Bryant Legal Group

Aetna, as part of The Hartford, is one of the nation’s leading disability insurance providers. Aetna’s policies promised to provide financial security to policyholders who cannot work due to an accident, injury, or illness. Unfortunately, the insurance company will often deny legitimate claims for short-term and long-term disability benefits to protect its profits.

If The Hartford or one of its subsidiaries denied your disability claim, you may be considering hiring a long-term disability attorney. Bryant Legal Group’s experienced team of disability insurance lawyers can help you navigate the appeal process. We have a long history of handling cases involving both Aetna and The Hartford, and have recovered millions in benefits for our clients.

In this article, we will discuss common tactics insurance companies may use to justify denying your disability claim, as well as how hiring a disability law firm early on can be crucial to your case’s success.

Hartford long term disability denied

The Hartford Processes All Aetna Disability Insurance Claims Today

For years, Aetna offered individuals and companies a variety of health, disability, and life insurance plans. However, in 2017, it sold its disability insurance and life insurance divisions to The Hartford for $1.45 billion. With the acquisition, The Hartford became the second largest disability insurance carrier in the United States.

So, what does this mean for you? Even if you purchased your policy from Aetna decades ago, The Hartford will review and process your claim for disability insurance benefits.

Even if you purchased your policy from Aetna decades ago, The Hartford will review and process your claim for disability insurance benefits.

What to Expect During an Aetna Disability Claim

Most long-term disability claims involve a series of steps.

  • Application: you complete a series of forms and provide the insurance company with information about your medical conditions, limitations, and ability to work.
  • Investigation: The insurer assigns your claim to an adjuster who will review your claim and make an initial decision (either approving or denying your claim). During this phase, the adjuster might ask you for more information, send you to an independent medical examination, or consult with physicians. You will get written notice of the adjuster’s decision.
  • Appeal: If Aetna or The Hartford denies your long-term disability insurance claim, you have the right to appeal. However, this process will vary depending on whether you have a privately purchased policy or an employer-sponsored disability plan.

If you do not have a long-term disability lawyer, you will have to handle this entire process yourself. That might mean a lot of phone calls, letters, and inquiries from the adjuster and other insurance company representatives. They might even pressure you to participate in field visits—which are really an excuse for surveillance.

That is why many claimants work closely with an Aetna long-term disability attorney. When you are represented, your lawyer will handle all the details and deadlines, and the adjuster must run all communications through your attorney’s office (instead of calling you).

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Common Tactics Disability Insurance Companies Use to Deny Your Claim and How to Avoid Them

Disability insurance companies like Aetna and The Hartford will often attempt to use a variety of different tactics to deny your disability claim. Knowing what these tactics are can help you to prepare yourself and strengthen your case. These tactics do not always hold up in a court of law, so it is important to know all you can to protect yourself against potential disability insurance denial.

1. Insufficient Objective Medical Evidence

Objective evidence is a main reason for many wrongfully denied claims, but this is often not considered s legitimate reason for disability insurance denial. Since many claims are based on subjective symptoms like pain and fatigue, it is sometimes impossible for injured persons to get objective results from tests like CAT scans, blood tests, and others.

This being the case, most of Aetna and The Hartford’s disability insurance policies do not require objective evidence for a claim to be filed. If you are denied this reason, take a closer look at your claim with a disability lawyer to see if you were subject to a wrongful denial. Insurance companies are often not allowed to deny claims for this reason, so be sure to stay aware of any attempts to do so.

2. Disability Definitions

The definition of disability varies based on what policy or what insurance company you may have. Knowing the definition that dictates your coverage is key to winning and maintaining your disability benefits. Your disability insurance coverage will fall into two categories that vary in degree of severity.

Own occupation disability insurance will cover you if you can prove you are unable to perform your own occupation, while also meeting all other disability criteria. All occupation disability insurance requires you to prove you are unable to perform any job at all.

Some insurance companies have policies that will change from own occupation to any occupation after a certain period. Be sure to check your own policy to ensure you can qualify for your definition and to protect against any potential surprise changes.

3. Medical Improvement

Your disability insurance company will most likely ask you for periodic updates on your condition to determine if they will continue paying your monthly benefits. When your insurance company asks for these updates, it is important to be honest about the severity of your condition. Don’t downplay any pain or inconvenience you may be facing, as it could cost you your disability benefits.

4. Conducting Surveillance

Insurance companies like Aetna and The Hartford will occasionally use private investigators to perform surveillance on your everyday activities. These investigators will observe you in any public space they can and are allowed to record you in such spaces. Insurance companies will use this video to prove your limitations are not legitimate and deny your claim.

If you have recently filed a disability insurance claim, pay attention to any unusual activity you may notice soon afterwards. Be sure to avoid pushing yourself beyond your limits, as an investigator could get video evidence of such activity and use it to deny your claim.

The Importance of an Aetna Long-Term Disability Attorney

Many of the intricacies of how insurance companies may attempt to deny your long-term disability insurance claim can be difficult to navigate on your own. Hiring a disability lawyer early on can be the difference between insurance companies denying your claim and you receiving your disability benefits in full.

Filing disability claims are a process filled with endless steps and paperwork, which makes having the assistance of a disability lawyer all that more valuable. Many professionals wait too long to speak to an experienced disability lawyer and regret it. At Bryant Legal Group, we see many claims that are unable to saved due to a delay in communication.

What Qualities to Look for in Your Disability Benefits Attorney

Being sure that you pick the right disability lawyer can be stressful but is important to ensuring the success of your claim. Make sure to ask the right questions to see if your attorney is the right fit for your case. The right experienced disability lawyer should have most, if not all, of the following qualities:

  • Specializes in disability insurance law
  • Knowledge of your local laws and statutes
  • A locally based office
  • Honest, empathetic, and upfront

Bryant Legal Group: Here to Protect Your Long-Term Disability Benefits from Insurance Companies

At Bryant Legal Group, we have a unique perspective on disability insurance law. Our disability insurance attorneys have decades of experience helping disabled professionals stand up to disability insurance companies to get the benefits they deserve. We are committed to providing professional and result-oriented service and are here to help you understand your disability insurance claim options.

To schedule your free consultation with a member of our team, call us at 312-561-3010 or complete this online form.

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

Contact Bryant Legal Group

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

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Most people think of tinnitus as “just” ringing in the ears. But if you are among the millions living with this audiological and neurological condition, you know how profoundly it can change your life.

However, tinnitus-related disability claims are often complicated. The condition is often diagnosed based on your reported symptoms—not a clear-cut test. So, insurance companies often deny these short-term and long-term disability claims, especially those involving subjective tinnitus.

If you are considering filing a disability insurance claim, we are here to assist you. Our team of disability lawyers can help you through the process of seeking short-term or long-term benefits for your impairment. In this article, we discuss the basics of tinnitus and how to strengthen your claim.

What Is Tinnitus?

Tinnitus is a condition effecting an estimated 15% of the public, according to the CDC. It causes a perception of sound, more commonly known as “ringing in the ears,” when no actual sound is occurring. While tinnitus can be both acute, or temporary, and chronic, around 20 million people suffer from chronic symptoms. Roughly two million tinnitus victims categorize their symptoms as either extreme or debilitating.

Although there is no one direct cause of tinnitus, there are a few leading causes:

  • Middle ear obstructions blocking the inner ear,
  • Head and neck trauma,
  • Traumatic brain injury
  • Hearing loss due to loud noises or the aging process

No two cases of tinnitus are the same, so it is important to understand where your case falls in the spectrum of symptoms. Tinnitus can be categorized into two main categories, subjective and objective, with the first being more common than the second.

Types of Tinnitus: Subjective vs. Objective Tinnitus

There is one key difference between the two forms of tinnitus, perception of sound. Visiting a medical professional, like an audiologist, may help you understand whether you have objective or subjective tinnitus. Disability claims will require a diagnosis from your doctor which may affect your eligibility, so it is important to seek a medical opinion before filing

  • Subjective: The more common of the two types of tinnitus, subjective tinnitus is when only the patient experiencing symptoms can perceive any head or ear noises. This form of tinnitus can be linked to a variety of different causes and is the most common form of tinnitus, with over 99% of cases falling into this category.
  • Objective: Objective tinnitus makes up less than 1% of all tinnitus cases and is normally caused by the body’s circulatory and somatic systems. Patients with this condition will experience head or ear noises that are audible to both them and other people, often through testing and examination.

Finding out what type of tinnitus you have is important for your claim, as it will likely affect your insurance’s decision. Insurance companies will ask for objective proof from a medical professional to confirm the causes and symptoms of your condition. They will request medical records of any test results, such as hearing tests, cognitive tests, or physical examinations.

is tinnitus a disability

Common Symptoms of Tinnitus

The symptoms of tinnitus vary from person to person in both form and degree but tend to fall under three categories. Tonal tinnitus shows more continuous and well-defined symptoms, often associated with subjective tinnitus. Pulsatile tinnitus, named after the pulsing sounds its patients experience, is associated with objective tinnitus, and usually indicates vascular issues. Musical tinnitus is the perception of music or singing and is extremely rare.

Tinnitus can cause patients to experience a wide variety of symptoms, both cognitive and physical, that can impact overall quality of life, so it is important to understand what may be related to your condition or not.

Physical Tinnitus Symptoms

Symptoms of tinnitus tend to be related to some form of perception of sound, but can go beyond, causing physical pain, disorientation, and hearing loss. It is important to get these symptoms assessed by a medical professional to strengthen your disability claim and diagnosis.

Physical symptoms can include:

  • Ringing in the ears at different or consistent pitches
  • Buzzing, roaring, clicking, hissing, or humming in the ears
  • Hearing loss or impairment
  • Vertigo
  • Nose or throat pain

Cognitive Tinnitus Symptoms

Cognitive symptoms can severely affect your mental health and are equally as important to your claim as physical symptoms. Gathering evidence of these symptoms will help to strengthen your claim and add further evidence of your qualification for disability. Some examples of cognitive symptoms caused by tinnitus are:

  • Depression
  • Anxiety
  • Trouble sleeping and concentrating

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Can I Get Long-Term Disability Benefits for Tinnitus?

If you are living with severe tinnitus, you might be eligible for short-term or long-term disability benefits. These insurance policies provide a monthly benefit during periods when you cannot work—but you must meet the requirements of your policy or plan.

Your plan document or policy should outline the specific terms and conditions that apply to your claim. However, you will always need to prove that you meet the insurance company’s definition of disability to receive benefits. Your policy probably defines “disability” in one of two ways:

  • Own occupation: you cannot perform your current job, due to tinnitus and other health issues
  • Any occupation: your tinnitus and health conditions make it impossible to do any type of work

Convincing an insurance adjuster that your tinnitus is disabling can be an uphill battle. Sometimes, doctors diagnose tinnitus solely based on your subjective symptoms, not objective diagnostic tests (like an MRI or hearing test). In these cases, the insurance company could argue that there is no “real” proof that you have tinnitus—or that your condition is as severe as you claim.

How to Strengthen Your Disability Benefit Claim for Tinnitus

For any short or long-term disability case, you will be required to provide both proof of your medical condition and ongoing treatment. In cases of tinnitus, insurance companies will often focus primarily on the symptom of hearing loss, although this is a common misconception. Hiring an experienced disability lawyer will help you to build your case and ensure you follow all the right steps to get the benefits you deserve.

Here are a few ways that you can strengthen your claim for disability insurance benefits.

Do Not Minimize Your Hearing Loss, Mental Health Conditions, Cognitive Problems, or Other Tinnitus Symptoms

The disability insurance adjuster must consider all your medical conditions and their related symptoms. However, if your medical records do not consistently document your tinnitus-related issues, you might run into problems.

If you have been hesitant to talk to your doctors about the severity of your tinnitus or related psychological or cognitive challenges, the adjuster might argue that your symptoms are not as severe as you claim or that your condition has improved.

Here are a few things you need to know.

Tinnitus and Hearing Loss

Although hearing loss is often a main cause and effect of tinnitus, many patients gloss over it, because they consider other symptoms to be more disabling. However, insurance companies often deny disability claims that do not include proof of substantial hearing loss.

If you do not undergo regular hearing tests, ask your doctors if it is time for a new assessment.

Tinnitus and Cognitive Impairments

Although hearing loss may be a major symptom that can cause long-term issues for tinnitus sufferers, most cases list cognitive impairments as one of the main reasons for their disability. Tinnitus can make it impossible to focus, sleep, or concentrate.

Do not ignore your cognitive symptoms. Even if it is hard to talk about your struggles completing daily tasks or your mental lapses, you need to bring these issues up with your medical team. Your doctors might schedule a neuropsychology exam, which can help you understand how tinnitus is affecting your ability to think and process information.

Tinnitus, Depression, and Anxiety

In some serious cases, tinnitus can cause or worsen depression and anxiety. Do not ignore common signs of mental health problems, including:

  • Feelings of sadness
  • Generalized worry
  • Social isolation or anxiety when out in public
  • Racing thoughts
  • Irritability or mood changes
  • Lack of interest in your past hobbies and pastimes
  • Malaise or fatigue
  • Thoughts of self-harm

Your doctors and therapists can help you manage these feelings with medication, counseling, and other therapies.

If you are suffering from suicidal thoughts, please seek immediate mental health treatment.

Receive Appropriate Treatment for Your Condition

Currently, there is no cure for most types of tinnitus, but that does not mean you should suffer alone. There are still ways for people with tinnitus to receive medical treatment for their condition. Whether audiological, physical, or neurological, the treatment you receive will provide valuable information that should support your short-term or long-term disability claim.

In cases involving objective tinnitus, treatment will focus on an underlying cause or condition. Treatment may focus on addressing your blood pressure issues, cardiovascular disease, TMJ, eustachian tube dysfunction, Lyme disease, or other conditions.

If an underlying condition is not the cause of your tinnitus, you may be given treatment focusing on symptom management. Treatment of these symptoms can include a wide range of options, such as use of hearing aids, cochlear implants, physical therapy, cognitive behavioral therapy, white noise machine therapy, neuromonic device therapy, and avoidance of certain foods or substances.

While you might be tempted to self-treat, it is important to follow your doctors’ recommendations. Every time you see a doctor or therapist, they will create notes that outline your current symptoms, limitations, and their recommended treatment. While this might seem unimportant, these records will be an essential part of your disability insurance claim—and the adjuster is not likely to take you at your word along.

Follow Up With Your Doctors, When Needed

Regardless of the recommendations your physician may recommend, it is important that you continue to follow them to remain compliant. Insurance companies will not continue to pay your disability insurance claim unless you have ongoing proof of disability. If you miss too many appointments or do not provide regular updates, your insurance company might terminate your disability benefits.

Insurance companies know that symptoms can be improved over time with treatment, which is why they ask for such updates.

Consult With a Long-Term Disability Attorney

Filing a disability insurance claim can feel overwhelming, especially if you are struggling with cognitive impairments, depression, or anxiety. When you work with an experienced long-term disability attorney, they will handle all the details of your claim for you.

That means that the adjuster will no longer contact you directly. Instead, your lawyer will respond to all the insurer’s requests, make sure that you meet the necessary deadlines, and provide you with the information you need to make smart decisions.

Bryant Legal Group:

Helping Those with Tinnitus in Their Time of Need

At Bryant Legal Group, our team of experienced disability attorneys are committed to a value-based, practical approach to disability insurance claims. We have helped our clients receive millions in disability compensation and are here to help you understand your disability insurance claim.

If you have any questions about your tinnitus disability claim, contact our office today. To schedule your free consultation with a member of our team, call us at 312-561-3010 or complete our online form.

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

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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When you make a long-term disability claim, it is not enough to say that you cannot work. You must prove it. That means you need to have documentation that identifies your medical diagnoses, your symptoms, and your functional limitations.

But what exactly is a functional limitation? When disability insurance lawyers evaluate your claim, they consider how your health conditions affect your ability to work and perform activities of daily living (ADLs). If these limitations prevent you from working, you might be disabled under your policy.

In this article, we explore functional limitations and their importance during a short-term or long-term disability insurance claim.

Functional Limitation: How a Medical Condition Impact a Person’s Life

You have functional limitations if your medical conditions reduce or eliminate your ability to do certain activities within a normal range of function. For example, if your degenerative disc disease or osteoarthritis makes it difficult to bend, twist, push, and pull, you have functional limitations.

And while we often focus on physical limitations, mental health conditions can also restrict your ADLs and work activities.

Doctors and vocational experts typically break functional limitations into several categories:

  • Exertional: physical limitations that affect your ability to perform activities like walking, sitting, standing, bending, twisting, lifting, pushing, and pulling
  • Non-Exertional: limitations that do not involve strength or physical effort. You can further break non-exertional limitations into sub-categories:
    • Mental: difficulties involving memory, attention span, decision-making, interpersonal skills, stress tolerance, and other cognitive and emotional functions
    • Postural: these include difficulties with prolonged sitting, stooping, and the need to elevate your legs or feet throughout the day
    • Sensory: problems with your ability to see, hear, touch, smell, and feel
  • Environmental: an inability to work or live in areas that expose you to heights, dangerous equipment, respiratory irritants (like dust or fumes), or extreme temperatures.

Typically, your doctor will recommend restrictions that address your functional limitations and help you avoid aggravating the condition.

Why Are Functional Limitations Important to My Disability Insurance Claim?

Simply having a medical diagnosis will not be sufficient to make you eligible for long-term disability benefits. You must meet your disability insurance policy’s definition of disability. Typically, you must show that:

  • Your physical and psychological conditions make it impossible to do your existing job, or
  • You cannot perform any full-time, competitive work, due to your injuries, illnesses, or chronic conditions

In short, the insurance company will never approve your disability claim unless you have significant functional limitations—and you can prove that they exist.

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How Do I Prove My Functional Limitations?

It is not enough to tell the insurance company that you cannot stand for long periods or struggle with short-term memory loss. Instead, you will need to provide medical evidence that documents and explains your limitations. This might include:

  • Medical records from doctors and specialists
  • Inpatient hospitalization records
  • Diagnostic testing, like x-rays, MRIs, CT scans, and pulmonary function tests
  • Assessments from physical and/or occupational therapists
  • Functional capacity evaluations
  • Testing by neuropsychologists and mental health providers

Your disability insurance attorney will help you compile all this evidence. They might also refer you to specialists who can evaluate your functional abilities and assess how your physical and mental health conditions affect your daily tasks and your ability to care for yourself.

Do Not Put off Your Health Care

When you are unable to work, it is sometimes tempting to postpone “routine” doctor’s appointments or self-medicate when a chronic illness flares up. However, while you might save on co-pays, you also might also seriously damage your disability case.

A consistent, detailed medical history will help you document the severity of your conditions, track the progression of your symptoms, and document each symptomatic flare. This evidence can be invaluable in the hands of a skilled disability lawyer—and can help counteract common insurance company tactics.

what are functional limitations

Residual Functional Capacity, Independent Medical Examinations, and Disability

During a disability insurance claim, you might encounter references to “residual functional capacity,” although the term is most commonly associated with Social Security cases. A residual functional capacity (RFC) assessment focused on what you can do physically and mentally, with your existing impairments.

Please note that Bryant Legal Group does not handle standalone Social Security disability claims. Our disability lawyers focus their practice on employer-sponsored and privately purchased disability insurance policies.

The insurance company might ask your doctor to complete a residual functional capacity form that outlines how long you can perform certain activities and movements, including:

  • Sitting
  • Standing
  • Walking
  • Lifting (both light and heavy objects)
  • Bending
  • Twisting
  • Pushing
  • Pulling
  • Reaching (including overhead reaching)
  • Kneeling
  • Squatting
  • Stooping
  • Handling both small and large objects
  • Performing repetitive activities

Then, based on your current abilities, a vocational expert will assess whether you can perform your most recent job or other types of work.

However, different doctors and vocational experts might arrive at dramatically different conclusions. Sometimes, the insurance company will schedule you for an “independent medical examination” or send your records to a “consulting physician” who will issue a report discussing your medical conditions, restrictions, and abilities.

Do not be surprised if the insurance company’s doctors and experts believe that you are capable of much more than your treating physician or your disability lawyer’s team of experts.

Chronic Pain, Self-Reported Limitations, and Functional Impairment

It is relatively easy to prove certain functional limitations. For example, if you have vision problems, testing can document how your reduced visual acuity limits your ability to do household and occupational tasks. The same might apply if you have neuropathy that decreases the function of your hands.

However, most serious health conditions have “softer” symptoms that can affect your ability to perform daily living activities. Fatigue, pain, depression, and anxiety are all very real. But there is not a simple test that unequivocally confirms your self-reported symptoms. This gives insurance company doctors a chance to question your credibility and imply that you are exaggerating the level of your impairment.

If your short-term or long-term disability case is denied because the insurance company overestimated your abilities, you should consult with an experienced disability lawyer right away. An attorney can help you clarify your limitations and refute the adjuster’s assessment of your case.

Bryant Legal Group: Fighting for People With Disabling Conditions

Bryant Legal Group’s disability insurance attorneys have decades of experience helping people with life-changing illnesses, injuries, and health conditions recover the benefits they deserve. Our team regularly works with experts, including physicians, occupational and physical therapists, and vocational consultants, who can help us explain the extent of your limitations and their effect on your life.

Contact a long-term disability attorney in Chicago today by calling 312-667-2536 or completing our online form.

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

Contact Bryant Legal Group

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

Request Your Free Consultation

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

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Bryant Legal Group

Long-term disability benefits can be a lifesaver for people who are no longer able to earn an income due to sickness or injury. If you are not able to work for months or even years at a time, it is a relief to know that you will still be getting a monthly check to help pay for your necessary expenses.

However, there may be an alternative option: a long-term disability buyout. If you choose to go this route, instead of getting monthly payments until your policy limits expire (which could be until retirement age), you will receive a lump sum payment from the insurance company to buy out your disability insurance claim.

But is it a good idea? To answer that question, you need to understand what your long-term disability claim is worth. In this blog post, we will examine ways to do this.

What Factors Can Affect the Value of a Disability Insurance Policy Buyout?

There are a few major items that will be taken into consideration when valuing your long-term disability claim. While nothing compares to a disability insurance lawyer’s personalized assessment and calculations, here are a few factors you must consider.

The total value of your remaining benefits

This is simply your monthly benefit multiplied by the number of months left of coverage. If, for example, your monthly benefit is $3,000 and you have 15 years until benefits end, the full value of your long-term disability benefits would be $540,000 ($3,00 x 12 x 15). However, for the reasons below, your settlement offer will never be this high.

The net present value (NPV) of your future benefits

The value of $3,000 today is not the same as the value of $3,000 in another 10 or 15 years, due to inflation and other factors. So, to calculate the buyout, the insurance company will take an estimate of what your future benefits will be worth using “present value,” or today’s dollars. This is known as a discount rate, and depending on how much longer your benefits are scheduled to last, this could result in your buyout value being significantly less than your NPV.

Your life expectancy

If you die before your benefits are scheduled to end, your payments simply stop, whereas the remainder of a lump sum could be passed on to your heirs. If the insurance company believes you are unlikely to live to the end of your benefits period, they will offer you a lower buyout settlement.

How long you are likely to need benefits

If the disability insurance company feels that you are likely to be able to return to work before your benefits expire, or believe they will have a good reason to dispute your claim in the future, they may refuse to offer a buyout or reduce your buyout offer.

Pros and Cons of Taking a Lump Sum Payment

Taking a lump sum buyout comes with both advantages and disadvantages. If your insurance company offers to buy out your LTD claim, you will have to consider carefully which choice will be best for your unique circumstances.

Also, it is important to keep in mind that your insurance company would not be making the offer unless it believed that it would save them money in the long run. Although you might agree that it is the better option for you as well, the insurance company has their own interests at heart—not yours.

Advantages to Settling Your Long-Term Disability Claim

The main advantage to taking the lump sum is that it puts you in more control over your long-term finances. You may feel that you will come out ahead if you are able to invest the money, rather than continuing to draw a smaller monthly benefit payment (which, due to inflation and cost of living adjustments, may not be worth as much later as it is today). Or, you may simply be sick of dealing with the insurance company, worried that they may try to dispute or challenge your disability status in the future, or looking to build a “nest egg” for your children after you die.

Disadvantages to Settling Your Long-Term Disability Claim

The main disadvantage is that, once you settle, the matter is closed and you can no longer go back and receive regular payments. If you run out of money—whether because you mishandled it, or had additional unexpected medical expenses, or outlived your life expectancy, or any other reason—you will have no recourse.

For these reasons, it is extremely important to understand what your claim is truly worth before considering any lump sum settlement.

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Should I Use a Long-Term Disability Buyout Calculator?

Many websites offer a free online calculator to estimate a fair value for your lump sum payout. While such tools can provide a rough and approximate starting point, it is important to understand that the true value of your case cannot be determined by a simple formula.

There are many factors to consider when making this kind of calculation, and the process is not always straightforward. The assumptions, and projections the insurance company makes about your case may be quite different from those considered by the calculator.

As a result, you should always consult with a long-term disability attorney before accepting any settlement offer. An experienced attorney can bring unique insight into how much your claim is truly worth, and can provide you with impartial advice about whether a buyout makes sense for your unique circumstances—and if so, how much the insurance company would need to offer to make it worth your while.

long term disability buyout calculator

Do Not Be Tempted by Lowball Offers From the Insurance Company

Again, you must remember that the insurance company’s goal with any long-term disability insurance buyout is to save themselves money in the long run. So, you should be cautious about taking their calculations about the true value of your disability case at face value.

For example, almost anyone would agree that the value of money changes over time, due to inflation, investment gains, and interest. Lawyers and financial professionals often refer to this concept as the “present value of money.”

But how much more valuable is it? This is impossible to know for certain, so insurance companies and other professionals use “discount rates” and other metrics to estimate your claim’s present value. Discount rates takes into consideration an estimated rate of return and other factors.

However, insurers make assumptions about which discount rate to use when calculating your lump sum buyout. Do not be surprised if those assumptions are far more favorable to them than they are to you.

Deciding whether to trade your monthly benefits for a lump sum payment may be one of the most significant financial decisions of your life. It may be hard to say no to a one-time check worth hundreds of thousands of dollars, but if you settle for too little, it could mean disaster down the road. A disability lawyer can protect you and help you make a wise decision.

Bryant Legal Group: Helping Disabled Individuals Secure Their Financial Future

At Bryant Legal Group, serving our clients is always our top priority. Our attorneys have decades of experience representing disabled individuals and helped them secure the benefits they deserve, fight unfair denials, and plan for their long-term future.

When you are working through a disability claim, or deciding whether a buyout is the right decision, our experienced attorneys can talk you through your options, weigh the pros and cons, and help you make the right choice for yourself and your family.

Contact a long-term disability attorney in Chicago today by calling 312-667-2536 or completing our online form.

 

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

Contact Bryant Legal Group

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

Request Your Free Consultation

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

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

Bryant Legal Group

Intense workplace stress has been on the rise in the United States for years, and the problem has only been exacerbated by the COVID-19 pandemic.

A 2018 Gallup survey of 7,500 workers found that almost 1 in 4 (23%) were feeling burnt out at work. By spring of 2021, the job listing aggregator Indeed estimated the rate at more than 1 in 2 (52%) based on its survey of 1,500 workers. The estimated rates are even higher among doctors, nurses, and other medical workers who have been on the front lines throughout the pandemic.

Burnout can be the primary contributing factor to mental and even physical health problems, many of which can significantly affect your job performance or even keep you from working temporarily. However, successfully claiming short-term disability benefits for burnout (or other mental health struggles) can often be challenging, and if you do not take the appropriate steps beforehand, your disability claim is likely to be denied.

In this blog, we take a closer look at burnout, how it can interfere with work, and the steps you must take if you wish to qualify for short-term disability benefits.

What Is Burnout?

Everybody experiences stress at work from time to time. However, when work-related stress becomes chronic and employees feel like they never get a chance to take a mental break, significant symptoms can develop.

Common signs, symptoms, and risks include:

  • Mental and physical exhaustion
  • Inability to concentrate
  • Irritability
  • Anxiety
  • Disruptions in sleep habits
  • Chronic headaches
  • Unexplained stomach or bowel problems
  • Depression

People suffering from burnout are also at increased risk of abusing drugs and alcohol or developing eating disorders, as well as a host of other mental and physical health issues.

Burnout may arise in workers who are forced to work long hours and meet impossible demands, feel uncertain about their responsibilities, are isolated from their coworkers, or must put up with toxic work environments.

At the core of it all, though, is usually a feeling of helpless and loss of control. Burned out workers not only feel overwhelmed, but they also feel that there is nothing they can do to make the situation better.

Physician Burnout: A Growing Epidemic

In the 2021 Medscape National Physician Burnout & Suicide Report, one physician surveyed commented, “I often feel despair, I have severe anxiety and PTSD. I have severe self-doubt, and I have lost the strong sense of self and values I once had.”

If this sounds like you, you are not alone.

Physician burnout has been an issue for years, but the COVID-19 pandemic accelerated the trend. About 42% of doctors experience burnout—and 47% of that population report severe symptoms that strongly affect their lives. It is resulting in doctors reducing their hours, changing their work settings, and even putting their practices up for sale.

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What Is Short-Term Disability?

Short-term disability insurance pays disabled individuals a monthly benefit while they recover from a physical or mental health condition. Many people have short-term disability coverage through their employer. Or, you might have purchased a private or individual short-term disability policy yourself.

Like their name implies, you cannot receive short-term disability benefits forever. Most policies will cover your disability claim for a year or less. After that, you might be eligible for long-term disability benefits.

Can I Get Disability Benefits for Burnout?

Maybe. Short-term disability benefits typically pay you a monthly benefit when you meet your policy’s definition of disability. Common definitions of disability include:

  • Own occupation: you cannot perform the primary functions of your current job, due to health conditions
  • Own specialty: you cannot practice your exact medical specialty, due to psychological or physical limitations
  • Any occupation: you cannot any type of work, including the simplest, lightest jobs

If you need help interpreting your policy or plan’s requirements, it is a good idea to consult with a disability insurance lawyer. They can review your summary plan description or policy and offer personalized advice based on your unique situation.

Once you have assessed your eligibility for benefits, it is time to file a disability insurance claim. However, if you are experiencing disabling burnout, be prepared for a fight.

Excuses Insurance Companies Use to Deny Disability Claims for Burnout

While the term “burnout” was coined in the 1970s and the phenomenon has been the subject of studies for decades, it is not a medical diagnosis. You will never receive disability insurance benefits simply because you feel burnt out—you need a documented, disabling medical condition.

However, this does not mean that obtaining short-term disability benefits related to job burnout is an impossible task. It just means that extra care needs to be taken to prove that you are truly suffering from a medical condition that prevents you from performing your job duties.

What you might describe as burnout might really be symptoms of:

  • Anxiety
  • Depression
  • Post-traumatic stress disorder
  • Chronic fatigue syndrome

You will need to convince the insurance company that your documented mental health conditions (along with any physical health conditions you have) make you eligible for short-term disability benefits.

Insurance Adjusters Are Skeptical of Mental Health Claims and “Self-Reported” Symptoms

You can objectively prove that someone has coronary artery disease or ulnar neuropathy. It is not as easy to show that you have disabling depression, anxiety, or other burnout-related conditions. After all, mental health conditions do not appear on imaging studies or lab work.

Insurance adjusters are always looking for reasons to question your credibility, and many of them will argue that your mental health conditions are not as severe as you allege—especially if you inconsistently seek care. Many mental health claims involving depression, anxiety, bipolar disorder, and post-traumatic stress disorder are initially denied, even when the conditions are otherwise qualifying.

Treatment Is Key to a Successful Short-Term Disability Claim

Not enough professionals get the mental health treatment they need. In the 2021 Medscape Burnout Survey, about 20% of those surveyed reported clinical depression. Another 69% said they have colloquial depression. However, many doctors avoid mental health treatment, often arguing that they can deal with it on their own, minimizing their symptoms, or saying that they are just “too busy” to get the care they need.

Concerningly, 13% of the doctors indicated that they have suicidal thoughts.

If burnout at work is causing you significant mental or physical distress, you should always seek medical attention. If necessary, step away and focus on your wellness and self-care. Long-term unaddressed burnout can lead to serious, chronic problems, including heart disease, high blood pressure, and increased susceptibility to illness.

When you consult with your doctor, you should ask them to help you determine whether you are suffering from a diagnosable mental illness. Even though burnout is not a medical diagnosis in and of itself, it may overlap with one or more mental illnesses such as anxiety disorder or clinical depression.

But a medical diagnosis is just the beginning of your battle. Not everyone with depression or anxiety qualifies for short-term disability insurance. You must convince the insurance adjuster (or a judge) that your burnout makes it impossible to work.

That is where your history of consistent mental health treatment comes into play. Work with your doctor to develop a comprehensive treatment plan and follow it faithfully. In addition to helping you recover from burnout, you will be simultaneously building evidence that demonstrates the severity of your condition and that you and your doctor are taking the appropriate steps to treat it.

Tips to Reduce Workplace Stress

Burnout can be incredibly difficult to manage on your own, since often the stress comes from external factors, and a feeling of helplessness or lack of control is a common factor.

Still, if you are beginning to recognize the signs of burnout, these tips may be able to help:

  • Step away from your job temporarily and focus on self-care. If you have a couple of vacation or PTO days coming up, use them. Completely unplug while you are out.
  • Focus on getting at least 8 hours of sleep per night.
  • Exercise regularly. It can help you manage stress and take your mind off work for a period of time.
  • Eat a healthy diet. Getting proper nutrition can have a profoundly positive effect on your energy levels, alertness, and mood.
  • Try a relaxing activity or hobby in your spare time, such as meditation, yoga, cycling, or reading.
  • If you feel you can trust your supervisor, speak with them about your job expectations and see if there are any alternative options that can help make your job less stressful, such as flexible working hours, different responsibilities, or additional support.
  • If you start to feel like burnout is taking a toll on your wellbeing and you are not able to get it under control, do not put off seeking medical evaluation and treatment. Help is available.

Need Help With Your Short-Term Disability Claim? Contact Bryant Legal Group Today

Our attorneys excel at protected the legal rights of disabled workers and professionals, including doctors and nurses. We only represent individuals—never insurance companies—and will work hard to get you the full short-term disability benefits you deserve under your plan.

Making sure you have solid medical evidence of your disability is crucial in any short-term disability claim, but especially for mental health claims. We can help you understand your policy benefits and limitations, determine if you have a case, and guide you through the steps you need to take to have the best chance at getting the compensation you deserve.

To speak to an experienced Chicago short-term disability insurance lawyer at Bryant Legal Group, P.C., contact us by calling 312-667-2536 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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We do not need to tell you that the pandemic hit medical practices hard. As fewer patients scheduled appointments and non-essential care was paused, physicians were left with fewer options—and their revenue dropped. According to a 2020 MGMA survey, the average physician-owned practice lost between $78,000 and $175,000 in revenue per full-time doctor in 2019-2020.

While we are starting to get a handle on the pandemic, that means your practice has some catching up to do. In this article, our physician and medical practice attorneys highlight some lessons we learned and suggest practical steps you can take to improve your practice’s profitability and revenue stream.

Lesson 1: Claims Denials Are Rising, and You Need to Be Prepared

Since the beginning of the pandemic, the average practice’s denial rate increased by a shocking 11%. However, payers’ rationales for these denied claims have not changed much at all. The the most common reasons cited for denied claims include:

  • Eligibility and registration errors
  • Authorization issues
  • Service Not Covered denials

Roughly 86% of these denials could be avoided. Some of this spike was certainly due to the difficult circumstances we were all living in. Staff attrition might have left you short-handed and with knowledge gaps. Additionally, as your typical preventive and elective care dried up, your office was left with more complex, emergency cases—and these are the claims that are most prone to errors and payer scrutiny.

While it is understandable that your claims processes were imperfect during the early stages of the pandemic, you cannot afford to ignore avoidable, preventable revenue losses.

As you process claims, do your best to provide all the necessary information. However, do not stop there. Carefully track your claims’ progress and appeal denials when appropriate. (Our attorneys can help you determine how to proceed with complex individual or batch appeals, if you have questions.)

Lesson 2: Claims Are Also Getting Underpaid

When we talk about claims disputes, denials are usually at the top of mind. However, we are seeing a trend of underpaid claims, too. For example, the California Medical Association has reported such widespread problems with payments for COVID-19 rapid antigen testing that it asked the state to investigate the issue. The organization reports that at least two commercial payers (Anthem and UnitedHealthcare) were issuing payments that did not even cover the cost of the test kit.

Other physicians are reporting similar problems with their telehealth claims.

While getting $15.00 less on a claim might seem insignificant if it is a one-time event, consider the scope of your practice. Suppose you file 10,000 claims each year that are underpaid by $15.00 each. That is a $150,000 loss in revenue—and that amount is worth speaking to a physician and medical practice lawyer about.

It is a good idea to regularly audit your claims. You can identify underpayments early on, so you can act quickly to remedy the situation. And, more importantly, you can identify and correct operational issues that might replicate the problem over and over again.

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Lesson 3: Leverage Your Value and Renegotiate Your Payer Contracts

Scarcity of care can lead to unwanted healthcare outcomes; COVID-19 made that abundantly clear. As a frontline healthcare provider, you should be fairly compensated for the invaluable work you do.

As more payers transition to value-based care and payment structures, it is essential that you express your practice’s value proposition. If you are providing exceptional care that helps reduce your patients’ complication rates, work within an underserved community, or have a reputation for efficient and effective care, now is the time to highlight that.

With help from a physician or medical practice attorney, you might be able to renegotiate your provider-payer contracts with more favorable terms.

  • Exceptions that improve your fee schedule
  • Carve-outs
  • Increased time to submit a claim or file an appeal
  • Escalation clauses that help you keep pace with inflation

RELATED: Do You Understand Your Healthcare Payer Contracts?

Lesson 4: Many Patients Are Delaying Their Appointments, and This Trend Is Costly

Today, many people are hesitant to return to their doctors’ offices. One in five people delayed care during the pandemic. The number of children who are missing well child appointments is so significant that the American Association of Pediatricians launched a #CallYourPediatrician marketing campaign in 2020.

This led to a significant decrease in patient encounters over the last year. For physician-owned practices, the drop ranged from 11 to 18%. For hospital-owned practices, it was a jarring 35% to 50% reduction.

And while telehealth can help offset some of these losses, it is unlikely that it fully replaces your lost revenue.

According to Deloitte’s 2020 Survey of U.S. Healthcare Consumers, your patients are more engaged and concerned with their wellness than ever before—you just have to nurture your relationship and get them back in the door.

To help encourage these appointment-adverse patients, consider improving your patient experience:

  • Automate appointment reminders using software that texts or emails your patients, including follow-ups about necessary recare
  • Build trust by promoting office updates and events like vaccination clinics through your newsletter and your social media accounts
  • Create systems that boost efficiency and encourage more on-time appointments—especially if you are allowing fewer people in your waiting room
  • Offer online scheduling and payment options
  • Consider offering late or early appointments

Lesson 5: Do Not Ignore Your Operating Expenses

Most practices reported significant increases in their overhead and spending, much of that due to the skyrocketing cost of PPE. (Some practices, about 15%, reported that their costs associated with personal protective equipment more than doubled.) The average practice spent about 57% on PPE than they did pre-pandemic.

This burden fell most heavily on physician-owned practices that did not have the buying power of larger healthcare organizations. However, we would encourage you to build up your vendor relationships now.

Bryant Legal Group: Respected Medical Practice Attorneys in Chicago

Bryant Legal Group has earned a reputation as one of Illinois’ premier law firms for medical practice and payer-provider disputes. We have helped healthcare providers across the state renegotiate their contracts, navigate their complex provider-payer claims, and manage their revenue cycles.

We take a client-centered approach that is practical, sophisticated, and aggressive. If your organization has questions about boosting revenue and profitability, please contact our office for a free consultation. We can help you understand your legal options and rights.

To reach us, please call 312-667-2536 or complete 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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Over the past several years, medical practices (especially primary care practices) have struggled with their revenue streams—and the COVID-19 pandemic accelerated this trend. In an AMA survey, most doctors noted a significant drop in revenue during the pandemic; the average decrease was 32%.

Addressing these issues requires a multifaceted approach that embraces both new trends in healthcare and well-established best practices. Here, our physician and medical practice attorneys suggest practical steps you can take to improve your practice’s profitability and revenue stream.

1. Identify Missed Opportunities With a Gap Analysis

Even if you have a well-established medical practice, it is likely that you are missing out on opportunities to increase your revenue and patient volume. A gap analysis can help you identify room for improvement. During this exercise, you and your staff will review your current systems, assess their performance, and build a plan that addresses gaps in your medical practice.

Now, let’s explore the essential steps in your healthcare gap analysis.

Define the Gap Analysis’ Goal

Assessing your entire practice in a single gap analysis would likely be a daunting task. Instead, identify a few KPIs (key performance indicators) that you would like to improve. They might include:

  • Reducing the number of days your claims spend in accounts receivable
  • Increasing your number of new patients
  • Cutting your practice’s number of no-shows and cancellations
  • Improving your claim denial rate

If you are not sure how to identify the right KPIs for your practice, reach out to a medical practice attorney or consultant.

Critically Assess Your Medical Practice’s Operations

As your practice evolves, you will inevitably outgrow some of your old systems. Now is the time to critically look at everything you do and dig into your data. What are your staff and patients’ most common complaints? Are you having a hard time meeting certification or compliance standards? Are your patients or best employees leaving your practice at alarming rates?

During this process, you will find gaps in care and procedure; both are worth noting. For example, if your patients are failing to schedule annual exams or regularly no-showing for appointments, these are gaps in care. These gaps cost you money. One study suggests that every no-show and unfilled appointment slot costs your medical office $200.

As your practice evolves, you will inevitably outgrow some of your old systems. Now is the time to critically look at everything you do and dig into your data.

Procedural gaps involve organizational missteps or omissions that create inefficiency or result in financial losses. For example, you might discover that your medical billing team makes mistakes because they are using too many paper-based systems or lack training. Or, they might not have consistent systems when it comes to patient collections.

Do not sweep these gaps underneath the rug or make excuses. Instead, acknowledge them and start building systems that will help you rise above them.

Create Systems That Help You Reach Your Goals

Now that you know where you need to improve your practice management, you can start identifying possible solutions. During this process, weigh the costs and benefits of each solution. Sometimes, a possible solution might achieve your goals, but is too costly or time-consuming to practically implement.

For example, while you could hire several more front desk workers to call and email clients, reminding them about appointments, you might be able to use automated software that can seamlessly text and email your clients for a fraction of the cost.

Monitor Your Improvement and Adjust Your Tactics

Once you have implemented your new systems, carefully track your practice’s performance. Are you seeing steady improvement? Are you identifying other gaps and missed opportunities that you should address? Keeping track of your progress helps prevent a major crisis later.

2. Do Not Sit on Your Unpaid Claims (or Ignore Claims Denials)

Inefficient claims management is one of the top reasons that medical practices lose out on revenue. If your claims are spending more than 50-60 days in accounts receivable, you likely are experiencing cash flow issues.

However, denied claims do not just slow down your revenue stream. Every time your staff must rework a claim, it costs your practice about $118 per appeal.

Suppose your office sees 400 patients each month. Insurers deny about 13% of provider claims. That means that 52 of those monthly claims will get denied. If you rework them, you are going to pay at least $6,136 per month (or $73,632 per year) in administrative expenses.


And even worse, at least half of denied claims are never resubmitted, which means those practices are not getting compensated for their care.

Your office staff needs clear workflows and systems to ensure that they submit clean claims, understand each payer’s procedures and expectations, and can track each claim throughout the accounts receivable process.

Missed filing deadlines are one of the most common issues with unpaid claims. Make sure that you understand all the filing deadlines associated with your claims. There is a lot of variability between payer contracts. You might have 90 days or a year to request payment—or you might have as little as 15 days.

And, when a payer denies your claims, file corrected claims as quickly as possible. Those same filing deadlines often apply to corrected claims—so you might have a very short time frame to resubmit your reworked claim.

Collaborate with your billing team to manage their workflows, ensuring that you submit more clean claims, do not miss out on unbilled claims, and track their progress. (There are automated tools that can help you streamline this work).

RELATED: 5 Ways Your Healthcare Organization Can Reduce Payer Denials

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3. Renegotiate Your Payer Contracts

Too few physicians and medical practices review and renegotiate their payer contracts. Insurance companies are sometimes willing to offer more agreeable terms to high-performing medical groups. Your organization should highlight the following factors during your negotiations:

  • Low readmission rates and strong clinical outcomes
  • Appropriate delegation of care to lower-cost, high-quality providers (like nurse practitioners and telehealth services)
  • Issues relating to access to care or scarcity of providers in your community
  • High utilization rates for low-cost, preventive services (like well-care visits)
  • Metrics highlighting your patient experience

Notably, these factors align with the Healthcare Effectiveness Data and Information Set (HEDIS), which many plans must report on to maintain their health plan accreditation and Medicare star ratings.

If you are contributing to the healthcare plan’s bottom line by improving their HEDIS metrics and their ROI, you can credibly demand more favorable terms in your payer contracts.

If you are not sure where to start with the negotiation process, contact our law firm. Bryant Legal Group has helped numerous medical groups and physicians review, negotiate, and enforce their complex payer contracts.

RELATED: Do You Understand Your Healthcare Payer Contracts?

4. Embrace Your Patients’ Evolving Healthcare Consumerism

In many communities, especially large urban areas like Chicago, consumers are demanding more of their healthcare providers. They are looking at reviews, clinical outcome data, and other factors when deciding whether to work with (or stay with) a medical practice. If you are not delivering them care when and where they need it, you are likely going to lose out of business.

This might involve reducing your patients’ wait times, offering after-hours services, virtual visits, and new services (like walk-in immunization clinics or in-office laboratory testing). These changes, while sometimes work intensive, will boost your patient experience and appeal to savvy healthcare consumers.

Marketing can also play a role in increasing your revenue. You can build trust, loyalty, and brand awareness by connecting with your potential and existing patients online. Consider enhancing your website (for example, by including a patient portal, e-visit information, and online payment options), deepening your social media presence, and encouraging your patients to post testimonials and ratings on popular review sites.

While healthcare marketing might not provide an immediate increase in your medical practice profits, it will (over time) enhance your practice by boosting patient satisfaction and creating goodwill in your community.

Bryant Legal Group: Respected Medical Practice Attorneys in Chicago

Bryant Legal Group has earned a reputation as one of Illinois’ premier law firms for medical practice and payer-provider disputes. We have helped healthcare providers across the state renegotiate their contracts, navigate their complex provider-payer claims, and manage their revenue cycles.

We take a client-centered approach that is practical, sophisticated, and aggressive. If your organization has questions about boosting revenue and profitability, please contact our office for a free consultation. We can help you understand your legal options and rights.

To reach us, please call 312-667-2536 or complete this brief online form.

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

Contact Bryant Legal Group

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

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As we age, our chances of needing long-term care increase—and about 53% of us will need some form of long-term care for more than a year. In 2020, the average cost of a private room in an Illinois nursing home was $84,312. In the greater Chicago area, it cost $102,384.

Even if you have significant assets, these costs might seem unmanageable. That is why many people invest in long-term care insurance to help reduce this financial burden.

When the insurance company denies your loved one’s long-term care claim, it can feel like a violation of trust. After all, your family member has spent a considerable amount of money for this policy, only to be denied help when they need it most.

Our attorneys help people get the coverage they deserve, using practical, client-centered strategies and aggressive tactics. In this article, we explore long-term care denials and suggest ways you can improve your chances on appeal.

What Is Long-Term Care Insurance?

Some people are surprised to discover that Medicare will only pay for 100 days of skilled care. If your loved one’s need for care extends beyond that time, they will either need to pay the bill or qualify for Medicaid.

If you have significant assets or income, it is unlikely that you will qualify for Medicaid. Many middle-income and upper-income individuals purchase long-term insurance policies that step in and cover some of the costs of skilled nursing care, assisted living, at-home care, and even adult day care.

Long-term care insurance is typically sold by for-profit insurance companies like Mutual of Omaha and UNUM. These policies can vary dramatically. Some offer comprehensive coverage that pays for in-home, dementia, skilled nursing, and assisted living services, while others strictly limit coverage and have broad exclusions.

When someone with long-term care insurance no longer can live independently, they can file a claim. However, many families run into unexpected difficulties.

5 Reasons Why The Insurance Company Might Deny Your Long-Term Care Claim

1. The Facility or Caregiver Is Not an “Eligible Care Provider”

Long-term care insurance companies are very particular about who can provide covered services. Your loved one’s policy will probably only pay for services from an “eligible care provider.” Typically, these individuals and facilities are state-certified professionals.

Before you apply for long-term care benefits, it is a good idea to carefully review your policy’s language. If you request payment for services provided by a caregiver or facility that does not meet its criteria, the insurer will probably deny the claim.

Another possible stumbling block involves eligible care providers and waiting periods. For example, some long-term care policies’ waiting periods do not start until your loved one is consistently receiving care from a trained professional, and you will not get credit for similar services that a spouse or family member provided.

2. Your Loved One Can Still Perform Some Activities of Daily Living

To qualify for long-term care benefits, you typically must be unable to care for yourself independently. Many policies insist that you are unable to perform at least two out of six essential activities of daily living (ADLs).

These activities include:

  • Bathing and grooming
  • Dressing yourself
  • Feeding yourself
  • Continence
  • Toileting
  • Mobility

Sometimes, insurance adjusters will argue that your loved one can still perform basic ADLs, even though they struggle with them and might be unsafe living alone.

In these cases, a long-term care attorney can help you document your family member’s difficulties and need for skilled care. However, please note that some policies will not cover certain personal services, like light housekeeping, running errands, or social companionship.

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What Should You Do After An Insurer Denies Your Long-Term Care Insurance Claim

You should never assume that the insurance company’s long-term care insurance denial is correct. Long-term care is expensive, and companies are always trying to save money. Many insurers will dispute claims that they should legitimately cover, hoping that the policyholder will simply give up.

As soon as you receive a denial, you should contact a long-term care lawyer. They can help you interpret your loved one’s policy and assess your legal options. We might discover that they are owed long-term care insurance benefits and will suggest ways you can move forward.

Bryant Legal Group: Respected Long-Term Care Attorneys In Chicago

Bryant Legal Group has earned a reputation as one of Illinois’ premier disability and long-term care insurance firms. We have helped people across the state navigate their complex insurance claims and lawsuits. We take a client-centered approach that is practical, sophisticated, and aggressive.

If the insurance company denied your loved one’s long-term care insurance claim, please contact our office for a free consultation. We can help you understand your legal options and rights. To reach us, please call 312-667-2536 or complete this brief online form Contact Us.

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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Crohn’s disease and inflammatory bowel disease (IBD) are often considered “invisible disabilities,” but they can have a profound effect on your life. It can be impossible to work when you need unscheduled restroom breaks and live with chronic pain— not to mention the stress of living with other effects of the disease, like malnutrition and other serious symptoms.

If you have Crohn’s disease and are considering filing for long-term disability insurance benefits, the attorneys at Bryant Legal Group want to help. We guide professionals throughout Chicago, Illinois, and the rest of the country through their complex disability insurance claims.

In this article, we explore long-term disability claims involving Crohn’s disease and suggest ways you can strengthen your case from day one.

What Is Crohn’s Disease?

Crohn’s disease is a type of chronic inflammatory bowel disease. About three million people in the United States live with Crohn’s disease. The disease causes your immune system to overreact, attacking healthy tissues in your gastrointestinal tract—including your small bowel (ileum) and colon. Often, the disease affects the entire thickness of the bowel wall, causing severe pain and cramping.

Symptoms of Crohn’s disease can include:

  • Diarrhea and bowel urgency
  • Abdominal pain and cramping
  • Vomiting
  • Fatigue
  • Reduced appetite
  • Weight loss
  • Fever
  • Bloody stools and rectal bleeding
  • Strictures, or narrowing of your intestine
  • Fistulas, or ulcers that go through the entire bowel wall
  • Fissures
  • Mouth sores
  • Swollen, painful joints

For some people, it is a relatively minor inconvenience, with occasional pain and cramping, fatigue, and diarrhea. For others, the disease profoundly affects their lives, causing malnutrition, anemia, and bowel obstructions.

How Do You Treat Crohn’s Disease?

Currently, there is no cure for Crohn’s disease. And, because people with the disease can have very different symptoms, there is not a standard treatment protocol. Instead, your doctor and gastroenterologist will build a treatment plan that targets your specific issues and symptoms.

Depending on your circumstances, your treatment plan might include medications, surgeries, and dietary changes. Some treatment options, especially biologic therapies, require regular visits to a medical center for infusions. Others, especially some immunomodulators, can result in serious side effects, like nausea, vomiting, and even liver damage.

What Is the Difference Between Crohn’s Disease and Ulcerative Colitis?

Ulcerative colitis (UC) is another form of IBD (inflammatory bowel disease). Unlike Crohn’s disease, it affects only a limited amount of the gastrointestinal tract, typically the colon and rectum, and harms only the inner lining of your intestines.

Bloody stools, fatigue, abdominal pain, and bowel urgency are common symptoms of ulcerative colitis. While Crohn’s disease might skip areas of your GI tract, UC causes a more continuous inflammation and does not skip.

Working With Crohn’s Disease

Working with Crohn’s disease can be tricky, especially if you are prone to flares. According to a Journal of Medical Economics study, the average Crohn’s patient misses about 9.5 days each year, due to the disease. However, people with severe cases can miss a lot more time at work—especially if they require inpatient care or an invasive surgery.

If you can work with accommodations, like the ability to take frequent, unscheduled restroom breaks or work from home as needed, we encourage you to do so. However, over time, many people cannot maintain their jobs due to Crohn’s disease. In these cases, applying for disability insurance benefits can help offset your lost income.

RELATED: “Own Occupation” Disability Insurance Policies: A Guide for Doctors

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Can I Get Long-Term Disability Benefits for Crohn’s Disease or Inflammatory Bowel Disease?

Sometimes, Crohn’s disease can make you eligible for disability insurance benefits. During a short-lived flare, you might qualify for short-term disability benefits, which typically cover leaves of absence that are under a year. However, if you are facing a more prolonged issue, you might qualify for LTD (long-term disability) benefits.

Before you apply for long-term disability insurance benefits, you should carefully review your policy. Its terms, conditions, and definition of disability will impact your eligibility for monthly LTD benefits.

Most policies define disability in one of two ways:

  • Own occupation: If you cannot perform your current job, you are eligible for long-term disability benefits.
  • Any occupation: You are disabled if you cannot perform any type of full-time work, including the simplest, lightest jobs.

While most LTD policies, especially employer-sponsored ones, use the more restrictive “any occupation” definition, some policies do apply the “own occupation” standard. (However, after two years, some “own occupation” policies transition to the “any occupation definition.)

If you need help translating all the waiting periods, terminology, and procedures outlined in your insurance policy, contact our office, and schedule a consultation.

How Can I Strengthen My Long-Term Disability Insurance Claim?

Long-term disability claims involving Crohn’s disease and IBD can become complicated. Many of the disease’s symptoms, like fatigue, decreased appetite, and chronic pain are subjective, and you cannot easily document their severity. Sometimes, insurance adjusters will argue that your diagnostic testing and the frequency of your medical appointments are not consistent with a disabling, severe impairment. Other times, they will argue that you are noncompliant because you have struggled with dietary changes or medication side effects.

Do not accept these arguments on face value. Instead, consult with an experienced disability lawyer who can help you strengthen your case and fight back.

While nothing compares to personalized legal advice, here are some things you can do now to build up your Crohn’s disease-related disability insurance claim.

RELATED: “Self-Reported” Symptoms: How to Fight Back With Medical Evidence

See Your Doctors and Follow Their Recommendations

When you are living with a chronic condition like Crohn’s disease, it is tempting to self-treat your symptoms at home. After all, you probably know what your gastroenterologist will recommend and it might save you on medical bills.

However, medical records also help document your flares and can help your doctors track the progression of your disease and its severity. This information will be essential during your long-term disability claim.

First, it can help you pinpoint the time when your symptoms became disabling. Second, consistent medical care can refute the insurance company’s arguments that you are in better health than you claim to be.

Additionally, insurance companies sometimes deny claims because people are “noncompliant” with their treatment. Do your best to follow your gastroenterologist’s recommendations. And if you cannot tolerate a recommended therapy, reach out to your doctor before you make changes to your treatment plan.

Track Your Crohn’s Disease Symptoms and Flares

While a symptom journal is not as compelling as carefully written medical records, these logs can help you, your doctors, and your disability insurance lawyer understand your day-to-day limitations.

It is easy to report that you are doing “about the same” or “okay” when you see your doctors or fill out insurance forms. However, when you track your symptoms, you might realize that you have experienced a gradual worsening of your Crohn’s symptoms or that your number of “bad days” is increasing.

For example, you might want to monitor your daily pain levels, bowel urgency, weight loss, loss of appetite, energy levels, and other issues caused by Crohn’s disease in a notebook, calendar, or online app.

If you are not sure where to start with symptom tracking, check out our free Disability Insurance Claim Roadmap. It includes helpful worksheets and other advice that can help you prepare your LTD claim.

RELATED: Disability Insurance Claims, Made Simpler

Do Not Minimize Side Effects Associated With Your Medications

Many treatments associated with Crohn’s disease have serious side effects—and the insurance adjuster must take them into account when evaluating your disability claim. If you are struggling with nausea, fatigue, or other issues, mention this to your doctors, disability lawyer, and the insurance company.

Consult With an Experienced Disability Insurance Lawyer

It is easy to make mistakes when you’re dealing simultaneously with a chronic health condition and a long-term disability claim. When you work with one of our disability insurance lawyers, we handle the insurance company and the details of your claim. Our goal is to give you peace of mind and space to focus on your health.

Initial consultations with our law firm are free, so there is little to no risk associated with exploring your legal options.

Bryant Legal Group: Chicago’s Premier Disability Insurance Firm

The disability attorneys at Bryant Legal Group guide professionals through their complex legal claims. We take a practical, client-centered approach that focuses on you and your family’s unique needs—and we have recovered millions in compensation for our clients.

If you have questions about whether you are entitled to disability benefits due to Crohn’s disease or IBD, schedule your free consultation today. You can reach us by calling 312-667-2536 or completing this brief online form.

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

Contact Bryant Legal Group

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

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An estimated 60 to 80 percent of us will experience back pain during our lifetime. When conservative treatment options like injections and physical therapy do not control your chronic back pain, surgery might be your next option.

If you are facing a spinal surgery, you are not alone. Between 1998 and 2008, the number of back surgeries performed in the U.S. increased by more than 250%. More than a million people each year undergo these invasive operations.

Most people are unable to work while recovering from a back surgery. During this period, you may qualify for monthly disability insurance benefits if you have a short-term or long-term disability policy.

Please note that Bryant Legal Group focuses its practice on employer-sponsored and private disability insurance policies and plans. This article does not address eligibility for Social Security Disability Insurance (SSDI) benefits.

What to Expect After a Back Surgery

Here are some basics about the most common forms of spinal surgeries.

Discectomy

Discs are spongy shock absorbers that sit in between your spine’s bones (called vertebral bodies). When they are damaged, they can herniate or rupture—causing pressure on your spine’s nerve roots or the spinal cord. A discectomy involves removing part of a damaged or herniated disc.

Doctors perform minimally invasive discectomies (sometimes called microdiscectomies or laser discectomies) and open discectomies (where a large incision is made). The operations have different recovery times, with open surgeries taking longer to heal.

If you have an office job, you might return to work within a month. However, if your work is more physically demanding, you might be unable to work for four months or more.

Laminectomy

Laminectomies aim to relieve pain by relieving pressure in the spine. A lamina is an arch-shaped part of your vertebral body which surrounds the spinal canal along the back side of the spine. If the spinal canal has become narrowed (spinal stenosis), removing part of a lamina can give your nerves more space and relieve radiculopathy, a type of nerve pain that radiates down a limb. It is sometimes combined with another operation, like a discectomy or fusion.

If you are simply undergoing a laminectomy, you might return to work in a few weeks—especially if you have a light office job. If you must stand, stoop, lift as part of your job, you might be unable to work for two months or more.

Spinal Fusion

During a spinal fusion, your orthopedic or neurosurgeon will fuse two of your vertebral bodies (the bones that make up your spine) together, using a bone graft and hardware. The operation aims to stabilize your spine and reduce pressure on your nerve roots and spinal cord.

It is one of the more invasive forms of back surgery and it can take more than a year to fully recover from a fusion. However, your doctor may allow you to gradually return to activities within three to six months.

Disc Replacement

Sometimes, disc replacement is an option. This newer form of back surgery involves removing a damaged disc and inserting metal or plastic artificial disc in its place. It is an alternative to a spinal fusion surgery.

Some patients need three months or more to recover from a disc replacement.

Your Recovery Time Will Depend on Many Factors

While no two recoveries are the same, there are some common factors that will affect the speed and effectiveness of the healing process. Here are some of the primary factors that might affect your recovery times.

Tobacco Use and Vaping

Smoking and tobacco use slow your recovery by reducing your blood flow and the amount of oxygen in your blood. It also makes you more prone to infections.

Most orthopedic physicians will not operate on people who are actively smoking or vaping. However, if you return to the habit post-operatively, you might be putting your recovery in danger. It might also complicate your disability insurance claim, since the adjuster might argue that your inability to work is due to noncompliance, rather than your medical conditions.

Pre-Existing Depression and Anxiety

People with a history of depression, anxiety, or other mental health issues tend to report slower and more difficult recoveries after back surgery. Research suggests that mental health issues can amplify pain and reduce your quality of life. Over time, these conditions can snowball, resulting in debilitating chronic pain, depression, and anxiety.

If you are struggling with your mental health, speak with your doctor right away. They can offer therapies and medications that can help you regain control. And if you are experiencing thoughts of self-harm, please call 911 or seek immediate medical care.

Post-Surgical Complications and Failed Back Syndrome

Non-unions, infections, and other complications can add weeks, months, or even years to your recovery—especially if you need a revision surgery. Unfortunately, even if your surgery is relatively unremarkable, it does not guarantee that your back pain will resolve.

According to one study, at least 50% of spine surgery patients reported ongoing back problems post-operatively. Depending on your circumstances, you might need treatment from a pain specialist, physical therapist, or surgeon.

Looking for Personalized Advice From an Insurance Lawyer?

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When Is a Back Surgery Disabling?

Most people cannot work immediately after a spinal surgery. Your doctor will likely tell you that you should not work until after your first post-surgical checkup, and then they will tailor your restrictions based on your outcome and job duties.

However, “disability” is a legal term, and you need to understand your short-term or long-term disability insurance policy’s definition before you apply for benefits. Most plans define disability in one of two ways:

  • Own occupation: You are eligible for a monthly benefit payment if you cannot perform your current job.
  • Any occupation: You are disabled if you cannot perform any type of full-time work, including the simplest, lightest jobs.

This analysis requires a careful consideration of your medical records, work restrictions, training and qualifications, and other information. Before you apply for disability insurance benefits, you should review your policy and identify which definition applies to your disability claim. While most short-term disability plans follow an “own occupation” standard, long-term disability policies are more variable.

You should also look out for elimination or waiting periods in your policy. These periods act as a sort of deductible.

For example, suppose you cannot work for three months while you heal from a discectomy, and your short-term disability policy has a two-week elimination period. So, instead of receiving three months of benefits, you will only get about two-and-a-half months of compensation. (12 weeks of disability – 2 weeks = 10 weeks of benefits.) If your elimination period exceeds your time off work, you will not receive disability insurance benefits at all.

If you need help understanding your policy’s precise terms and conditions, schedule a consultation with one of our disability insurance lawyers.

How to File for Short-Term or Long-Term Disability Insurance After a Back Surgery

Once you have assessed your eligibility for disability insurance benefits, you and your lawyer can start the application process. This typically involves completing a series of forms and requesting information from your doctors.

Next, the insurance company will investigate your claim. Its adjuster will review your medical records, statements from both you and your medical team, and decide whether they think you have the functional capacity to work. Once they have made a decision, you will get a written notice that your claim was either approved or denied.

However, do not assume that the insurance company got it right. These for-profit businesses frequently deny legitimate claims to save money. If the insurer denies your claim, it is best to consult with a respected disability insurance lawyer who can give you an honest assessment of your case.

RELATED: How Do You Prove You Are Disabled Under a Disability Insurance Policy?

Bryant Legal Group: Chicago’s Disability Insurance Firm

The disability attorneys at Bryant Legal Group guide professionals through their complex legal claims. We take a practical, client-centered approach that focuses on you and your family’s unique needs—and we have recovered millions in compensation for our clients.

If you have questions about whether you are entitled to disability benefits due to a back condition or surgery, schedule your free consultation today. You can reach us by calling 312-667-2536 or completing this brief online form.

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

Contact Bryant Legal Group

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

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.

Bryant Legal Group

In 2011, legendary basketball coach Pat Summitt announced that she had been diagnosed with early-onset dementia. She continued to coach the Tennessee Volunteers for another season with support from her staff.

While this seemed novel back then, Coach Summitt’s story is increasingly common today. Doctors are diagnosing dementia earlier and earlier. That means that many people—especially people with early-onset dementia—are trying to figure out how to manage their professional lives and their condition simultaneously.

If you or a loved one were recently diagnosed with dementia, you have options. Sometimes, you can manage your condition and workload—at least for a while. In this article, the disability insurance lawyers at Bryant Legal Group explore early-onset dementia and how it might impact your ability to work.

Doctors Are Diagnosing Alzheimer’s Disease and Dementia Earlier Than Ever

According to data from Blue Cross Blue Shield, early-onset dementia diagnoses increased by 200% between 2013 and 2017. While doctors sometimes diagnose early-onset dementia in 30-year-olds, the insurance company reports that the average age of these patients was 49.

If you are a younger person (under the age of 65) living with a dementia diagnosis, you might feel like you have a lot on the line. Unlike older dementia patients, your family might be relatively young. You probably have more financial obligations, like a mortgage or a child’s tuition bills.

However, now is not the time to bury your head in the sand. The more you prepare early on, the better situated you and your loved ones will be if or when your disease progresses.

The Stages of Dementia: An Overview

Dementia is much more than Alzheimer’s disease—although that is the most common dementia-related diagnosis. From mild cognitive impairment (MCI) to Lewy body and vascular dementia, there are many diagnoses that fall into the spectrum of “dementia.” Different people will exhibit different symptoms—and their disease might progress at different rates.

Doctors typically describe three stages in a dementia diagnosis:

  • Early dementia: During this period, you might notice mild memory loss, such as frequently losing objects or feeling absent-minded, as well as word-finding problems. In the past, early dementia was often undiagnosed, but this is changing. Many people continue to work with early-stage dementia.
  • Middle-stage dementia: You or your caregiver might notice that significant memory loss is affecting your daily routine. You might neglect activities of daily living and personal care, like eating regular meals, bathing, and grooming. Some people develop mood changes and can become emotionally volatile. This is the longest stage for most dementia patients.
  • Late dementia: In late-stage dementia, you require 24-hour care and quickly forget new information. You also might have a hard time communicating with your loved ones, walking, sitting, or even swallowing.

While your early-stage dementia symptoms might seem inconsequential, it is essential that you take action early on and start planning for your future. This might include drafting a power of attorney that names your personal representative, detailed financial planning, and considering your long-term care options (home care, respite care, assisted living, nursing home, etc.)

Looking for Personalized Advice From an Insurance Lawyer?

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Can You Work With Dementia or Alzheimer’s Disease?

Sometimes, people can continue to work for a period after being diagnosed with dementia. Coach Summitt, for example, wrapped up her final season with significant support from her coaching staff.

If you want to continue working, you should consult with your medical team and identify accommodations that can support you. Many people take pride in the fact that they could wrap up important projects, transfer their knowledge, or refer their clients or patients to another respected professional before they retired.

Your work and lifestyle accommodations might include:

  • Adopting a more structured, consistent schedule or daily routine that includes rest and meal periods
  • Avoiding high-stress or high-pressure situations
  • Limiting distractions during important meetings or activities
  • Transitioning to a more team-based approach that offers support and opportunities for collaboration
  • Using calendars and other tools to keep track of your work

However, every case is different—and you should not put your pride above other people’s safety or welfare.

If your job requires attention to detail, precise calculations, or extreme mental acuity and decision-making, you might have to quit your job sooner—even if you can still perform routine, simple tasks. While healthcare and healing professions are the most obvious examples here, other highly skilled occupations and those involving physical hazards might also require a quick departure from the workforce.

RELATED: How Do You Prove You Are Disabled Under a Disability Insurance Policy?

Unable to Work Due to Dementia? Consider Filing for Long-Term Disability Benefits

When you or a family member are preparing for a life with dementia, long-term disability insurance will likely be part of your plan. You might have an employer-sponsored plan or a private policy that provides monthly income when you can no longer work.

Before you apply for disability insurance benefits, you should carefully review your policy’s language. While some policies will only pay monthly benefits to those who are completely unable to work, others will issue benefits if you are unable to do your current job. Some plans will even pay a residual or partial benefit if you return to a different, less difficult job.

If you need help understanding your policy’s terms and conditions, we can help you. Our team of experienced disability lawyers has helped disabled individuals recover millions in compensation and benefits—giving both them and their families peace of mind.

What to Look Out for in a Dementia-Related Disability Claim

Even if you think your dementia is undeniable, the disability insurance company might see your case differently. Sometimes, insurance adjusters will try to argue that disability insurance claims for dementia are limited to two years of benefits, citing the policy’s mental health or “self-reported symptoms” limitations.

Do not fall for this tactic. Dementia affects both your mental and physical health, and you might have a strong argument that these limitations do not apply to your claim. A skilled disability insurance lawyer can help you collect evidence, including brain scans and blood tests that document your condition.

Similarly, even if you have an “any occupation” policy, which only pays disability benefits if you cannot perform any type of work, do not assume that you are not disabled. Working with neuropsychologists, doctors, and other specialists, a lawyer might be able to show that your dementia makes it impossible to work.

Bryant Legal Group: Chicago’s Long-Term Disability Attorneys

Bryant Legal Group’s respected disability insurance lawyers are known for their sophisticated legal strategies and client-focused results. Whether you are preparing your long-term financial and care plan, or the insurance company denied your claim or limited your dementia-related benefits, contact our office for a free consultation. We can help you understand your legal options.

To reach us, please call 312-667-2536 or complete this brief online form.

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

Contact Bryant Legal Group

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

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.

Bryant Legal Group

We have learned a lot about COVID-19: how it is transmitted, how we can fight the disease, and who is most at risk. However, we are only just beginning to understand how the virus affects our bodies over the long term.

If you are one of the roughly 30% of coronavirus patients who are living with long COVID or post-COVID symptoms, you might be eligible for long-term disability insurance benefits. In this article, our team explores some of the emerging research regarding long haul Covid and your options if you can no longer work due to the disease.

COVID-19 Can Cause Permanent Damage and Disability

Most people with COVID-19 start feeling better within a matter of weeks, but this life-threatening virus can have a profound effect on the human body — and we are just now starting to understand its full impact.

A Michigan-based survey, which assessed outcomes of 1,648 patients, found that at least one-third of hospitalized COVID-19 patients experience symptoms a month after their diagnosis. Further, 10% of people who were not hospitalized reported ongoing fatigue, muscle weakness, mental fogginess, and shortness of breath.

These numbers are similar to a comprehensive VA study that tracked more than 73,000 VA patients who were hospitalized with COVID-19. A troubling pattern emerged from the study’s data:

  • People with COVID-19 were 60% more likely to die within six months of becoming infected
  • COVID-19 patients who were not hospitalized were 20% more likely to need outpatient medical care than non-COVID patients
  • In addition to lung and respiratory problems, COVID-19 patients reported a wide array of new, previously undiagnosed medical conditions — including cardiovascular issues, neurological dysfunction, mental illness, sleep disorders, and gastrointestinal problems.

It appears that there are many ways that COVID-19 can affect your body long-term, including:

  • Multi-organ damage: COVID-19 can damage to your lungs, heart, brain, and nervous system — even leading to multisystem inflammatory syndrome (MIS) and autoimmune disorders.
  • Post-intensive care syndrome and PTSD: While life-maintaining equipment is often essential in severe COVID cases, it is hard on our minds and bodies. Many people who spend a long time in the ICU experience both a mental and physical decline in their health.
  • Long COVID: Many patients report persistent COVID-19 symptoms, even when they do not have an active infection. Many survivors refer to themselves as ‘long haulers.”

While some of these conditions are supported by objective data (CT scans, pulmonary function tests, etc.), many long haulers struggle with subjective symptoms, such as fatigue and mental fogginess. This can lead to challenges in a short-term or long-term disability claim.

What Is Long COVID?

Doctors and researcher do not yet fully understand “long COVID,” or “post-acute sequelae of SARS-CoV2 infection.” A significant number of COVID-19 patients struggle to fully recover after contracting the virus. Even if their viral loads seem low and their diagnostic tests are within “normal limits,” they have difficulties returning to their pre-COVID routine, often reporting debilitating fatigue, shortness of breath, anxiety, and other symptoms.

In 2021, the National Institutes of Health launched a $1.15 billion four-year project that aims to uncover the condition’s causes, treatment options, and outcomes. Similarly, the National Institutes for Health Research in the UK are tracking 10,000 patients to monitor their long-term health outcomes.

RELATED: Disability Insurance in a Nutshell

Can I Get Long-Term Disability for Long COVID?

Possibly. To fully evaluate your eligibility and coverage for long-term disability benefits, you should start by reviewing your policy’s language. Specifically, look for the following information:

  • Your policy’s definition of disability
  • Its exclusions and limitations, especially those involving “self-reported” symptoms
  • Its claim and appeal procedures
  • Any waiting or exclusion periods that apply to your claim

If you need help interpreting your policy’s convoluted, technical language, schedule a consultation with an experienced disability insurance lawyer.

When you are ready to file a claim for disability insurance benefits, you will need to collect a lot of information about your medical conditions and current abilities. Because long COVID is a new condition, the insurance adjusters have a limited understanding of its signs and symptoms — you will need to do a lot of educating.

You should compile:

  • Copies of your medical records, especially those involving your COVID-19 diagnosis and post-COVID treatment
  • Statements from your doctors about your long COVID symptoms and any objective findings supporting your claim
  • Any other information you have about your diagnosis and limitations

RELATED: How Do You Prove You Are Disabled Under a Disability Insurance Policy?

Looking for Personalized Advice From an Insurance Lawyer?

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Are Insurers Denying COVID Long-Haulers’ Disability Claims?

Disability insurance adjusters tend to deny claims where they have a rare or newly discovered diagnosis — especially when people experience hard-to-measure symptoms like fatigue and mental fogginess. Right now, we are seeing insurance companies approach long COVID with a lot skepticism.

You should not assume that your long COVID disability claim will be simple and straightforward. We expect a lot of adjusters to argue that people with long COVID have fully recovered from the coronavirus and can return to work— implying that they are exaggerating their symptoms. They might also claim that long COVID symptoms are self-reported, triggering a two-year limitation on LTD benefits.

To fight back, you will need to work closely with a leading disability insurance attorney and experts who can explain this developing diagnosis, the objective findings that support it, and how it limits their ability to work. This might include consulting with neuropsychologists and other specialists.

Bryant Legal Group: Respected Long-Term Care Attorneys In Chicago

Bryant Legal Group’s respected disability insurance lawyers are known for their sophisticated legal strategies and client-focused results. If the insurance company denied your claim or limited your benefits due to long COVID, please contact our office for a free consultation. We can help you understand your legal options.

To reach us, please call 312-667-2536 or complete this brief online form.

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

Contact Bryant Legal Group

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

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.