LTD appeal

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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LTD appeal

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.

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.