Do you have a physical or mental condition or even a sickness that prevents you from sustaining regular work on a full-time basis? If so, you may qualify for long-term disability benefits. Understanding the criteria for eligibility is essential for anyone considering filing a claim.
Federal rules, under the Employee Retirement Income Security Act (ERISA), govern claims for employer-sponsored plans. There are significant time-sensitive steps involved, so reaching out to a skilled California disability denial claims attorney immediately can help safeguard your rights. For prompt help, call (818) 356-4747 now.
Long-Term disability policies have multiple parts to them. There is a short-term portion and a long-term portion that has two separate definitions to it. Most policies define “disability” as an inability to perform the material duties on a full-time basis of your own occupation due to a medically verified condition. However, the exact definitions can vary significantly from one insurance provider to another.
This variance means that a condition deemed disabling under one policy might not meet the criteria under a different policy. The Social Security Administration (SSA) provides a well-recognized framework for understanding disability. According to SSA guidelines, a disability is established when a medical condition is severe enough to prevent engagement in substantial gainful activity and is expected to last at least 12 consecutive months or result in death. However, long-term disability insurance companies do not abide by this rule.
When insurers denies your claim, a California disability denial claims lawyer can review your policy terms and records to help provide guidance and information to help you meet the necessary criteria. We will scrutinize the policy language and compare it with federal standards, and the policy in question, to build a solid case. See the following examples:
Sample 1: Total Inability to Work
Consider an individual whose severe rheumatoid arthritis prevents them from performing any physical tasks required at their job as a warehouse worker. In this scenario, documentation might include:
Most insurance companies do not think there is enough. However our office can help explain the information and get additional information to support this claim.
Sample 2: Task-Specific Limitations
Now, take the example of an office worker with carpal tunnel syndrome that makes typing and data entry impossible. Here, the focus shifts to the specific tasks that the job entails. This would apply to your own-occupation definition of your claim. Documentation could include:
Sample 3: Progressive Conditions
For progressive conditions, such as multiple sclerosis (MS), the claim may rest on documented evidence of a deteriorating condition over time. In these cases, effective documentation might include:
Accurate objective medical documentation is the cornerstone of any disability claim. Comprehensive test results, detailed treatment plans, and corroborative physician statements serve as critical evidence, both during the initial claim and if an appeal becomes necessary. Additionally, understanding the specific exclusions and limitations within your policy is essential. A thorough review can reveal nuances that might affect your claim, such as pre-existing conditions or policy-specific deadlines for submitting documentation.
Working through a disability claim can feel daunting, but timely action often makes all the difference. Todd Krauss, APC helps claimants pursue fair treatment, whether through appeals or litigation under ERISA. Secure the support you need to move forward—call (818) 356-4747. Reach out and contact us today.
Facing issues with your Employee Retirement Income Security Act (ERISA) benefits can be overwhelming. At Todd Krauss, APC, we provide the legal help needed to address these concerns and protect your rights in your time of need. If you have been denied disability claims, or life insurance benefits, understanding when to seek legal assistance is crucial.
If your disability insurance claim is denied, it’s important to act quickly. ERISA law has strict deadlines for filing appeals. An experienced California disability denial claims attorney can review your situation and determine the best course of action. Here are some common reasons to seek legal ERISA help:
Denied claims require a precise strategy involving an administrative appeal. If the appeal is unsuccessful, litigation is necessary. Our legal team understands the timelines and procedures of ERISA cases, giving you a better chance of success when pursuing your disability benefits. Don’t wait to seek assistance. The clock is always ticking.
ERISA, governs employer-sponsored benefits like life insurance and long-term care insurance. If these benefits are denied, an ERISA attorney can help you understand your rights and the appeals process. Denials often occur due to technicalities or disputed medical evidence, and an attorney can assess the validity of your claim. They can also guide you through the detailed appeals process, ensuring deadlines are met and documents are properly submitted.
Skilled in negotiation, an ERISA attorney may reach a favorable settlement without litigation. If your claim is repeatedly denied, they can represent you in court, utilizing their knowledge of ERISA law. ERISA cases require thorough legal insight to ensure your rights are protected and your claim is managed correctly.
Waiting too long to take action can also significantly impact your ability to recover benefits. Deadlines in ERISA cases are strict, and failing to file an appeal or lawsuit on time could result in the permanent loss of your rights. If you’re dealing with a denial of disability, retirement, or life insurance benefits, it’s essential to consult with a knowledgeable lawyer as soon as possible.
If you’re facing a disability denial or struggling with ERISA-related issues, it’s important to act swiftly. Todd Krauss, APC, can help you navigate the ERISA legal process, ensuring your rights are protected every step of the way. Whether you need assistance with a denied claim, retirement dispute, or life insurance issue, our team is ready to fight for you. Call us today to schedule a consultation.
When facing disability claims, individuals often encounter vocational consultants tasked with evaluating whether claimants possess transferable skills that could potentially lead to alternative employment. This is a critical stage where the future of your benefits might hang in the balance. Todd Krauss, APC, a law firm deeply rooted in ERISA and disability claims, has seen numerous cases where such evaluations have significantly impacted claimants’ lives.
Vocational consultants play a pivotal role in the evaluation of disability claims by assessing a claimant’s abilities to determine if they can work in a different job than their previous one, despite any disabilities. These assessments focus on identifying transferable skills—broad abilities like communication and problem-solving—that theoretically could enable individuals to engage in different employment. However, this analysis can sometimes be simplistic and may not fully consider the claimant’s actual capabilities or the specific limitations imposed by their disabilities.
Under U.S. disability law, evaluations for disability must consider the individual’s ability to perform jobs existing in significant numbers within the national economy, taking into account the claimant’s age, education, training, work experience and sometimes wages benefits. The insurance companies do not always clearly factor in all the necessary elements in hopes of trying to deny a claimants rights to benefits.
The assessment of transferable skills can be a double-edged sword in disability claims. On one hand, identifying skills that can be transferred to other jobs can be beneficial for individuals looking to adapt to new employment after an injury. On the other hand, this analysis is often used by insurance companies to justify denying disability benefits, arguing that the presence of such skills implies that the claimant can find suitable employment despite their disability.
This perspective does not always reflect the realities of the job market or the specific challenges that come with an individual’s condition. What the insurance companies do not do is emphasize that the evaluation process should account for an individual’s ability to perform work consistently and on a regular basis, considering their physical limitations, pain, and fatigue, as well as mental health impairments. Furthermore, they do not always accurately identify what is transferrable, what rates the transferrable skills are at and more. All of this is done to deny a claimant their rightful benefits.
As the old saying goes, you need to fight fire with fire. If the insurance company conducts a transferable skills and vocational analysis in an attempt to deny your benefits, you must respond and show why their analysis is wrong.
Choosing the right legal representative can make the difference between losing out on essential benefits and securing the support you need to manage your disability. With a dedicated team led by a seasoned California disability denial claims lawyer, our firm ensures that every case is handled with the utmost care and legal acumen.
Ready to protect your rights and reclaim your benefits? Contact us today to schedule your consultation and take the first step towards securing your future.
When you rely on long term disability insurance benefits, noticing a reduction in your monthly payments can be both surprising and distressing. At Todd Krauss, APC, a key focus is helping clients understand and address such changes, especially those covered under the Employee Retirement Income Security Act (ERISA). This insight can provide clarity on why your insurer might be lowering the benefits you depend on.
Offsets are provisions in disability insurance policies that allow the insurance company to reduce your monthly benefit amount by the amount you receive from other sources of income. These sources can include Social Security Disability Insurance (SSDI), state disability benefits, workers’ compensation, and pension benefits.
The purpose of offsets is to prevent you from receiving more income than you earned before your disability. Insurance offsets occur when your insurance provider deducts specific amounts from your benefit payments, which are often due to these income sources you may be receiving. These offsets can also lead to an overpayment issue which means the insurance company will be asking for money back from you.
The details of how offsets work will vary depending on your specific disability insurance policy. It’s crucial to carefully review your policy documents to understand:
Disability insurance benefits can be reduced by offsets from other income sources. Understanding these offsets is crucial for accurately calculating your potential disability income. If you’re concerned about a reduction in your disability benefits, consulting with a California disability denial claims attorney can help you protect your rights.
If your disability insurance company reduces your benefits due to offsets, it’s important to understand if the reduction is valid. Here are some situations where you may want to consider seeking legal assistance from a California disability denial claims lawyer:
Insurance companies often operate within their contractual rights when applying offsets, but errors can occur. Whether these deductions are justified can sometimes be a matter of complex legal evaluation. At Todd Krauss, APC, our commitment is to ensure that your rights are vigorously defended so that you receive every dollar of the benefits you deserve. Reach out to us and let our seasoned attorney provide the support and advocacy you need. Don’t hesitate to contact us today for a free consultation to discuss your specific situation.
Todd Krauss, APC was asked to take over a case for another firm that does not actually litigate cases. It was an auto case where the Plaintiff was rear ended by a driver for a company he was working for and not paying attention. The Plaintiff suffered injuries to his neck and back along with some psychological issues dealing with all of his loss. It affected the Plaintiff, his family and his job.
The Plaintiff had a previous injury to his back and had extensive medical care along with a recommendation for surgery, and had not fully recovered at the time of the accident. The Defendants attempted to argue that previous back injury, which there was a recommendation for surgery, was not caused by this accident and they were not responsible for it.
There were seven experts on each, from orthopedic, neurosurgeons, accident reconstructionist, certified accountants, and more. Todd Krauss, APC had to deal with what was already done previously by the Plaintiff’s former counsel, but was still able to do enough discovery along with handling all the expert witnesses as he prepared the case for what eventually was an arbitration between the parties.
The case was handled over a couple of days along with submitted numerous documents to the arbitrator.
After reviewing all the evidence, the arbitrator issued a 10 page ruling in favor of the Plaintiff and awarded 2.35 Million Dollars. Needless to say, this is a life changing event for the Plaintiff who will be able to get his life back on track.
If you or anyone you know needs assistance with a case call me now.
Receiving a long-term insurance denial can be frustrating, especially when the reason cited is a pre-existing condition. At Todd Krauss, APC, we have extensive experience dealing with such denials and are dedicated to advocating for the rights of our clients.
When it comes to insurance claims, especially those related to long-term disability the term “pre-existing condition” plays a pivotal role in the evaluation process. A pre-existing condition is any health issue that was diagnosed or treated prior to the commencement of an insurance policy within a certain timeframe of your potential long-term disability insurance coverage. Insurers often scrutinize these conditions closely and may use them as a basis to deny claims. This scrutiny arises because insurance policies are typically designed to cover conditions that develop after coverage has begun, leaving those illnesses or injuries that occurred before to possibly fall outside the scope of coverage.
The presence of a pre-existing condition can act to exclude a person from their long term disability benefits. It often leads to increased scrutiny of a claimant’s medical history and can result in longer and more complex dealings with insurance companies. This issue is particularly significant in claims for disability benefits where the stakes are high for both the insurer and the insured.
When filing for insurance claims, the accuracy and completeness of the information provided can significantly impact the outcome. Here are the three most common reasons for denials.
One of the most common triggers for claim denial is the failure of applicants to fully disclose their medical histories on their long term disability applications. If, after submitting a claim, an insurer discovers that a medical condition was being treated within a certain timeframe of coverage, they will use this to deny the claim.
Every long-term disability policy has definitions that they follow in determining if a person meets the definition of disability. When it comes to pre-existing conditions, they set forth in the definitions what they are allowed to check to see if a person has what the insurance company deems a pre-existing condition which allows them to try and exclude the person from coverage.
If you have been denied long term insurance disability benefits due to a pre-existing condition, it’s not the end of the road. Legal avenues are available, and with the right support, you can contest the denial effectively. At Todd Krauss, APC, our skilled California disability denial claims lawyer stands ready to assist you with your disability denial claims, ensuring you receive the benefits you rightfully deserve. If you need assistance or have questions about your specific case, do not hesitate to contact us today. Let us help you secure the benefits you need and deserve.
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