For interesting insight into the thinking of the Ninth Circuit Court Of Appeals during oral argument of an ERISA short term disability case you can watch the following YouTube link. https://www.youtube.com/watch?
The last of the summer reruns in refreshed form. Regards, Randy Noah
Another installment of the summer rerun series featuring answers to some of the most important and frequently asked questions concerning ERISA governed long term disability insurance benefit claims and appeals. This refreshed feature from 2011 discusses the recommended documentation to create the strongest case for a successful long term disability insurance claim, appeal or lawsuit. When filing an application for long-term disability insurance benefits, the most important and persuasive documents are going to be your medical records from your treating doctors which clearly lay out your medical condition and how it prevents you from working at your job. The more medical records the better, since the application and/or appeal period may well be your only chance to document your disability during the entire time of your appeal process, and that includes the lawsuit, if necessary. The paper file is the beating heart and soul of your claim. Give the claims examiner for the insurance company all the medical records you can (of course you always have the option of keeping certain records private, it is your own choice) which in any way validate your medical issue and work disability. There will never be too many records, but leaving out documentation could be fatal to your claim. There are other documents that may also play a vital role in a successful long-term disability claim. Do you have any persuasive or compelling documents from your workplace? Any documentation you can provide from your employer which (1) demonstrates the essential duties of your occupation and (2) documents your inability to perform your job will go a long way in getting your benefits claim approved. Other job documents such as glowing performance reviews before the onset of a serious medical condition, followed by performance reviews noting the drop off in your ability can be very persuasive in demonstrating you cannot meet the essential job duties of your occupation. Additional key documents may include (1) social security disability records of an approved claim, (2) functional capacity exams, and (3) vocational analysis reports. Since testimony is generally not allowed in an ERISA governed long term disability insurance lawsuit, a personal statement which tells the story of your disability can be an essential part of your documents in the insurance claim file. This may well be your only opportunity to tell your story concerning the disability and its impact on your work life. Your personal story can also be told through a video and sent to the claim representative in a DVD. This has the added benefit of bringing a real person to the judge in the event your claim proceeds to an ERISA governed trial. Your own power point or video may be far more instructive to the judge than 30 to 60 minutes of undercover insurance company video showing you driving to the store to buy groceries, or attending a doctor appointment. Realize that the documents, statements, reports and possibly video you submit to your disability insurance company are not only the foundation of your claim, but the entire structure, so build the strongest possible house when you document your long term disability insurance claim.
Randy Noah, a lawyer specializing in the representation of individuals denied long-term disability insurance benefits. For more information please visit prandallnoah.com.
Law Office of P. Randall Noah
21 Orinda Way, Suite C, #316
Orinda, CA 94563
P.O. Box 9421
South Lake Tahoe, CA 96158 Phone: 925-253-5540
The Critical Role Of Mediation In A Long Term Disability Insurance Benefits Lawsuit:
This is an newly edited version of a previous entry on attorney fees. Attorney fee questions are so common that I thought it would be worthwhile to repeat the basics on fees in long term disability insurance appeals and lawsuits.
Spring is in the air, which means goodbye to a long winter and hello to the IRS. The tax man shows up right along with the first Spring flowers. Does it also mean goodbye to all of your money? Maybe. Disclaimer: This blog entry is by no means meant to be tax advice, which I am in no way qualified to give.
Most group long term disability insurance policies (those governed by ERISA) include coverage for a work disability due to drug and or alcohol addiction and dependency, which many policy holders do not realize. While these benefits are generally for a limited period of time, often 24 months, they can prove to be a welcome lifeline when there is a need to take time off work to get the help needed to control drug and alcohol related illness. The long term disability benefit amount is the same as for physical illness disability, generally 60% of base income, but for a limited period of time.
Employers use many different types of long-term disability plans. Most plans are provided by insurance companies, to whom your employer pays a premium each month. You may even contribute money from your paycheck for part of that premium.Navigating The Application/Appeal Process:When you have a long-term disability insurance claim, you must apply to your disability insurance provider. Your application and appeal, if necessary, should be based on strong medical support of a condition, which disables you from continuing in your occupation. If you are denied benefits, you can appeal to the insurance carrier for reconsideration. If the insurer continues to deny your benefits, you have the right to take your claim to a federal court.The federal laws relating to group benefit claims are part of ERISA - the Employee Retirement Income Security Act of 1974. ERISA also sets forth administrative rules for the procedures of handling a long-term disability claim. The rules and regulations set forth in ERISA must be followed. They often are not what you may logically expect, and they are complicated. At the point of the appeal of a denial you may want to consult with an attorney who specializes in long-term disability insurance claims. Typically, you have 180 days to appeal to the insurance company its denial of your benefits. If the appeal is also denied, you may then proceed to federal court for a lawsuit against the insurance carrier, based primarily on the medical records, witnesses, statements, documents contained in the insurance claim file, including internal emails, noting that in ERISA governed cases (employer provided insurance programs) there are very strict limits on what, if anything, can be used in court outside of documents in the claim file.Employer provided or group long-term disability policies have many limitations and are often not what they may appear. You may want to carefully review your policy with a knowledgeable attorney if you believe you may need to file an application for disability benefits.Randy Noah, a lawyer specializing in the representation of individuals denied long term disability insurance benefits.
Nature has a wonderful beneficial effect both on the practice of law concentrating on assistance to long term disability insurance claimants, and for people who are living with total work disabilities. A persistent drought kept Lake Tahoe dry this Christmas, but travelling to Yellowstone National Park on Christmas found winter in all it's white glory.
The fight goes on in 2014 with states such as California pursuing the elimination of long term disability insurers' ability in ERISA governed policies to enforce a "discretionary clause." In essesence the discretionary clause in the policy makes the insurance company the judge and jury of their own determiniations of who qualifies as totally disabled under the policy. The results are predicatable. Countless denials of LTD benefits when the court system would have enforced LTD benefits under the terms of the insurance contract, if they were not obligated to give deference to the insurance company's finding of "not disabled." Attorneys and advocates for disabled individuals seeking LTD insurance benefits keep hammering away at the iron curtain of the discretionary clause. Perhaps 2014 will be the break through year.