Let’s say you’ve been suffering from a progressive neurological disease for the past 10 years. In the last few months, your pain, fatigue and cognitive problems have been interfering with your ability to perform your job duties. Last month you received your first bad performance review in the 15 years you’ve worked for your employer. You love your job and want to keep working, but you’re struggling with your medical condition, and you’re afraid you will be fired. So, you’ve made the tough decision to stop working and go out on disability. But, you are so overwhelmed by your symptoms, you don’t know where to begin. Whether you have your own individual policy or a group policy through your employer, we can help.
The Long Term Disability application process can be confusing and cumbersome, especially when you are suffering from the debilitating effects of your medical conditions. Hiring a knowledgeable attorney from the outset of your disability claim can help you to avoid the insurance company’s tricks and the common pitfalls that plague many claimants. The disability attorneys at Hiller, PC have decades of experience successfully helping clients apply for, and obtain, their disability benefits.
Here are some of the steps we take when helping a client file a Long Term Disability claim:
1. Provide Notice of Claim to the Insurance Company. We will notify your insurance company that you have a claim for disability benefits. In the Notice of Claim letter, we will advise the insurance company that you are represented by counsel, and that all correspondence should go through our office. In other words, the insurance company should not contact you directly. Your focus should be on treating your symptoms, not dealing with your insurance company’s requests.
Once your Notice of Claim is submitted, your insurance company will send us the application or “Proof of Claim” forms to complete.
2. Assist in Completing Your Long Term Disability Claim Application. The Long Term Disability Application can be lengthy, and often times confusing (by design). It typically consists of three parts, as follows:
– Claimant’s Statement. Here, the insurance company will ask you to answer questions about your occupation and disability. For example, your insurer may ask for: your job title; your job duties; the date you first noticed your symptoms; the date you stopped working; the reasons why you cannot perform your specific job duties; the contact information for your treating doctors; a list of your prescription medications; and a list of your daily activities, and how they have changed since your disability began. The answers to these questions, while seemingly insignificant, are actually very important. For example, if you have an own occupation policy, you should document your job duties in great detail, and thoroughly explain how your symptoms prevent you from performing those duties.
If the insurer does not schedule an interview (discussed below), this application may be your only opportunity to explain, in your own words, why you are disabled. So, you should not limit yourself to the space provided on the application forms. Insurance companies notoriously provide only two or three lines for you to answer a question that could easily take multiple paragraphs or pages. We will assist in creating the rider necessary to provide detailed and comprehensive responses to the insurer’s questions.
– Attending Physician’s Statement. This form should be completed by the treating doctor(s) that recommended you stop working on account of your disability. It will ask your doctor questions regarding your: diagnoses; symptoms; objective physical exam findings; subjective complaints; hospitalizations; restrictions; and limitations. The Attending Physician’s Statement generally asks your doctor when he/she told you to stop working, and when you can return to work.
– Employer’s Statement. This form will ask your employer to provide general information about your job. For example, the form will request information regarding: your date of hire; the date you last worked; your salary at the time you stopped working; the date you first became covered under the Long Term Disability Policy (if applicable); your job duties; and the premium payment information.
In addition, the Insurance Company will request that you sign an authorization allowing them to request information from your doctors.
We will assist you in completing your Claimant’s Statement and we will work with your doctors and employers to complete their respective forms. For any disability claim, it is of the utmost importance that these forms be completed thoroughly and accurately. We will make sure you don’t get “tripped up” by the insurance companies’ manipulations.
3. Gather Medical & Vocational Evidence. In addition to the Attending Physician’s Statement, we will gather all other necessary information and evidence to prove that you are unable to work in your own or (where applicable) any occupation. This may include, without limitation:
– Medical Records from your treating doctors to document your symptoms, physical examination findings, treatment, and diagnoses;
– Narrative Reports from your treating doctors to explain your conditions/symptoms in more detail;
– Functional Capacity Questionnaires to help document your specific restrictions and limitations;
– Objective Testing such as MRIs, CT Scans, X-rays, Electromyograms/Nerve Conduction Studies, Pulmonary Function Tests, Electrocardiograms, Stress Tests, etc. Depending on the nature of your disability, we may also suggest some specific testing such as a Functional Capacity Evaluation, Neuropsychological Testing; or a Cardiopulmonary Exercise Test;
– Symptom Diary or Headache Log to document the frequency, severity, and duration of your symptoms. These documents can prove particularly helpful if you suffer from the type of disability that does not lend itself to objective testing, such as Migraine Headaches, Complex Regional Pain Syndrome, Chronic Fatigue Syndrome, etc.
– Detailed job description to document the specific requirements of your occupation; and
– Vocational Assessment to explain how your medical conditions and symptoms are incompatible with performance of your job duties.
We understand people will experience their symptoms differently — even people with the same diagnosis. As a result, we work closely with you to devise an individualized claim strategy designed to maximize the chances of obtaining approval of your disability benefits. Our goal is to obtain your benefits for you without having to resort to the appeal process which could leave you without your disability benefits for an extended period of time.
4. Submit Your Claim for Disability Benefits to the Insurance Company. Once your application is completed and we’ve compiled the necessary evidence to prove your disability, we will submit your application package to your insurance company. As you can imagine, this may consist of hundreds, if not thousands, of pages depending on the extent of your medical documentation. We will ensure that your claim is filed within any deadlines given by your insurer or contained in your disability policy. We will also comply with any additional requests the insurance company may have after your application is submitted.
5. Attend Interviews with the Insurance Company. After the submission of your disability application, your insurance company may request either a telephonic or in-person interview. We will thoroughly prepare you, and attend the interview with you. We will not let the insurer interview you alone, and will do our best to protect your interests.
Contact a Lawyer for Help with Your Disability Claim
Long Term Disability claims contain many moving parts, and can be difficult to navigate. You should be sure to submit sufficient evidence to prove your claim. Having knowledgeable New York disability attorneys assisting you from the start of your claim will help you to avoid some mistakes that could lead to an unfair denial. Contact NY disability insurance lawyers at Hiller, PC at (212) 319-4000 to get started today!