Disability Insurance

Shoulder pain is incredibly common: about 18–26% of all adults will experience it in their lifetime. While some of us will recover relatively quickly, many people with shoulder problems experience chronic, disabling symptoms.

At Bryant Legal Group, we help people with shoulder pain and dysfunction receive the disability insurance benefits they deserve. In this article, we explain the essentials of a disability insurance claim involving shoulder pain.

What Causes Shoulder Pain?

Your shoulder is one of the most complex joints in your body. Thanks to the shoulder’s robust structure and wide range of motion, you’re able to lift, push, pull, carry, reach, and move your arm in all directions.

However, when something happens to the bones, ligaments, muscles, and joint capsule that make up your shoulder, you can suddenly find yourself unable to perform even simple tasks, like brushing your hair or picking up a bag of groceries.

There are many causes of shoulder pain:

  • Arthritis or degenerative joint disease: A lifetime of wear and tear can lead to degenerative changes in your shoulder, including thinning of tissues, bone spurs, loss of cartilage, and swelling.
  • Bursitis and tendinitis: When structures in your shoulder, like the bursa or tendons, become swollen and irritated, it can cause severe shoulder pain.
  • Frozen shoulder: Also called adhesive capsulitis, this condition occurs when the connective tissues in your shoulder thicken or tighten, making it difficult to move. You typically develop a frozen shoulder after the joint has been immobilized for a long time, such as after surgery.
  • Labral tears: Your labrum is a cuff of cartilage that keeps your shoulder joint in place. SLAP lesions and other labral injuries can be very painful and may limit your use of the shoulder.
  • Rheumatoid arthritis: As your immune system attacks your tissues, you may experience swelling, bone erosion, and contractures in your shoulders and other joints.
  • Rotator cuff injuries: Your rotator cuff stabilizes your shoulder and allows for the joint’s broad range of motion. If any of the muscles that make up your rotator cuff are damaged, you may experience severe pain and limitations.
  • Shoulder instability: Because your shoulder is the most moveable joint in your body, it can dislocate relatively easily. However, once you’ve suffered a shoulder dislocation, you may experience chronic instability, which means your arm bones can slip out of place.

Some professionals face a higher risk of shoulder issues than others. If you frequently have to lift heavy weights, push, pull, carry, work above shoulder height, work in awkward positions, or take the force of vibrations, you’re more likely to experience shoulder pain. And shoulder pain isn’t just for blue-collar workers: surgeons, dentists, nurses, and athletes also report high levels of shoulder pain.

Can I Get Disability Insurance Benefits for Shoulder Pain?

Yes. However, your eligibility for disability insurance benefits will depend on a series of factors:

  • The severity of your shoulder condition
  • How long you’ll be unable to work due to your shoulder issues
  • Your work experience and education
  • Your disability insurance policy’s terms and conditions

If you need help assessing your eligibility for short-term or long-term disability insurance benefits, you should consult an experienced disability lawyer.

RELATED: How to Apply for Disability Insurance: A Professional’s Guide

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3 Ways to Strengthen Your Shoulder Pain Disability Claim

Even if you have an obvious shoulder injury, you might have a hard time collecting the disability insurance benefits you deserve. Here are three things you can do to strengthen your application for short-term or long-term disability.

1. Understand Your Disability Plan’s Terms and Conditions

Every disability insurance plan has different terms and conditions that can affect your right to benefits. First, look at how your plan defines “disability.” If you have an “own occupation” policy, you only need to prove that you cannot perform your actual job. However, if your plan has an “any occupation” definition of disability, you’ll need to show that you cannot perform any type of work.

Even if you have an “own occupation” policy, the insurance company might try to redefine your job. For example, suppose you’re a cardiothoracic surgeon with chronic shoulder pain. You file for long-term disability, but the insurance company argues that you can still work as a family physician, telehealth provider, or healthcare administrator. To fight back, you’ll need a skilled disability insurance lawyer and testimony from a vocational expert.

Second, look out for your policy’s limitations and exclusions. You may have a significant waiting period before you become eligible for disability benefits. Or, your plan might deny coverage for specific conditions, especially if you have a private disability insurance policy.

You can review your plan’s exact terms in the Plan Document or Summary Plan Description. If you’re having a tough time understanding all the legalese, contact Bryant Legal Group for help.

2. Get Consistent Medical Treatment

Shoulder injuries are notoriously slow to heal and difficult to treat. If you don’t have consistent, ongoing treatment, the insurance company might argue that your symptoms have improved, that you’re capable of working, or that your pain isn’t substantiated by objective medical evidence. You’ll be in a much stronger position if you have medical records, including MRI and CT scans, that track your progress, document your symptoms, and outline the root causes.

3. Speak With a Disability Insurance Lawyer

Filing a short or long-term disability insurance claim requires attention to detail and extensive legal and medical knowledge. Unlike an adjuster, who works for the insurance company, a disability insurance lawyer will be on your side.

At Bryant Legal Group, we help our clients navigate their shoulder-related insurance claims, ensuring that they meet strict filing deadlines, build strong evidentiary records, and avoid being taken advantage of by unscrupulous insurance companies.

Bryant Legal Group: Knowledgeable and Respected Disability Insurance Lawyers

If you or a loved one live with shoulder pain, the team at Bryant Legal Group can help you understand your legal options. We’ve been helping people with serious shoulder conditions for decades, and we understand the challenges you face. As one of Illinois’ premier disability law firms, we can also help you regain control.

To schedule your free, no-risk consultation, contact us at (312) 561-3010 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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Disability Insurance

If you’re receiving long-term disability benefits, you may find yourself in a confusing situation. It’s not uncommon for disabled people’s conditions to improve (or ebb and flow). However, the disability insurance company may argue that you’re no longer eligible for monthly benefit payments based on your improved circumstances. What are you supposed to do?

Disabled individuals typically must take steps to improve their condition. However, when you start gaining function, your LTD insurer may start scheduling medical examinations and asking tough questions. In this blog, our experienced disability insurance lawyers explain how you should handle this situation and what you should do if your benefits are cut off.

Disability Insurance Companies Can Define “Disability” in One of Two Ways

As your medical conditions evolve, the insurance company will want to occasionally reassess your eligibility for benefits. When this happens, the claims adjuster will return to your policy’s definition of disability. So, it’s important that you understand this definition. Most LTD policies define “disability” in one of two ways:

  • Own occupation: You are disabled if your medical conditions or injuries prevent you from doing your actual job.
  • Any occupation: The insurance company will pay your LTD benefits if you are unable to perform any type of work.

While most employer-sponsored, group LTD plans use the more stringent “any occupation” language, some private LTD policies contain an “own occupation” definition.

Your policy’s definition may significantly impact your right to ongoing long-term disability benefits. For example, suppose you work as an emergency department physician. After a mild or moderate traumatic brain injury, you’re unable to continue this employment due to problems with your attention, concentration, and executive functioning.

However, with intensive therapy and counseling, you eventually regain some of your short-term memory and find coping mechanisms that could help you do simpler, less stressful jobs. If you have an “own occupation” policy, your benefits would likely continue after your modest improvement. With an “any occupation” policy, you may receive a termination of benefits notice.

When Should I Report Changed Circumstances to My LTD Insurance Company?

Whether you must report a change of circumstances depends on the “materiality” of the change. A change in circumstances is material if it will influence your eligibility to receive disability benefits or the amount of benefits that you might receive.

For example, let’s say you are currently receiving benefits for a total disability, but you underwent a surgical intervention that improved your condition. You are now only eligible to receive “residual benefits,” and you would have to notify your insurer.

Not all material changes are linked to the disabling condition itself. The basis of disability insurance benefits is that you are incapable of working. So, if your former employer offers to change the duties of the job to better suit your new limitations (and offers you the position), then you will likely have to notify your insurer of this change.

If your change in circumstances could affect your eligibility for benefits, you should report it to the insurance company. In many LTD policies, there is a required reporting schedule that you must follow. Under this schedule, you’ll probably have to update the insurance company on your health and medical treatment annually (some policies ask for an update every six months). However, there may also be an additional voluntary reporting requirement.  If you need help understanding your reporting obligations, consult an experienced LTD attorney.

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What Will Happen After I Update the Insurance Company About My Disability Claim?

Once you’ve notified the insurance company about a change in your circumstances, the insurer will start to reassess your eligibility for LTD benefits. This may involve a series of tactics:

  • Requests for updated medical records: The insurance adjuster reviews your recent medical records to assess the severity of your condition and capabilities
  • Independent medical examinations: The insurance company pays a doctor to examine you and write a report that outlines your current limitations
  • Consulting physician assessments: Rather than examine you, the insurance company’s doctor simply reviews your medical records and issues a report
  • Field interviews: An insurance company representative meets with you in person to discuss your change in circumstances
  • Surveillance: Private investigators track you both in real life and online, looking for evidence that you’re capable of returning to work

This process can feel invasive and uncomfortable, which is why so many disability insurance claimants choose to negotiate an insurance buyout or settlement instead.

The Insurance Company Just Stopped My Benefits. What Should I Do?

First, don’t panic if the insurance company terminates your monthly benefits. However, you do need to act quickly. Depending on whether your LTD plan is privately funded or employer-sponsored, you may face strict filing deadlines for an appeal. To give yourself the best chance for success, you need to start building your case right away.

For most LTD claimants, the first step in their appeal is contacting an experienced disability insurance lawyer. An attorney can provide you with an honest assessment of your claim, suggest ways you can strengthen your appeal, and help you navigate the complex process of filing an administrative appeal or a lawsuit.

Bryant Legal Group: Chicago’s Respected Disability Insurance Team

At Bryant Legal Group, we’ve earned a reputation for our practical, client-focused approach to disability insurance law. Whether you’re considering applying for LTD benefits or the insurance company terminated your monthly payments, our team can help you build a plan and educate you about your legal options. We assist people in Chicago and throughout Illinois with their disability insurance claims and appeals.

To schedule your free consultation with an attorney from our team, call us at 312-561-3010 or use 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.

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Disability Insurance

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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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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Disability Insurance

You’ve paid your private disability insurance premiums on time for years. Then, when you file a claim for disability insurance benefits, you get a letter saying you “hid” a medical condition, and your policy is canceled or void. How can this happen?

Most private disability insurance policies require that you tell the truth and accurately describe your medical conditions in an application. But even if you’ve been completely truthful, insurers will sometimes try to void your policy to get out of paying your short-term and long-term disability benefits.

If you made a mistake on your disability insurance application or the adjuster claims you did, it’s time to consult an experienced disability attorney from Bryant Legal Group. Your disability benefits claim may still be legitimate, even if there were mistakes (or misrepresentations) in your insurance contract or application. To learn more, keep reading.

When Can an Insurer Cancel a Policy?

Under Illinois law, there are various reasons why an insurance company can cancel a disability insurance policy. For example, you’ll lose coverage if you fail to pay your monthly premiums or violate the terms of the plan. When this happens, you should get a written notice in the mail.

However, insurance companies can also void your policy or deny a claim if you made misrepresentations in your written application or other policy documents. Typically, the insurance adjuster will say that you hid a chronic or disabling medical condition. Instead of getting a cancellation notice, you may receive a letter denying your short-term or long-term disability claim.

Pre-Existing Conditions and Disability Insurance

When you apply for a private disability insurance policy, the insurer will typically ask you about your pre-existing conditions. It’s in your best interest to outline all of your chronic conditions and existing injuries. However, mistakes can happen. Other times, the insurance adjuster will study your medical records and search for evidence of an undisclosed, pre-existing condition.

Many private disability insurance policies include a detailed list of pre-existing condition exclusions. If your condition existed when you applied for coverage and is excluded, you’ll likely be denied benefits.

However, the adjuster will sometimes take things out of context. Suppose you occasionally complained of headaches at your doctor’s appointments, often due to allergies or a cold. Later on, you develop migraine headaches. The insurance adjuster may try to deny your migraine-related disability, arguing that you failed to mention your (unrelated) headaches when you applied for coverage. In this case, you should immediately contact a disability insurance lawyer and work with them to file an appeal or lawsuit.

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Misrepresentations Won’t Always Void a Disability Insurance Policy

In Illinois, our state’s Insurance Code outlines the circumstances when an insurer can rescind a policy and deny your disability insurance claim. Under Section 154 of the code, the insurance company must show that:

  • The insurance contract or application contains a written misrepresentation
  • Your statements were false, and you intended to deceive the insurance company
  • The misrepresentation was material to the spirit of the disability insurance contract and would have influenced coverage

Generally speaking, an honest mistake on an insurance application will not give an insurer the right to revoke your policy. 

For example, suppose you forgot about a childhood injury, and you didn’t include it in your application’s medical history section. Years later, when you file a claim for LTD benefits, the insurance adjuster denies your benefits due to this “misrepresentation.”  As long as you can show that the error was unintentional, you should be able to enforce the insurance policy.

Whether a misstatement or omission is “material” is more complicated and depends on the circumstances. The insurer must show that, had they known the truth, they would have denied your coverage or changed the terms of your insurance policy.

For example, suppose you lied about your marital status in your application. Later on, you’re in a catastrophic car accident and suffer a spinal cord injury. Your marital status probably has nothing to do with your claim and would not have impacted the insurance company’s decision to cover you.

However, let’s say you have a long history of back pain. You apply for short-term disability coverage and fail to list your orthopedic doctor, your physical therapist, or your diagnosis on your application. Later on, you undergo spinal surgery due to severe degenerative changes. When you file for disability insurance benefits, you may face challenges due to your unreported medical history.

If the insurance company is arguing that you made a material misrepresentation, it’s best to contact an experienced disability insurance lawyer. They can guide you through this nuanced legal analysis and help you identify your next steps.

Bryant Legal Group: We Stand Up to Insurance Companies in Illinois

At Bryant Legal Group, our team helps people across Illinois and Chicago get the disability insurance benefits they deserve. If your long-term or short-term disability insurer denied you claim due to a pre-existing or “hidden” condition, call us today. Our client-focused approach will help you regain control.

To schedule an appointment, either 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.

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.

This field is for validation purposes and should be left unchanged.

Disability Insurance

When most of us think about “disability,” we define the term simply: you can’t work because of an illness, medical condition, or injury. However, when you apply for long-term disability insurance, you’ll discover that “disability” can mean many different things, depending on your policy.

Unfortunately, many disabled individuals don’t realize that their policy’s language can have a profound impact on their right to benefits. This lack of understanding can lead to a lot of frustration and denied benefits. In this blog article, our disability insurance lawyers break down the difference between “own occupation disability” and “any occupation disability.”

Read Your Long-Term Disability Plan Document

A long-term disability (LTD) policy is a contract. Either you or your employer agreed to the terms in the contract when they bought the coverage, even if you didn’t read them. When you apply for long-term disability benefits, these terms and conditions will affect when you apply, whether you’ll get monthly benefit payments, and how much you’ll receive.

If you apply for disability insurance benefits before reviewing your policy’s standards and processes, you’ll be at a serious disadvantage. To get started, you should request the following documents:

  • Plan Document: Details every term, condition, and process that applies to your policy; Plan Documents are often dense and difficult to read
  • Summary Plan Description (SPD): Outlines the key elements and procedures of your long-term disability plan in an easier to read format

While you may prefer reviewing the SPD, your disability lawyer will probably dig into the precise language of the Plan Document.

One of the most important issues outlined in your LTD policy is its definition of disability. If you don’t meet the definition, you cannot receive benefits. While every policy has unique quirks, most lawyers break disability definitions into two categories: own occupation disability and any occupation disability.

Own Occupation Disability Focuses on Your Actual Job

Own occupation and regular occupation policies will pay your long-term disability benefits if you can prove that you are unable to perform the primary duties of your current job because of an illness, injury, or chronic medical condition.

For example, a surgeon with severe nerve damage in their hands may be unable to perform surgery. Even if the surgeon could take on different, less hand-intensive work, they should get disability benefits under an own occupation disability insurance plan.

Compared to “any occupation” disability plans, it’s easier to get disability insurance benefits under an own occupation plan since you only have to show that you’re unable to perform the substantial duties of your specific occupation. You also may be able to perform simpler or lighter work and still get the benefits you need.

For this reason, insurance companies tend to avoid the “own occupation” definition of disability in long-term disability policies. (It is much more common in short-term disability plans.) However, if you have an individual disability insurance policy that you purchased, you may have an own occupation definition in your Plan Document.

What’s My Occupation?

If you have an own occupation disability policy, don’t be surprised if the insurance company tries to categorize your work in a way that’s inaccurate. Insurance adjusters often try to describe your job as broader and easier than your specific occupation. If this occurs during your disability claim, your disability lawyer will typically work with vocational experts, assessing your job description, essential duties, and employment records to determine how to categorize and define your occupation.

Insurance Companies Often Add Limitations to Own Occupation Policies

Because a true own occupation policy is relatively lenient, insurance companies often try to add qualifications and limitations to these definitions. When you review your Plan Document or Summary Plan Description, look out for these more restricted versions of an own occupation policy.

  • Modified own occupation: You must show that you cannot perform your actual job and you are not working in any other occupation.
  • Transitional own occupation: This definition of disability requires that you cannot perform your actual job and are not earning more than your pre-disability income.

Other times, you may receive a partial long-term disability benefit if you have returned to work.

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Any Occupation Disability Usually Requires Total Disability

Any occupation definitions of disability are common in long-term disability plans. Insurance companies prefer the any occupation definition because it makes it harder for individuals to receive benefits. If your policy contains “any occupation” language, you must prove that you’re unable to perform the substantial duties of any occupation, not just your own job.

For example, let’s revisit the surgeon with severe nerve damage in their hands. Suppose that the surgeon’s work restrictions limit repetitive use of their hands, gripping, and grasping, but they are otherwise healthy. While the doctor is unable to perform surgeries, the insurance company will argue that they have other options, like teaching at a medical school, telemedicine, or even simple jobs outside the medical profession.

Look for “Gainful Occupation” Language in Your Long-Term Disability Policy

Some long-term disability policies define disability as being unable to perform any gainful occupation. While this may sound identical to “any occupation,” the addition of the “gainful” can loosen your policy’s definition of disability.

  • Any occupation: You must show that you are unable to perform any job, including the simplest, lowest-paying ones.
  • Any gainful occupation: A gainful occupation is one that pays you a significant portion of your pre-disability wages, often between 60–80%.

For example, suppose our surgeon’s policy says they cannot perform any gainful occupation and defines a gainful occupation as one that earns them at least 60% of their pre-disability income. Before they stopped working, the surgeon earned $500,000 annually. The surgeon’s disability insurance lawyers collect evidence that shows the surgeon’s restrictions limit them to jobs that pay roughly $100,000, or 20% of their prior earnings. In this case, the surgeon may be eligible for long-term disability benefits.

Look Out for Hybrid Own Occupation and Any Occupation Language

Even if your long-term disability plan starts as an own occupation policy, don’t assume it will stay that way. Some disability insurance plans take a hybrid approach. For a specified period (typically two years), the insurance company will pay your disability benefits if you’re unable to do your own job. However, after that time, your policy will convert into an any occupation plan.

We’ve met with many people who felt blindsided when the insurance adjuster suddenly terminated their LTD benefits, even though their condition had not changed. We often discover that these denials are due to a changed disability definition.

However, remember that you have rights and options after you receive a denial. If you receive a letter ending your long-term disability benefits, you should always consult a disability insurance lawyer. The team at Bryant Legal Group can help you understand your legal options and work with you to get you the benefits you deserve.

Bryant Legal Group: Illinois’ Trusted Disability Insurance Team

If you’d like to learn more about your long-term disability plan’s terms and conditions, or if you need help filing a claim or appeal, contact Bryant Legal Group today.

Our respected disability lawyers take a practical, hands-on approach, and we’ve recovered millions for our clients. We also offer remote consultations if you would rather not meet in person due to concerns about your health.

To schedule your free initial consultation, call us at 312-667-2536 or complete 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.

This field is for validation purposes and should be left unchanged.

Disability Insurance

When you’re unable to work, due to an injury, illness, or chronic medical condition, you may be eligible for short-term disability benefits. Many people think that getting short-term disability is a simple process and are surprised when issues come up that lead to a denial or termination of benefits.

If you’re considering applying for short-term disability, you need to be prepared. To give yourself the best chance at getting benefits without an appeal, you need to provide detailed information and substantial evidence. In this article, we’ll outline the essentials of a short-term disability claim.

What Is Short-Term Disability Insurance?

Short-term disability insurance plans are available either independently through a private insurance plan or through your employer. The employee benefits from these plans serve as a limited wage replacement during a temporary disability period.

For example, suppose you are in a car accident and need cervical spine surgery. Your doctor takes you off work for six months while you heal and rebuild strength. Thankfully, your back heals, and you’re able to return to work. Under these circumstances, you may be eligible for short-term disability benefits during the six months of recovery.

Short-term disability is different from workers’ compensation. To get workers’ comp, your injury or illness must be work-related, which means you either suffered the injury on the job or it occurred directly because of your work duties. With short-term disability, you can collect benefits even if the injury or illness happened away from your workplace and had nothing to do with your work.

Also, short-term disability and workers’ compensation don’t necessarily exclude each other; in some instances, it is possible to collect both types of benefits at the same time.

Short-term disability is also not related to Social Security Disability (SSD). The Social Security Administration does not offer any type of short-term benefits.

Am I Eligible for Short-Term Disability Benefits?

Depending on your short-term disability insurance plan, you can have quite different requirements for qualification. Each plan has its own definition of what constitutes a qualifying “disability,” and there are additional requirements that can differ, too.  These requirements may include:

  • Minimum period of time working for an employer before coverage applies
  • Full-time employment
  • Minimum duration of disability (usually a minimum of 8–9 weeks)
  • Frequency of medical updates

Requirements may differ from plan to plan, but in general, short-term disability coverage requires that you have a condition that prevents you from working for a significant but temporary period, usually between two months and one year. There is often a waiting period (also called an “elimination period”) before you are entitled to receive benefits, and you may have to use sick days at work before your benefits kick in.

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How Much Will I Receive in Short-Term Disability Benefits?

Short-term disability benefits will pay a percentage of your wages. Depending on the terms of your disability insurance plan, you may receive 40, 50, or 60 percent of your wages on a weekly, biweekly, or monthly schedule.

For example, if you were earning $3,000 per month and your short-term disability plan paid out 50 percent of your wages, you could receive $1,500 per month in biweekly payments of $750.

How Long Will My Short-Term Disability Benefits Last?

Short-term disability benefits are intended as a stopgap measure that replaces your wages following an unexpected event, like an accident or illness. Under most plans, the benefit period lasts for a year or less.

If your disabling condition continues, you may be eligible to receive long-term disability benefits. Depending on the plan, your short-term disability benefits may automatically qualify you for long-term disability benefits after a certain period of time.  Otherwise, you will have to reapply and qualify for long-term disability benefits.

RELATED: How Long Do I Have to Wait for a Disability Insurance Decision?

How Do I Apply for Short-Term Disability Benefits?

Before you apply for short-term disability benefits, it’s important to understand your plan’s exact terms and conditions. You should request a copy of your Plan Document and Summary Plan Description from your employer’s human resources department or directly from the insurance company. Then, carefully read these documents (or work with an attorney who can read them) to identify the disability definition, filing deadlines, and procedures that apply to your claim.

Because filing a disability claim is a highly technical process, we encourage short-term disability claimants to schedule a consultation with an experienced lawyer. Disability insurance claims require a detailed understanding of the law, medicine, and vocational analysis, and a single misstep can cost you the benefits you deserve.

Also, short-term disability benefits are short-lived. Sometimes, insurance companies deny or delay valid claims, hoping that you’ll simply return to work and give up. So, it’s critical that you consult an attorney early on in the process. Your attorney will challenge wrongful denials and work to make sure that your full benefits are paid promptly.

Once you understand the policies and processes that will frame your short-term benefit claim, you and your lawyer will compile evidence, including medical records and statements from your physicians. You’ll also complete a series of forms that discuss your disability, work experience, job requirements, and other issues.

RELATED: Common Reasons for Denial of Short-Term Disability Benefits

What Happens After I File for Short-Term Disability Benefits?

Once the disability insurance company receives your application for benefits, an adjuster will investigate your claim. They may ask for additional information or schedule an examination with one of their doctors. In general, the company will look for reasons to deny your claim, like a pre-existing condition. Based on its assessment, the insurance company will either approve or deny your claim.

However, you do have the right to appeal the insurance company’s decision. If you receive a written notice denying your short-term disability claim, you should contact a disability insurance attorney immediately to discuss your legal options.

Bryant Legal Group Is Here to Help With Short-Term Disability Claims in Chicago

If you’re ready to apply for short-term disability benefits, it’s time to get in touch with an experienced Chicago short-term disability attorney at Bryant Legal Group. Our attorneys have decades of experience helping people file successful short-term disability claims and challenge unreasonable denials. We are committed to our clients, and we make ourselves available to answer any questions or concerns you may have regarding the claims process.

Call 312-561-3010 or complete our online contact form to speak with one of our short-term disability attorneys today. We look forward to assisting you.

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

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Disability Insurance

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.

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Disability Insurance

The Hartford is a massive insurance company. Founded more than 200 years ago, it is the second-largest provider of group life and disability insurance in the United States. The insurance company expanded significantly in 2017, when it acquired Aetna’s disability insurance business. In 2018, The Hartford made $19 billion in profits.

At Bryant Legal Group, we help disabled people navigate their short and long-term disability claims with The Hartford. Over the decades, we’ve learned a lot about the company’s tactics.

Keep reading to learn four essential things that every Hartford claimant needs to know.

1. Be Prepared for Surveillance

The Hartford has earned a reputation for its use of surveillance. The company frequently hires private investigators to monitor disabled claimants’ online and real-life activities. If your lifestyle seems inconsistent with your reported limitations and abilities, The Hartford may deny your claim or terminate your benefits.

If you feel like you’re being watched or tracked, you may be right. However, don’t panic if you’re the subject of surveillance. Instead, consult with a lawyer, know your rights, and protect yourself.

For example, investigators cannot enter your property without your permission or record you in your bedroom or bathroom. They also cannot harass or threaten you.

You also should do your best to live within your doctors’ suggested restrictions. For example, if your orthopedic surgeon says you should never lift more than 5 pounds, don’t pick up a 20-pound bag of dog food at the store, even on a good day. First, you may injure yourself. Second, an investigator might be recording your every move.

At Bryant Legal Group, we find that most surveillance footage is relatively benign. It may show you walking to the mailbox or pushing a grocery cart for a few minutes. It rarely shows the price you pay after your brief period of activity or your symptoms during a flare-up. However, you’ll still need evidence, such as medical records, that clarifies the surveillance footage and puts it into perspective.

2. Don’t Expect The Hartford to Investigate Your Disability Claim Properly

This piece of advice applies to every disability insurance company, including The Hartford. You should never rely solely on the company’s representatives to fully investigate and prepare your claim. While you may list all of your physicians and providers in your long-term disability application, the company might not request every single record — and they certainly won’t go out of their way to find evidence that supports your claim.

Instead, you need to compile your medical records, statements from your doctors, and other vital information. This is particularly important in ERISA (Employee Retirement Income Security Act of 1974) claims. In an ERISA or employer-sponsored LTD plan, you only have a limited time to submit evidence.

There are two levels of appeal in an ERISA claim: administrative and federal court. During the administrative (or insurance-level) appeal, you need to build up or “stack” your record with all your supporting evidence — such as your doctors’ notes and opinions.

Once the insurance company closes its case and makes its final decision, you can no longer submit additional evidence. That means that if you wait too long to hire a lawyer or properly develop your claim, it could be too late.

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3. Be Skeptical of The Hartford’s Settlement Strategies

In 2005, a group of workers’ compensation and personal injury claimants filed a class-action lawsuit against The Hartford, alleging that the company intentionally failed to disclose that it would retain 15% of its structured settlement payments. Rather than take the case to trial, the insurance company settled it for $72.5 million in 2010.

While the class-action lawsuit’s allegations were never proven at trial, you should be cautious when accepting a settlement (especially a structured settlement) from The Hartford. Before you agree to a settlement or sign any paperwork, you should always consult with an experienced disability insurance lawyer.

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

4. Be Prepared to File an Appeal

The Hartford denies a lot of long-term and short-term disability claims, including cases where people are truly disabled. If you get a denial or termination of benefits letter in the mail, you’re not alone. However, you do need to take immediate action to protect your legal rights. Disability insurance claims have relatively short filing deadlines, and if you miss them, you could lose your right to benefits.

You’ll also want to consult with an experienced disability insurance lawyer at Bryant Legal Group. ERISA appeals are complicated, and you’ll have to follow a series of strict procedural requirements at every step. One missed deadline or clerical mistake can have a profound negative impact on your claim. 

Bryant Legal Group: We’re Prepared to Stand up to The Hartford

Did The Hartford recently deny your disability claim? The skilled lawyers at Bryant Legal Group have handled countless claims against The Hartford and understand their tactics and strategies. 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 312-561-3010 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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Disability Insurance

Globally, depression is the number one cause of disability. While mental health conditions are finally getting the attention they deserve, long-term disability (LTD) insurance companies are still reluctant to approve and pay claims related to depression and anxiety.

If you’re considering an LTD claim for depression or anxiety, you need to review your plan documents carefully and prepare your evidence. Keep reading to learn more about the essentials of a successful mental health LTD claim.

What Is Depression?

Depression is much more than just feelings of sadness. You may suffer from major depressive disorder if you experience:

  • Persistent sadness or emotional emptiness
  • Hopelessness
  • Feelings of guilt, helplessness, or worthlessness
  • Reduced interest in your hobbies, activities, or daily life
  • Fatigue, decreased energy, or problems sleeping
  • Problems concentrating or making decisions
  • Changes in appetite
  • Irritability
  • Unexplained pain
  • Suicidal thoughts or urges

While women are more likely than men to report depression, anyone can experience disabling depressive symptoms. Research shows that roughly 7% of adults will experience major depression in their lifetime.

What Is Anxiety?

We’ve all felt stress and anxiety. However, when you have an anxiety disorder, your anxious feelings persist and interfere with your life. Common symptoms associated with anxiety include:

  • Overwhelming worry about everyday concerns and interactions
  • Restlessness and irritability
  • Concentration problems
  • Insomnia and disrupted sleep
  • Panic attacks
  • Physical symptoms like sweating, dizziness, shortness of breath, and heart palpitations

While many people lump depression and anxiety disorders together, they are two separate diagnoses, although many people experience them at the same time.

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What Is Bipolar Disorder?

Almost 3% of adults have bipolar disorder. Sometimes called manic-depressive disorder, bipolar disorder involves alternating periods of mania and depression. Manic individuals feel euphoric, agitated, and easily distracted. They may make impulsive decisions and feel a decreased need for sleep.

Mental health providers categorize bipolar disorder in several ways. People with bipolar I disorder have experienced at least one severe manic episode. Bipolar II disorder involves significant depression and one milder manic (or hypomanic) episode.

Can I Get Long-Term Disability for Depression or Anxiety?

Sometimes, depression and anxiety can be controlled by psychotherapy, medication, and other mental health services. However, therapy and medication may not be enough, even when you follow your doctors’ recommendations. If you’re unable to work due to your severe depression, anxiety, or other mental health symptoms, you may be eligible for long-term disability benefits.

Read Your Policy: Many LTD Policies Put Caps on Mental Health Compensation

Many long-term disability policies put strict limitations on the amount of time they’ll pay for mental health-related disabilities. Before you apply for disability insurance benefits, you’ll want to review your plan documents carefully. Don’t be surprised if you find clauses that limit the payment of some mental health claims to two years.

However, don’t panic if you see one of these exclusionary clauses. You may be able to receive LTD benefits for a longer period of time if you also have physical disabilities. Some policies also exclude specific conditions, such as Alzheimer’s disease or schizophrenia, from the two-year limit.

Since reading and interpreting LTD policy language isn’t easy, it’s best to consult an experienced disability insurance lawyer early on. Your lawyer should be able to help you understand how your LTD plan’s terms and conditions will impact your claim, and they can also suggest strategies to maximize your benefits.

How Can I Strengthen My LTD Claim for Depression or Anxiety?

If you’re feeling overwhelmed by the thought of applying for LTD benefits or appealing a denied mental health claim, it’s best to get help from an experienced disability lawyer. Every LTD claim involving depression and anxiety is different, and a lawyer can help you build a compelling case for benefits.

However, there are some ways you can reliably strengthen your LTD claim for depression or anxiety.

  • Take Your Treatment Plan Seriously

Some people with depression and anxiety struggle to make it to appointments with doctors and counselors. Others forget to take their medications. However, if you don’t follow your treatment plan, the insurance company may deny your claim because there’s not enough evidence documenting your symptoms and limitations.
Even more importantly, treatment can save your life. If you have thoughts of suicide or self-harm, you should immediately seek medical care or call 911.

  • Don’t Minimize Your Symptoms

Talking about mental health is hard. Sometimes, people don’t want to admit how severe their symptoms are or desperately want to avoid an inpatient hospitalization. However, you can’t get the care you deserve if you stay quiet.
When you talk to your doctor or counselor, they will document your symptoms in your medical records. Their notes provide powerful evidence in your LTD claim and can help reinforce the severity of your conditions.

  • Talk to a Lawyer Who Understands LTD and Mental Health

Depression and anxiety can impact your decision-making, concentration, and persistence. On a bad day, you may feel like giving up on your LTD claim. Thankfully, you don’t have to fight alone.
When you have a skilled disability lawyer at your side, you get a source of emotional support and strength. At Bryant Legal Group, we carefully guide our clients through their LTD claims and educate them about every step of the process. We also give our clients space to heal and rebuild while we take care of the details of their claims.

RELATED BLOG ARTICLE: Disability Claimants Must Seek Timely and Adequate Care to Secure Full Benefits

Bryant Legal Group: Disability Advocates for People with Depression and Anxiety

If you or someone you love has questions about depression, anxiety, and long-term disability, it’s time to schedule your free consultation with an attorney from Bryant Legal Group. Our disability lawyers will listen to your story, help you understand your legal options, and suggest next steps. All consultations are confidential.

To schedule your free, no-risk consultation, call 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.

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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Disability Insurance

A multiple sclerosis (MS) diagnosis leads to a lot of questions, and you’re likely hearing conflicting information about your chances of receiving long-term disability (LTD) benefits. Keep reading to learn more about LTD benefits for MS, why this process is so complicated, and how you can strengthen your claim.

What Is Multiple Sclerosis (MS)?

Multiple sclerosis is a disease of the central nervous system that causes your immune system to attack your myelin, a fatty substance that covers and protects your nerves. When myelin is lost or damaged, plaque or scarring builds up on the nerves, making it more difficult to transmit impulses to-and-from the brain. Sometimes called demyelination, this process leads to MS symptoms, including:

  • Weakness in your limbs
  • Numbness and tingling
  • Unsteadiness and balance problems
  • Dizziness
  • Blurred and double vision
  • Word-finding and speech difficulties
  • Attention and concentration deficits
  • Cognitive issues
  • Fatigue
  • Incontinence

Many people with multiple sclerosis also struggle with depression and anxiety, and suicide rates are significantly higher among individuals with MS. In fact, one study reported that people with MS are up to 7.5 times more likely to attempt suicide than the general population.

Multiple sclerosis symptoms vary from person to person. Some people experience a relapsing-remitting form of multiple sclerosis in which their symptoms plateau for a period of time and may even go away. Others experience progressive worsening of their symptoms.

While there is no known cure for MS, your neurologist will probably suggest medications and treatment that can help control the disease’s symptoms. Today, two-thirds of MS patients are able to walk ten years after their initial diagnosis, although some need a cane or walker. Most people with MS have a normal lifespan, and the disease itself is not fatal.

Can I Get Long-Term Disease for Multiple Sclerosis?

Like many complicated diseases, you can get long-term disability benefits for MS. However, there are people with multiple sclerosis that continue to work for extended periods of time after their diagnosis. To determine your long-term disability eligibility, you’ll need to carefully evaluate your LTD policy’s terms and conditions — as well as your symptoms, limitations, and other factors.

To assess your eligibility, you should consider:

  • Whether the policy includes an “any occupation” or “own occupation” definition of disability
  • How your symptoms impact your daily activity — both mentally and physically
  • The side effects you’ve experienced from your prescribed medication (if any)
  • Any work restrictions that your doctor has suggested

However, there are some common situations that can complicate an LTD claim for MS. First, it takes time to diagnose multiple sclerosis. Many people wait years and suffer through multiple “differential” diagnoses before they finally get their MS diagnosis. Others are stuck in limbo with “possible MS” because their test studies and scans are inconclusive. Insurance adjusters are skeptical of developing diagnoses and tend to deny them.

RELATED ARTICLE: What Conditions Automatically Qualify You as Disabled?

Second, insurance adjusters sometimes have a hard time understanding relapsing-remitting MS. When your symptoms aren’t progressing, your doctors may write that your disease is “stable” and that you’re “doing well.” And while stable does not mean symptom-free, an adjuster might use this status against you to diminish the severity of your disease and daily struggles.

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How Can I Improve My Long-Term Disability Claim for Multiple Sclerosis?

Every MS disability claim is different and deserves its own personalized evaluation. You should always consult with a lawyer during your long-term disability claim, but there are also things you can do on your own to strengthen your claim.

Don’t Minimize Your Symptoms

Too frequently, we meet with MS (and other) patients who aren’t completely honest with their doctors. They’re not exaggerating their symptoms in the hopes of getting an LTD payout; they just don’t want to be seen as whiny, weak, or a burden, so they keep quiet about the severity of their disease.

If you have problems doing your daily tasks or notice an increase in symptoms, no matter how mild, it’s best to mention this at your doctors’ appointments. If you keep experiencing the symptom or issue, keep mentioning it at follow-up appointments. This information will help your doctors track the progression of your MS and identify therapies and treatments that may help. And when the LTD insurance adjuster reviews your medical records, they’ll get an accurate picture of your limitations.

RELATED ARTICLE: Disability Claim Tips

Don’t Quit Taking Medication Without a Doctor’s Consent

We get it. Many of the medications for multiple sclerosis, especially the immunosuppressive ones, have serious side effects. You may hate the flu-like symptoms that your medications cause and the frequent injections. However, you should never stop taking your medications without a doctor’s permission.

Some medications can cause dangerous withdrawal symptoms if they’re stopped cold turkey. Additionally, if you decide to stop your meds without talking to your doctor, your insurance company might consider this noncompliance with medical treatment and deny your claim.

Talk to a Lawyer Who Understands LTD and MS

Long-term disability applications and appeals involving multiple sclerosis are complicated. Rather than muddle through your claim, medical records, and vocational analysis, it’s best to consult with a lawyer who understands your disease and the LTD claims process.

An experienced MS disability lawyer may help you build a stronger case for benefits, highlighting the challenges you face, educating the claims adjuster, and providing new insight from experts.

RELATED ARTICLE: Building a Comprehensive Application for Disability Benefits

Bryant Legal Group Fights for People with Multiple Sclerosis

If you or a loved one have questions about multiple sclerosis and long-term disability, contact Bryant Legal Group. Our respected lawyers have decades of experience handling disability claims involving MS and other progressive diseases, and we’re here to you understand your legal options.

For a free, no-risk consultation, please call 312-561-3010 today or complete our 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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Disability Insurance

If you are suffering from a disability and have had your benefits claim denied by your private disability insurer, then you may be entitled to bring an action against your insurer — whether your insurance coverage was purchased individually or provided as part of an employer-sponsored plan.

Insurers are often quite aggressive in denying private disability benefits. In many cases, the insurer understands that if they deny a “difficult” or “ambiguous” benefits claim for which they can provide a reasonable justification, a number of claimants will simply refrain from any further attempts to secure their rightful benefits. This strategy saves insurers a substantial amount, as they can avoid having to payout benefits that they might otherwise have to pay if the claimant were to challenge the denial.

Consider the following justifications commonly used by private disability insurers to deny benefits.

Application of a Coverage Exclusion

Private disability insurance policies can vary drastically, and as such, your coverage may feature a number of exclusions that are unique to that particular insurance contract. Insurers may apply those exclusions in an over-broad manner to avoid having to payout benefits. It’s important that you seek the assistance of an attorney to evaluate the policy and determine the contours of those exclusions.

Some coverage exclusions are so common that they are nearly ubiquitous in the disability insurance context. For example, the vast majority of disability plans feature a coverage exclusion that makes those who intentionally cause their own disabling condition/injury ineligible for benefits.

Claim Submission Lacked Sufficient Information

When you submit your claim for benefits, it must include sufficient documentary evidence and information to support your claim — in fact, it must be so comprehensive that the insurer cannot reasonably deny your claim for insufficiency. If you are missing certain medical records in your application for benefits, for example, then the insurer is likely to use that as a basis to deny your claim.

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Coverage Rescinded Due to Material Misrepresentation

Insurers often deny claims when they determine that the policyholder has made a material misrepresentation on the original application to purchase coverage. Insurers tend to be overly aggressive in enforcing this rule, however, and in doing so, they may unjustifiably rescind coverage (and deny your claim) without property considering whether the misrepresentation at-issue was actually “material” — in other words, relevant — to the coverage.

For example, if you misspelled your name on the insurance application form, that would be considered irrelevant to your coverage. The insurer could not use something so minor and immaterial to justify denial.

Disability is Related to a Pre-Existing Condition

When an insurer provides disability coverage, they generally exclude benefits for pre-existing conditions. Of course, insurers tend to be rather excessive in interpreting the extent of your pre-existing condition and the relatedness of your new disability.

Medical Treatment and Mitigation Concerns

Insurers will almost certainly deny benefits if there are significant gaps in your medical care after you have received an injury, or suffered an illness or condition that later causes you to become disabled. Most disability policies require the appropriate treatment of your medical condition. Policyholders must make reasonable efforts to seek and maintain appropriate medical care.

Contact a Skilled Chicago Private Disability Attorney for Help

Here at Bryant Legal Group, P.C., our attorneys have extensive experience representing private disability claimants in disputes with their insurance carriers, including situations that involve wrongful denials.  We understand the underlying dynamic that fuels the conflict between insurer and policyholder — the incentive to deny disability claims and thereby avoid having to payout benefits — and how to approach the dispute so as to secure maximum benefits on our client’s behalf.

Interested in learning more about your claims?

Call (312) 561-3010 today to schedule a consultation with an experienced Chicago private disability attorney at Bryant Legal Group, P.C.  We will evaluate your claims and help you to develop an effective forward-strategy.

Disability is Related to a Pre-Existing Condition

When an insurer provides disability coverage, they generally exclude benefits for pre-existing conditions. Of course, insurers tend to be rather excessive in interpreting the extent of your pre-existing condition and the relatedness of your new disability.

Medical Treatment and Mitigation Concerns

Insurers will almost certainly deny benefits if there are significant gaps in your medical care after you have received an injury, or suffered an illness or condition that later causes you to become disabled. Most disability policies require the appropriate treatment of your medical condition. Policyholders must make reasonable efforts to seek and maintain appropriate medical care.

Contact a Skilled Chicago Private Disability Attorney for Help

Here at Bryant Legal Group, P.C., our attorneys have extensive experience representing private disability claimants in disputes with their insurance carriers, including situations that involve wrongful denials.  We understand the underlying dynamic that fuels the conflict between insurer and policyholder — the incentive to deny disability claims and thereby avoid having to payout benefits — and how to approach the dispute so as to secure maximum benefits on our client’s behalf.

Interested in learning more about your claims?

Call (312) 561-3010 today to schedule a consultation with an experienced Chicago private disability attorney at Bryant Legal Group, P.C.  We will evaluate your claims and help you to develop an effective forward-strategy.

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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Disability Insurance

If you’ve had a legitimate insurance claim denied in Illinois — whether a health insurance claim or a disability insurance claim — then you may find that the insurer justifies their denial on the basis of a discretionary clause written into the policy.

Discretionary clauses can vary in function somewhat, but as a general rule, they give the insurer the ability to interpret (in accordance with their own standards) the terms of the contract.  This type of “discretionary” power gives the insurer an enormous advantage when it comes time to determine whether or not to award health or disability benefits.

Discretionary Clauses are Prohibited in Health and Disability Insurance Policies

Fortunately for policyholders in Illinois, the state has banned discretionary clauses from health and disability insurance policies — the courts have determined that giving an insurer discretionary authority when interpreting the terms of an insurance policy would put the policyholder in a highly-disadvantageous position.

For example, an insurer would be prohibited from making a decision on whether to accept or deny your disability insurance claim due to some ambiguous discretionary standard.  A provision that allowed the insurer to deny a claim “at their discretion” (or using functionally similar language) would therefore not be enforceable.  You could challenge the use of discretionary authority by the insurer, and have a court re-examine the legitimacy of your insurance claim under an objective “de novo” standard of review.

Courts Must Apply the De Novo Standard of Review

When a court defers to the standards applied by an insurer (in making a decision relating to an insurance claim), they are applying the “deferential” standard of review.  By contrast, the “de novo” standard of review is one in which the court considers whether your insurance claim qualifies for benefits without paying any heed to the interpretation of the policy terms by the insurer.  In other words, “de novo” review is akin to starting with a blank slate.  The court will not give weight to the decision of the insurer.  They will examine the evidence in an unbiased manner.

In Illinois, the law not only prohibits the inclusion of discretionary language in health and disability insurance policies, but also requires that courts apply de novo standard of review when evaluating claim denials.  In fact, here at Bryant Legal Group, P.C., our attorneys have been involved at the cutting-edge of “de novo” standard of review case law in the state of Illinois.

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Get in Touch With an Experienced Chicago Insurance Attorney

If you’ve had your insurance claim wrongfully denied by your insurer, then you may be entitled to appeal the denial, or — in certain circumstances — pursue litigation against the insurer in order to recover your rightful benefits.

When challenging the decision of an insurer in Illinois, it’s worth noting that the reviewing court is required to apply the “de novo” standard of review, even if the insurance policy contains a discretionary clause (which is illegal in the state of Illinois).  In order to successfully navigate this complicated legal landscape, we encourage you to get in touch with an experienced Chicago insurance attorney here at Bryant Legal Group, P.C., who can advocate on your behalf through every step of the litigation process.

Our attorneys have represented numerous policyholder-clients in a range of disputes with their insurers, in both the health insurance and disability insurance contexts.  We are intimately familiar with worst tendencies of insurers — such as their willingness to include ambiguous and damaging provisions in the insurance contract — and are well-positioned to challenge their conduct in a court of law.

Call (312) 561-3010 today to schedule a free consultation with one of the skilled attorneys here at Bryant Legal Group, P.C.

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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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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