valid claim and force litigation
  • Deliberately undervalue a claim or settlement
  • Delay the processing or payment of a clearly valid claim

Admittedly, not every insurance denial involves bad faith. Many insurance disputes involve legitimate disagreements about someone’s eligibility for benefits.  

To determine whether the insurance company is acting unreasonably or vexatiously, insurance lawyers and the courts weigh all the facts surrounding the dispute. Typically, they will consider the sufficiency of the insurer’s investigation and claims process, its behavior during settlement negotiations, statements made by its adjusters and legal counsel, and its conduct towards the insured.

To build your health insurance bad faith claim, it’s best to keep copies of any correspondence between you and the insurer and careful notes from any conversations you have with the adjuster.

Bad Faith Claims Are Unavailable in ERISA Claims

Notably, ERISA, the federal law that governs employer-sponsored benefit plans, does not permit bad faith claims. If your claim involves your employer’s health insurance plan, you might be unable to file a bad faith claim against the company.

However, ERISA does not cover every health plan. Federal, state, and local government employees’ plans are typically exempt from this law. It also does not cover health insurance that you purchase on the marketplace.

RELATED: 5 FAQs About Private Disability Insurance Claims

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What Remedies Are Available in Bad Faith Claims?

In most health insurance claims, you’re demanding coverage, not compensation. However, under §155 of the Illinois Insurance Code, you might be eligible for compensation if a health insurer denies your claim in bad faith. In addition to your health benefits, you could potentially receive either:

  • 60% of your jury award
  • $60,000
  • The difference between your jury award and the insurance company’s settlement offer

Additionally, the insurance company will have to pay your attorney’s fee and case costs.

How Do I File a Bad Faith Claim Against a Health Insurance Company?

In Illinois, you have several options available after a health insurer denies your claim. First, you can file an appeal with the Illinois Department of Insurance. However, the Department of Insurance will not award compensation for a bad faith denial or delays. Instead, it will simply evaluate your eligibility for coverage.

Second, you can file a bad faith lawsuit in a state court. In this claim, you can demand compensation, attorney’s fees, and your case costs under §155. If you file your lawsuit with an Illinois court, you must do so within five years of the denial. 

You should also consider consulting with an experienced lawyer who handles bad faith insurance claims. These cases typically require a detailed legal and factual analysis, and most people cannot adequately represent themselves.

Bryant Legal Group: Trusted Illinois Disability Insurance Lawyers

Bryant Legal Group’s team of respected insurance lawyers handles bad faith claims in Chicago and throughout Illinois. If you believe that your health plan’s delays or denials are vexatious or unreasonable, contact us today for a no-risk consultation. We’ll help you understand your legal options.

To schedule an appointment, please complete our online form or call us at (312) 561-3010.

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.

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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Unlike some states, Illinois law requires that federal courts apply a de novo standard of review in long-term disability (LTD) claims if the coverage was issued or offered in Illinois. Judges can weigh all the evidence in your claim and do not have to defer to the insurance company’s past decisions. However, that doesn’t mean that your appeal will be easy.

If an insurance company has denied your long-term disability (LTD) benefits in Illinois, you need to understand how the courts will assess your legal and factual arguments. To learn the essentials, keep reading this article. To find out how these laws apply to your insurance claims, contact Bryant Legal Group.

What Is a Standard of Review?

Lawyers are obsessed with standards of review, but most clients don’t understand the concept. A standard of review can deeply impact your chances of winning your lawsuit. These standards set the rules of the game and determine how much flexibility and discretion a judge has when reviewing a case.

There are two possible standards of review in long-term disability claims.

  • De novo: The judge approaches the case with fresh eyes, and weighs all of the available evidence. De novo means “from the beginning” in Latin.
  • Abuse of discretion: The judge gives some deference to the insurance company’s decision and will only overturn a denial of benefits if the company’s decision violates the law, is irrational, or is completely unsupported by the evidence.

Insurance companies prefer the abuse of discretion standard since judges are more likely to uphold a denial of benefits. To make sure this lenient standard of review gets applied, most insurance companies insert special “discretionary clauses” into their plans.

RELATED: Zaccone v. Standard: Court Rules That De Novo Standard of Review Applies

Thankfully, while some states still permit these clauses, Illinois made discretionary clauses in insurance plans illegal in 2005. Federal courts upheld this law in 2015. Today, almost all insurance disputes in Illinois involve a de novo standard of review.

What Do Standards of Review Mean for My LTD Claim?

Today, thanks to the de novo standard of review, you have a better chance of winning your LTD appeal in Illinois than you did in the past. Judges in cases where the Illinois law applies now have broad powers to review long-term disability claims and can freely consider all of the evidence available to them. If the insurance company’s decision is inconsistent with the law or the evidence, the judge can grant your disability insurance benefits.

However, that doesn’t mean your long-term disability appeal will be successful. ERISA, the federal law that governs employer-sponsored benefits, may apply to your claim. This law sets strict limitations and procedures on employer-sponsored LTD claims. That’s why it’s in your best interest to consult an experienced LTD lawyer at Bryant Legal Group if you have an LTD claim in Illinois.

For decades, our team has helped people with disabilities get their disability insurance benefits. When you work with Bryant Legal Group, we will:

  • Explain in plain language the complex array of laws and regulations that impact LTD claims
  • Interpret your disability insurance plan documents and apply them to your situation
  • Collect evidence, including medical records and expert opinions, that can strengthen your legal claims
  • Help you navigate all the levels of the ERISA appeal process
  • Meet the tight filing deadlines and other procedures associated with an LTD claim

We take a client-centered approach, building strategies that focus on both your long-term and short-term goals.

RELATED: When Should I Speak With a Disability Insurance Lawyer?

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Can I Submit New Evidence During a Long-Term Disability Lawsuit?

Even though Illinois adopted a more lenient standard of review, it doesn’t mean judges have access to all your information and documents. Instead, your ability to submit new evidence will depend on whether your appeal involves an ERISA or private disability plan.

  • Employer-sponsored (ERISA): Your only chance to submit evidence is during the insurance company appeal process. The judge will only consider evidence that was available to the insurer at that time.
  • Private: You can submit admissible evidence and information throughout the claim, as long as you follow Illinois’ rules of evidence.

If you’re unsure whether you have an ERISA or private LTD plan, it’s a good idea to consult an attorney. We can help you understand the exact procedures that apply to your long-term disability claim and then build a compelling record of evidence that clearly explains your situation and your eligibility for benefits.

Bryant Legal Group: Trusted Illinois Disability Insurance Lawyers

We were at the forefront of the fight for de novo review in LTD claims. Today, we continue to stand up to insurance companies using a sophisticated and practical approach to ERISA and private long-term disability insurance appeals. Bryant Legal Group is based in Chicago but serves all of Illinois.

To schedule a consultation with one of our experienced attorneys, either fill out our online contact form or call us at (312) 561-3010.

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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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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While only an inconvenience for some, neuropathy can be debilitating for others. Unfortunately, peripheral nerve disorders — such as Guillain-Barre syndrome, carpal tunnel syndrome, and diabetic neuropathy — are sometimes difficult to diagnose and understand.

In this blog, Bryant Legal Group discusses the diverse causes of peripheral nerve damage, common treatment options, and suggestions for your long-term disability (LTD) claim.

What Are Peripheral Nerves?

Your nervous system is made up of two essential parts. First, your central nervous system, which includes your brain and spinal cord, processes and responds to information. Second, your peripheral nervous system, uses nerves that run throughout your body to connect the central nervous system with your muscles, organs, and other structures.

There are three main types of peripheral nerves:

  1. Autonomic nerves control unconscious activities — like breathing, heartbeat, and digestion
  2. Motor nerves control intentional muscle movements — letting you walk, talk, reach, and grasp
  3. Sensory nerves transmit information that your brain interprets as touch, temperature, and pain

Doctors frequently compare your peripheral nerves to telephone lines or internet cables. When they malfunction, the messages they transmit can become garbled, misconstrued, or even lost. Common symptoms include numbness, tingling, burning pain, sensitivity to touch, and muscle weakness.

Doctors refer to these malfunctions as peripheral nerve disorders or neuropathy, and there are more than 100 different known peripheral disorder diagnoses. Today, an estimated 20 million people live with a nerve disorder.

What Causes Peripheral Nerve Disorders?

Because peripheral nerve disorders cover a wide variety of diseases and conditions, neuropathy has many known causes.

Compression

Overuse injuries, swelling, and inflammation can lead to pressure on your nerves. Over time, this pressure can damage the nerve. Common nerve disorders due to compression include median neuropathy (carpal tunnel syndrome) and ulnar neuropathy (cubital tunnel syndrome).

Pressure from herniated discs and other spine problems can cause a different type of nerve damage called radiculopathy. It involves pressure at the nerve’s root and can cause shooting pain, motor weakness, and other serious symptoms.

Trauma

Car accidents, sports injuries, falls, and other traumatic events can lead to nerve damage when nerves are cut, torn, or stretched. Brachial plexus injuries, peroneal nerve damage, and compression injuries are examples of traumatic nerve damage.

Infection

When viruses and bacteria attack your nerves, you might experience nerve damage. You might experience nerve pain and dysfunction due to shingles, Lyme disease, West Nile virus, and other viruses. People with HIV are particularly susceptible to nerve damage; roughly 30% of HIV patients experience peripheral neuropathy and another 20% suffer from distal neuropathic pain.

Diabetes and Other Chronic Conditions

Diabetes is the top cause of polyneuropathy in the United States; about 60-70 percent of diabetics experience some form of nerve damage. However, other chronic conditions — including high blood pressure, autoimmune diseases, and cancer — can also damage your nerves.

Idiopathic Neuropathy

Unfortunately, doctors can’t always pinpoint an exact cause of your nerve damage. Sometimes called idiopathic neuropathy, you might be diagnosed with idiopathic neuropathy if you exhibit signs of a peripheral nerve disorder, but it is unclear what it is causing it.

RELATED: Autoimmune Disease and Disability Insurance: A Claimant’s Guide

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Can Doctors Fix My Nerve Damage?

Depending on your type of peripheral nerve disorder, its severity, and its cause, your doctor will suggest a treatment plan. Sometimes, this plan involves surgery, medications, devices like a TENS unit, assistive devices like canes and braces, and lifestyle changes.

Unlike brain and spinal nerves, your peripheral nerves continue to grow throughout your life. This makes them more resilient and can allow for a fuller recovery. However, while doctors can repair herniated discs, remove pressure from your carpal tunnel, and prescribe medications that minimize your pain, they cannot repair every damaged nerve.

Can I Receive LTD Benefits for Neuropathy?

If you only experience some occasional tingling in your fingers, you probably are not eligible for long-term disability benefits. However, many people with peripheral nerve disorders qualify for long-term disability.

Depending on your LTD plan, you must prove that you are either unable to perform your work or any occupation. This analysis requires a careful assessment of your physical and mental abilities, side effects from your medications and treatment plan, and your work history and education.

What to Do If the Insurance Company Says Your Diagnostic Studies Aren’t Consistent With Your Complaints

Because there are so many different forms of neuropathy, even the best doctors sometimes have a hard time diagnosing nerve damage. Unfortunately, insurance companies tend to oversimplify their analysis of disabling nerve damage. If you had a nerve study, such as an EMG (electromyography) or NCV (nerve conduction velocity test) that was “within normal limits,” it could result in a denied LTD claim.

However, while diagnostic tests like EMGs and NCTs can help diagnose peripheral nerve disorders, they are not perfect. Something as simple as a technician placing an EMG needle electrode in the incorrect position can impact the results. For this reason, it’s always best to have a well-trained and certified technician conduct your nerve conduction studies. Repeat studies can also help track your condition’s progression.

If the insurance company denied your long-term disability claim due to a “normal” nerve study, it’s in your best interest to consult with an experienced disability insurance lawyer.

Bryant Legal Group: Fighting for People With Serious Nerve Damage

Bryant Legal Group’s respected disability insurance lawyers are known for their sophisticated legal strategies and client-focused results. If you’re struggling with a nerve disorder and are considering applying for long-term disability benefits, please contact our office for a free consultation. We can help you understand your legal options.

To reach us, please call Bryant Legal Group by calling 312-561-3010 or completing this brief 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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You’ve filed your application for long-term disability (LTD) benefits, meticulously filling out all the necessary information and submitting all of your relevant medical records. When you get the insurance company’s response, you’re shocked to see a denial of benefits. Unfortunately, the insurance company determined that your disabling conditions were pre-existing.

At Bryant Legal Group, we’re used to insurance companies broadly interpreting our clients’ medical records and incorrectly applying pre-existing condition exclusions. Learn how you can fight back to get the LTD benefits that you deserve.

1. Pre-Existing Conditions Can Be Either Mental or Physical

As a cost-savings mechanism, most long-term disability plans exclude pre-existing conditions. While the definition will vary from plan to plan, pre-existing conditions usually include any chronic physical, mental, or emotional condition that you have been treated for shortly before you obtained coverage. Common pre-existing conditions include cancer, asthma, heart disease, arthritis, depression, and anxiety.

However, many long-term disability pre-existing condition clauses cover more than just a diagnosis. If you saw your doctor and complained of symptoms that were potentially related to a pre-existing condition, the insurer might attempt to deny your claim.

For example, suppose you reported moderate back pain and some numbness in your leg two months before obtaining LTD coverage. Later that year, your doctor referred you to a neurosurgeon who discovered a herniated disc in your lower back. Even though you didn’t have a clear diagnosis at the time you got coverage, the insurance company might deny your claim for disability insurance benefits.

2. Insurance Adjusters Broadly Interpret Pre-Existing Conditions to Deny LTD Claims

Before you apply for long-term disability benefits, you should always review your plan documents and identify potential obstacles. Your policy will include a very specific definition of “pre-existing condition,” as well as other exclusions. If these exclusions apply to your claim, you might be ineligible for LTD benefits.

However, these definitions are always subject to interpretation, so you should never assume that the insurance adjuster was correct in their assessment. Many times, an experienced disability lawyer can help you clarify your condition and avoid your plan’s pre-existing condition exclusion.

Refuting a pre-existing condition exclusion is not a simple process. You’ll need to carefully review the plan documents, identify all of your supporting medical records, and might even need to collect statements from your physicians and other experts.

RELATED: Common Insurer Justifications for the Denial of Private Disability Benefits

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3. Failure to Disclose Your Medical Conditions Can Mean Trouble

When you apply for a private LTD policy, you typically must provide extensive information about your medical conditions and treatment. Then, the insurance company calculates your premiums based on your likelihood of needing benefits in the short term — and may even exclude specific conditions (like cancer) from coverage.

Sometimes, when you apply for LTD benefits, the insurance company will argue that your disabling condition existed at the time you applied, and that you neglected to disclose it.

It’s always in your best interest to fully outline your known pre-existing conditions when you apply for private LTD coverage. However, it’s also understandable that you might not tell the company about that occasional twinge of hip pain that develops into excruciating pain and turns out to be severe degenerative joint disease.

In these situations, you should consult with an experienced disability insurance lawyer.

4. Group LTD Plans Typically Include Pre-Existing Condition Timelines

Group or employer-sponsored LTD plans can’t examine each covered employee’s medical records. Instead, the insurance company places limits on when it will cover a pre-existing condition. Typically, your condition will be excluded if:

  • You reported symptoms or sought medical treatment within a specific period before you obtained coverage (frequently 90 to 180 days).
  • You file for benefits within 12 months of getting LTD coverage.

Therefore, if you’re able to cope with your condition and continue working for more than a year, you might still be eligible for employer-sponsored LTD benefits. However, every LTD plan is different, and your policy could include a different time period or other exclusions.

If you need help interpreting your LTD policy and calculating your exclusion periods, please contact Bryant Legal Group for help.

Discover Bryant Legal Group’s Innovative Approach to Disability Insurance Appeals

Bryant Legal Group is one of Chicago’s most respected disability insurance law firms. We pride ourselves on our practical, client-centered approach and sophisticated legal strategies.

If you or a loved one were recently denied LTD benefits due to a pre-existing condition, it’s time to schedule a consultation with one of our skilled and experienced disability lawyers. We’ll help you understand all of your legal options and suggest meaningful next steps regarding your claim.

You can contact Bryant Legal Group by calling 312-561-3010 or completing this brief 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 of us will experience knee pain during our lifetimes. This pain can stop us from doing the things we love, and it can even rule out simple activities like taking a walk or sitting down comfortably to read a book. When knee pain gets this severe, a knee replacement may offer much-needed relief.

However, not everyone who undergoes a total knee replacement can return to work and enjoy their life as they knew it. In these cases, long-term and short-term disability insurance can help.

To learn more about knee replacement and disability claims, keep reading.

What Is a Knee Replacement?

Our knees are remarkably complicated joints. Knees have many parts, such as:

  • Patella (the kneecap)
  • Two C-shaped pieces of cartilage, called the medial and lateral menisci, that absorb shocks and prevent bone-on-bone friction
  • Ligaments, including the anterior cruciate ligament (ACL)
  • Articular cartilage
  • Bursae (fluid-filled sacs that help the knee move smoothly)
  • Tendons

The complexity of the knee leaves it vulnerable to injury. Trauma, degenerative wear and tear, and diseases like rheumatoid arthritis can damage bones, erode cartilage, and constrict joint spaces. These types of injuries can cause excruciating pain, limit your range of motion, and prevent you from sitting, standing, and walking for extended periods. The chronic pain from a knee injury can even impact your mental health and make it difficult to concentrate.

The aim of a knee replacement is to reduce your pain and improve your range of motion. A knee replacement is a significant surgery that involves:

  • Removing damaged cartilage and part of the underlying bone
  • Replacing these structures with metal hardware, which typically is cemented into place
  • Resurfacing the patella if needed
  • Inserting a spacer between the metal implants so the joints can move smoothly and freely

For many people, a knee replacement is a surgery of last resort, performed only after less invasive options like physical and injection therapies fail to control the pain. However, knee replacements are also becoming more and more common. Today, surgeons in the U.S. perform about 600,000 total knee replacements each year.

What Should I Expect After a Knee Replacement?

Recovering from a knee replacement isn’t an easy process. Your body will need to adjust to the artificial joint, and you’ll need to rebuild muscle strength. The recovery process will probably involve physical therapy, follow-up appointments with your orthopedic surgeon, and pain management services.

Unfortunately, many knee replacement patients make some unpleasant discoveries in the weeks, months, and years after their knee replacement. These discoveries may include:

  • The surgery rarely restores a knee’s full range of motion
  • Post-operative clicking, popping, and pain are common
  • Implant issues can complicate recovery
  • Some patients deal with infections and blood clots
  • Hardware can loosen, causing cracking and other damage
  • Most knee replacements last for a maximum of 15–20 years

It can be frustrating to realize you won’t regain all the function you lost. Even worse, you may find yourself still unable to work after your total knee replacement.

RELATED ARTICLE: Chronic Pain and Disability Insurance: A Claimant’s Guide

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If I Replace My Knee, Can I Get Disability Insurance Benefits?

Many people experience good results after a knee replacement, with an estimated 85% of knee replacement patients returning to work within a year. However, that leaves 15% of patients who can’t return to gainful employment after their difficult surgeries.

The problem isn’t limited to knee replacement patients who have physically demanding jobs, either. Even patients who work in a typical office setting sometimes discover they can’t stand or walk well enough to perform their work. Other patients find they can’t maintain their focus due to the combination of ongoing pain and medication side effects.

If you find yourself unable to work after a knee replacement surgery, you may be eligible for disability insurance benefits. The strength of your claim will depend on your symptoms, your medical records’ clarity, your professional background, and the terms and conditions of your disability insurance plan. To learn more about your options, get in touch with an experienced disability lawyer.

Bryant Legal Group: Experienced Chicago Disability Insurance Lawyers

If you’re still struggling after a total knee replacement or any other joint surgery, it’s time to build a plan for your future. At Bryant Legal Group, we assist disabled individuals throughout Chicago and Illinois with their complex disability insurance claims.

To schedule your free consultation and find out whether you may be able to receive vital disability benefits, call our office at 312-561-3010 or complete 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.

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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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As you prepare your application for long-term disability (LTD) benefits, you’ll quickly realize how important your doctors’ opinions are to your claim. Unfortunately, many people are uncomfortable discussing their disability with their doctors and avoid these crucial conversations.

In this article, Bryant Legal Group suggests some ways you can broach the topics of your disability and functional capacity with your doctor. Keep reading to learn more.

Your Doctors’ Opinions Carry Significant Weight in a Long-Term Disability Claim

When you apply for long-term or short-term disability, you will have to outline your limitations and why they prevent you from working full time. However, you’ll need more than your word to convince an insurance adjuster that you’re eligible for LTD. You will also need to provide strong evidence that supports your claims. Your physicians’ medical records and statements are essential to your claim.

For example, these reports can:

  • Track your medical conditions’ progression over time
  • Identify when your conditions became disabling
  • Document your reported symptoms and their severity
  • Substantiate your limitations with objective test results — such as MRIs, CT scans, EMGs, and bloodwork
  • Outline your restrictions and functional capacity

This is especially true if you have been seeing your doctor for a long time or if they’re a respected specialist.

However, many of us find discussions about disability, limitations, and our symptoms incredibly difficult. Too often, we resort to telling our doctors that our conditions are “the same as ever” or that “we’re doing just fine.” Rather than sugar coat your symptoms or provide evasive answers, it’s always best to be candid with your medical providers.

4 Ways You Can Bring Up Disability With Your Doctors

Before you apply for long-term disability, you and your lawyer should understand the strength of your medical records and overall claim. At some point, you’ll probably need to discuss your future and ability to work with your doctor.

It’s worth noting that staying positive can help your case. Doctors are always concerned about malingering or when a patient exaggerates their symptoms for financial gain. If you start your discussion with “I need you to say I’m disabled” rather than “Should I file for disability?”  or “Do you think I can work safely?” you might trigger red flags with your physicians.

Here are some simple ways you can start a conversation about disability with your doctors.

1. Show Them Your Disability Journal

We encourage our clients to keep a disability journal that tracks their symptoms and limitations. This information can give your doctor deep insight into your daily struggle and help refine their opinions.

Before you apply for disability, you may want to sit down with your doctor and show them your journal. Then, you can ask them if they think that your reported symptoms would allow you to work full time.

2. Ask for Work Restrictions

Sometimes, a doctor will be uncomfortable completing a disability form but may be willing to outline precautions or limitations that you’d need at work. These restrictions could still help you document your disability.

For example, suppose your doctor notes that you’ll need to take unscheduled rest breaks as needed throughout the day. Most employers cannot accommodate this type of restriction.

Or suppose your orthopedic specialist notes that you cannot lift more than a file folder and need to sit and stand as needed. At the same time, your psychologist indicates that your depression and anxiety prevent you from doing more than simple tasks, and that you may be off-task for significant periods of the workday. When put together, these restrictions may be disabling.

3. Explain Your Plan’s Definition of Disability

Not every insurance plan defines “disability” in the same way. Typically, there are two forms:

    • Any occupation: you cannot perform any work
    • Own occupation: you cannot perform your job

You may have an easier time talking to your doctor about your ability to do your occupation rather than any occupation.

However, even an “any occupation” plan may include additional limitations. For example, many policies state that you are eligible for benefits if you are unable to perform “gainful employment.” In the disability insurance world, “gainful employment” is typically tied to your past earnings.

If you need help understanding your insurance plan’s definition of disability, refer to your Summary Plan Description (SPD) or consult with an experienced disability insurance lawyer.

 4. Ask Your Disability Insurance Lawyer for Help

If you’re not comfortable initiating a conversation about disability with your doctor, you should ask your lawyer for help. At Bryant Legal Group, we understand these conversations can be difficult, so we’re happy to help our clients sort through their complex medical and legal issues.

RELATED ARTICLE: Own Occupation vs. Any Occupation Definitions of Disability

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What Happens If My Doctor Refuses to Support My Disability Claim?

Sometimes, a doctor’s refusal to support a disability claim can feel like a violation of trust. You’ve been vulnerable and asked for help only to be turned away. We understand how that can be hurtful. However, you cannot force your doctor into supporting your LTD claim.

While it’s difficult, try to understand the doctor’s perspective. Some physicians simply don’t want to get involved in disability claims. Others feel like it’s outside their area of expertise and want to focus on the healing arts rather than insurance forms.

If this happens to you, don’t panic. Instead, talk to an experienced disability insurance lawyer. Your attorney might suggest ways to supplement your medical records by using medical experts, functional capacity examinations, and other tools.

You also shouldn’t start doctor shopping — at least until your lawyer suggests you get a second opinion. If your records show a pattern of switching doctors in search of the “right” evidence, it will likely damage your credibility with the insurance company and the courts.

Bryant Legal Group: Respected Chicago Disability Lawyers

Bryant Legal Group’s disability insurance lawyers have decades of cumulative experience handling short-term and long-term disability claims. If you’re considering an LTD claim, it’s time to schedule an appointment with one of our respected attorneys. Please call 312-561-3010 or complete this brief 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 they can no longer work, many people turn to their MetLife long-term disability insurance. Unfortunately, the company denies a large number of claims each year, and many deserving people are left in financial limbo.

Before you give up and accept MetLife’s decision, you should always consult with a respected disability insurance lawyer at Bryant Legal Group. We have extensive experience with MetLife disability insurance appeals, and can help you understand your legal options. Keep reading to learn the essential steps you should take after a disability insurance denial.

MetLife Is a Global Insurance Giant

MetLife is a massive global company that made almost $68 billion in total revenue in 2018 alone. It’s been in operation for more than 150 years and sells insurance products in more than 40 countries. While MetLife is typically associated life insurance and financial services, the company has a robust disability insurance business as well.

MetLife Has a Track Record of Denying Valid Claims

While many of us associated MetLife with friendly images of blimps at sporting events and advertising with cartoon characters, it is a hard-nosed, savvy company. Unfortunately, it has sometimes run afoul of state insurance regulators.

MetLife has a history of mishandling claims and even losing them. In January of 2019, New York regulators fined MetLife $19.75 million for mishandling and misplacing thousands of its clients’ pension claims. It also must pay hundreds of millions to those whose claims were lost, delayed, or otherwise mishandled.

For large companies like MetLife, their primary goal is profit. They have thousands of claims to process and with so many pieces of the puzzle, cutting corners is more common that any of us want to admit. However, there are ways you can protect yourself and improve your likelihood of getting the disability benefits you deserve.

RELATED ARTICLE: When Should I Speak With a Disability Lawyer?

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4 Ways You Can Strengthen Your MetLife Disability Insurance Claim

If MetLife denied your disability insurance claim, you have a very short window of time to appeal the ruling, submit your evidence, and avoid catastrophically damaging your claim. This is particularly true if your disability insurance is employer-funded.

If MetLife denied your disability insurance claim, here’s what you need to do.

1. Don’t Expect MetLife to Go Above and Beyond for You

MetLife’s claims adjusters and representatives are focusing on for the company’s bottom line, not your future. They are unlikely to hunt down hard-to-find records, collect your doctors’ statements, or dig deep into your complicated medical conditions. Instead you, or your disability insurance lawyer, need to do all of this important leg work for them.

2. Call a Disability Insurance Lawyer Right Away

Employer-sponsored disability plans fall under ERISA, a federal law that imposes strict procedural rules on appeals. Navigating this process is notoriously tricky, fast-moving, and can easily trip you up. When you consult with an experienced disability insurance lawyer early on, you’re less likely to make mistakes that could cost you your benefits.

3. Be Frank With Your Doctor

Your medical records and doctors’ notes will be a significant portion of your evidence. If they don’t accurately document your condition, you will be at a disadvantage. You should always be as candid as possible when they’re speaking with your doctors about your conditions. Don’t sugarcoat your abilities, pain, or other daily details that might make the difference in your appeal.

4. Make Sure Your Evidentiary Record Is Complete

In an ERISA claim, you only have a limited amount of time to submit evidence. Once MetLife reviews your appeal and makes its final decision, you cannot provide submit additional information, no matter how important it is to your case.

Unfortunately, many people make the mistake of submitting an appeal without additional evidence. Your lawyer can help you collect and submit evidence that supports your allegations and documents your disabilities.

Lastly, don’t give up. MetLife denies a lot of legitimate disability insurance claims every year. Rather, consult with a knowledgeable lawyer who will advocate on your behalf.

RELATED ARTICLE: 5 Essential Questions You Should Ask a Disability Lawyer

Bryant Legal Group: Disability Lawyers Who Can Fight for Your Rights

If MetLife recently denied your disability claim, it’s in your best interest to consult with a skilled lawyer at Bryant Legal Group. We are proud to help our clients assess their legal options, identify the correct procedures, “stack” their evidentiary record, and negotiate with the long-term disability company.

To learn more about our approach and how we might be able to help you, please contact us today to receive a free and confidential consultation. You can reach Bryant Legal Group by calling 312-586-9128 or completing this brief 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

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When you research disability insurance benefits, most of the information you’ll find addresses employer-sponsored disability plans. However, many people, especially self-employed individuals, purchase private or individual disability insurance as a safety net.

You might not realize that private long-term disability (LTD) insurance claims involve a different set of rules than their employer-sponsored counterparts. In this blog, the team at Bryant Legal Group answers five of our clients’ most frequent questions about individual disability insurance.

1. What’s the Difference Between Private Disability Insurance and ERISA Plans?

If you’ve been researching disability insurance claims, you’ve probably read about ERISA (Employee Retirement Income Security Act of 1974),  a federal law that governs many employee benefit programs — including LTD plans.

However, ERISA only applies to employer-sponsored benefit programs. If your company pays for your LTD insurance premiums or participation is mandatory, ERISA probably applies to your disability insurance claim.

However, if you purchased your LTD coverage individually or voluntarily, the Illinois Insurance Code and other state laws will typically apply to your claim. Importantly, the claims and appeal process under Illinois law is very different from those under the more insurance company-friendly ERISA.

While nothing compares with a personalized assessment from an experienced disability insurance lawyer, here are some common signs that you have a private disability insurance policy:

  • You are self-employed.
  • You purchased disability insurance from a broker or carrier who partners with your medical society or bar association.
  • You purchased supplemental disability coverage through an insurance broker.
  • You pay the entire premium yourself or it’s deducted from your paycheck post-tax.

If you’re unsure whether ERISA or Illinois law applies to your case, please contact Bryant Legal Group for assistance. All initial consultations are complimentary and confidential.

2. What’s the Process for Appealing a Private Disability Insurance Denial?

You may have read about how you have to exhaust your administrative remedies and complete an insurance company appeal before filing an ERISA lawsuit. Thankfully, this burdensome process isn’t mandatory in a private disability insurance claim.

While your disability insurance lawyer might decide that pursuing the insurance company’s in-house appeals process makes sense, you have the option of filing a lawsuit immediately after receiving a denial of benefits.

Once you file a private disability insurance lawsuit, Illinois’ procedural and evidentiary rules apply. That means you’ll have opportunities to negotiate with the insurance company, present new evidence and testimony, and explain why you’re eligible for LTD benefits.

RELATED ARTICLE: Common Insurer Justifications for the Denial of Private Disability Benefits

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3. Can I Request a Jury Trial?

One of the biggest differences between ERISA and private disability insurance claims is the right to a jury trial. If your LTD plan is employer-sponsored, a judge will review your claim — not a jury. However, in a private disability insurance claim, you can request a jury trial.

Many people value the chance to present their case and legal arguments to a jury of their peers. However, you need to make a timely demand for a jury trial. Typically, your disability insurance lawyer will help you navigate these procedural requirements.

4. Can I Get Pain and Suffering Damages for the Insurance Company’s Unreasonable Denial of Benefits?

While the Illinois Insurance Code does not permit compensation for your pain and suffering, it does allow for additional statutory damages when the insurance company denies your claim in “bad faith.” Under Section 155, you can receive no more than an additional:

  • 60% of the damages the judge or jury award you at trial
  • $60,000 or the difference between the jury award and the insurance company’s settlement offer

You may also be entitled to attorney’s fees.

However, you will first have to prove that the insurance company delays were either “unreasonable” or “vexatious.” If your case involves a bona fide dispute, these statutory damages may be unavailable.

Under ERISA, you cannot file a “bad faith” claim against an insurance company.

5. How Much Time Do I Have to File an Individual Disability Insurance Lawsuit?

Under Illinois law, you typically have up to 10 years to file a private disability insurance lawsuit. However, there is a loophole to this filing deadline.

Insurance companies can insert a different limitation clause in your insurance policy. Illinois courts typically uphold these contractual filing deadlines as long as they are reasonable. For example, the courts will probably uphold a three-year filing deadline, but a 30-day limitation period is unlikely to pass judicial scrutiny.

To protect your legal claims, you should immediately review your LTD policy before you apply for LTD benefits. Note the exact deadlines imposed by your policy and follow them carefully. However, if you’re working with an experienced disability insurance lawyer, they will oversee all of your filing and procedural deadlines.

Bryant Legal Group: Get Answers to Your LTD Questions

At Bryant Legal Group, we’ve been helping disabled individuals get the benefits they deserve for decades. If you have questions about your private disability insurance policy, we would love to sit down with you to help you understand your legal options.

Please schedule your free consultation with one of Chicago’s premier long-term disability law firms by calling 312-561-3010 or completing this brief 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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Sufferers of migraine headaches, like many people with “invisible” conditions, frequently have their symptoms misunderstood and minimized. However, if you’re one of the 2 million people in the United States who live with migraines, you know exactly how debilitating and frustrating they can be. Many people who suffer from chronic migraines can’t work consistently, which may eventually force them to apply for long-term disability (LTD) benefits.

In this article, we’ll explain the basics of how migraine-related long-term disability claims work. Keep reading to learn more.

What Is a Migraine?

Migraines are recurrent headaches that often cause severe, debilitating symptoms. A migraine can involve up to four different stages.

  • Prodrome

Sometimes called the “preheadache” phase, the prodrome stage warns you that a migraine is developing. You may notice increased irritability, uncontrolled yawning, food cravings, sensitivity to light and sound, nausea, fatigue, and other symptoms during prodrome.

While not everyone experiences prodrome consistently, preventative measures during prodrome, like avoiding known triggers and taking medications, can reduce the severity of a migraine. The prodrome phase can last for a few hours to a few days.

  • Aura

Immediately before a migraine, many people experience dramatic symptoms, including visual disturbances. You may see dots, zigzags, and bright lights. You may also experience blurred vision during the aura phase of a migraine.

However, the aura phase can also involve more than just vision problems. You may also experience muscle weakness, numbness, and tingling. Aura symptoms can continue into the active headache phase.

For many migraine sufferers, the aura phase is a frightening and disabling experience. People sometimes confuse aura symptoms with a stroke.

  • Headache

The headache phase of a migraine may last for anywhere from a few hours to several days. Common symptoms include a sharp or throbbing headache, nausea, vomiting, sensitivity to light and sound, neck pain, nasal congestion, and dizziness.

  • Postdrome

Most people feel exhausted and sore during the postdrome phase, which is also called the post-headache or recovery phase. You may also have problems concentrating and processing information for a day or two.

Not all migraines are the same. Only an estimated 25% of migraine sufferers experience an aura, for example. Others deal with silent or acephalgic migraines where they experience all the symptoms of a migraine other than pain. And sufferers with chronic migraines experience headaches and other symptoms for at least 15 days out of every month.

Can I Get LTD Benefits for Migraine Headaches?

To win a long-term disability claim, you must prove that you will be unable to work full-time for an extended period. While some LTD plans define disability as an inability to perform your regular job, most use a broader definition of an inability to perform any occupation. If your long-term disability plan uses the “any occupation” standard, you will have to show that your migraines and other conditions completely prevent you from working full-time at any job, not just the one you’re used to.

It is possible to get long-term disability benefits for migraine headaches, especially chronic migraines. However, because there isn’t always an identifiable cause for migraines, like TMJ dysfunction or a tumor, you may face challenges during your claim. Insurance adjusters are skeptical of medical conditions that are not easily explained; while a herniated disc on an MRI may explain someone’s neck pain, there probably isn’t a diagnostic study or test that can pinpoint the exact cause of your migraines. So, you’ll need to work with an attorney to build a comprehensive and detailed record that supports your claim.

RELATED ARTICLE: Learn How a Disability Journal Can Help Your Disability Claim

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How Do I Prove the Severity of My Migraines?

Consistency is key to a migraine-related disability claim. While it’s tempting to self-treat your migraines and try to ignore how severe your symptoms are, you’ll be much better off if you speak honestly with your doctors and take an active role in your treatment plan.

  • Get Medical Care for Your Migraines

At the peak of a migraine, you probably want to curl up in a dark, quiet room and rest. You may have experience self-treating your symptoms, and when you’ve had many migraines before, it may seem like a lot of unnecessary hassle to go to the doctor for treatment.

However, if you haven’t been to the doctor about your migraines yet, or if you’re having a very severe migraine or exhibiting new symptoms, it’s a good idea to consult a doctor as soon as possible. Your medical team may be able to alleviate your symptoms with medications and other treatments, and they will document the migraine in their records. These medical records will become valuable evidence in an LTD claim.

You should also build relationships with specialists who treat headaches and chronic pain. These doctors could have insight into your condition and may be able to suggest innovative ways to control your symptoms. Visiting a specialist can also help strengthen your LTD claim since insurance adjusters tend to value opinions from a specialist more than those from a general physician.

  • Create a Migraine Journal or Diary

A migraine journal offers many benefits. For example, identifying your triggers can help you better control your migraines. However, a journal can also improve your long-term disability claim.

It’s easy to ignore everyday migraine symptoms. When you create a diary, you may discover that your migraines are more frequent or disabling than you thought. For example, you may realize that it takes you days to fully recover from a migraine. You and your doctors can use this information to refine your treatment plan and adjust your work restrictions.

Your migraine diary can also help you complete your LTD application. During the application and claim process, insurance company representatives may ask you for details about your daily activities and the frequency of your migraine symptoms. Your diary can help you provide accurate answers that are backed by documentation.

  • Follow Your Doctor’s Recommendations

Many factors can contribute to a migraine, including stress, hormones, changes in the weather, caffeine, tobacco, and diet. If your doctor has suggested that you change your lifestyle, you should take this advice seriously.

This is doubly true when it comes to medication. If your doctor is recommending a specific medication protocol, you should follow it to the best of your abilities. Do not under or over-use your medications.

Insurance adjusters are constantly looking for reasons to question your credibility and deny your LTD claim. When you refuse to follow your doctors’ orders, the insurance company will almost certainly use it against you.

  • Consult an Experienced Disability Insurance Lawyer

At Bryant Legal Group, we know from experience how migraine symptoms, especially fatigue, nausea, and visual disturbances, can complicate the disability insurance claim process. It’s easy to make mistakes and miss deadlines when you’re battling a migraine.

If you’re unable to work due to severe migraines, you don’t have to navigate your long-term disability claim alone. A disability insurance lawyer can provide guidance and ensure you don’t make errors that lead to a denial of benefits.

Also, stress is one of the top contributors to a migraine. When you work with one of our LTD lawyers, you get peace of mind, which might even help reduce the frequency of your headaches or ease symptoms.

RELATED ARTICLE: Chronic Pain and Disability Insurance: A Claimant’s Guide

Bryant Legal Group: We Understand Migraine Disability Claims

Our team of disability insurance lawyers at Bryant Legal Group has earned an outstanding reputation based on our attention to detail, practical strategies, and real-world results. Bryant Legal Group assists disability insurance claimants in Chicago and beyond with complex LTD claims to give them peace of mind and help them get the benefits they’re entitled to.

To schedule your free consultation, contact us at 312-561-3010 or complete 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.

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