In our last blog we listed long-term disability definitions from A – L. Here are some more definitions to help you understand the terminology used by insurers in your long-term disability policy.

M

Material Duty (or Duties) – Material duties are defined as the set of tasks or abilities required for your particular occupation. These are duties that cannot be omitted or changed without jeopardizing your ability to perform your job. Small differences in material duties can have a significant impact on whether you qualify for disability benefits.

Maximum Capacity – The full utilization of the employee’s abilities in any occupation that he or she is capable of performing.

Maximum Monthly Benefit – The highest payment under the Long-Term Disability plan, a disabled employee can receive monthly.

Mental Health Limitation – Benefits for mental health conditions such as depression, anxiety or bipolar disorder will only be paid for 24 months.

N

Non-contributory Plan – a group coverage plan in which the employee does not contribute, and the employer pays the entire premium.

Non-Exertional Limitations – Non-exertional limitations include fatigue, intellectual and cognitive limitations, headache, memory loss and medication side effects.

O

Offset – Payments or benefits received by the claimant from a third party that reduce the amount of long-term disability benefit payable, including settlements from lawsuits, Social Security disability, certain retirement disability benefits, Workers’ Compensation, and certain state disability benefits.

Own occupation – A claimant needs to be unable to perform their “own occupation” that they have been trained to perform for the first 24 months or as defined in the policy.

P

Plaintiff – a person who opens a lawsuit in a court of law.

Policy / Contract – A legal agreement between a person or a group and an insurance company listing all the details of the plan’s coverage.

Policyholder / Contract Holder – A person or group who purchases an insurance plan from an insurer.

Pre-existing Condition – a medical condition for which a person has received medical care prior to the effective date of the policy.

Punitive Damages – A money award that the injured plaintiff receives when the insurance company has been found to engage in fraudulent, oppressive or malicious behavior.

R

Rate of Benefit – The percentage of income to be replaced by the disability plan.

Residual Disability – If you are physically unable to perform some, but not all, of your regular job functions because of sickness or injury.

Residual Functional Capacity (RFC) – A claimant’s RFC is based on the level of work a person can physically perform. The levels are sedentary, light, medium, heavy and very heavy.

S

Salary Percentage Requirement – The insurance company is required to find occupations that pay at least 80% of the claimant’s pre-disability income.

Schedule of Benefits and Exclusions – The section of the disability insurance policy that describes what the policy covers and what it does not cover.

Self-reported Symptoms Limitation – Some policies have a provision that limits coverage (often for two years) for disability benefits based on self-reported symptoms such as Chronic Pain, Chronic Fatigue Syndrome and Fibromyalgia.

Statute of Limitations – A legal provision which sets a time limit for initiating legal proceedings.

U

Underwriter – The responsible company that receives the insurance premiums and carries out the policy contract.

V

Vocational Expert Opinions –A vocational expert forms an expert opinion on what jobs a claimant may be able to perform taking into account all restrictions and limitations caused by the impairment, as well as age, education, background, work experience and skills.

W

Waiver of Premium – Individuals who become disabled and qualify for benefits are not required to pay any additional disability premiums during the period that benefits are being paid out.

Need Help with Long-Term Disability?

Talk to us at Cunnane Law today about your claim. We are ready to assist you if you have been denied long-term disability benefits. It is critical that you understand the terms of your policy as well as the law.

Note: This information was provided not for any specific claim and is written in broad and general terms and may not be the right path to follow for a particular claim or case. This information is not intended to create an attorney client relationship. It is always best to receive direct legal counsel for your legal issues. It is never too early to call the attorney, but it can be too late.

If you have a disability claim, you’re already at a disadvantage attempting to decipher 90% of the material you’re now required to read, comprehend, and answer to. A glossary is required to make sense of the provisions of your long-term disability policy. This list of definitions of disability insurance terms will assist you.

A

Active Full-Time Employee – A full-time employee who works a regular workweek for a company is known as an active full-time employee.

Active Work Requirement – To be eligible for disability benefits, you must be working at least the minimum number of hours per week as described in your company’s policy.

Activities of Daily Living (ADLs) – Routine activities that people do on a daily basis without assistance. Eating, bathing, dressing, toileting, walking, and continence are the six basic ADLs.

Adjuster – An insurance company employee or subcontractor who investigates insurance claims and determines how much the insurer must pay for a submitted claim.

Attending Physician Statement – A medical report written by the insured’s doctor that details his or her medical history, both past and present.

B

Bad Faith – Insurance companies are legally bound by a “covenant of good faith and fair dealing.” When an insurer breaks this covenant by delaying or denying payments in an unreasonable manner, it is considered to be acting in bad faith.

Beneficiary – The person or entity authorized to receive the proceeds or benefits of an insurance policy.

C

Catastrophic Disability – A claimant is so severely disabled by an accident or disease that he or she need assistance with even the most basic tasks of daily living, such as feeding, dressing, or showering.

Claim – A payment request made under a disability insurance policy.

Contributory Plan – A group insurance plan in which a company and its employees split the costs.

D

Deductible – A stipulation in a disability insurance policy requiring the policyholder to pay an initial amount of expenses before the disability insurance coverage begins.

Disability – The criteria used by the insurance company to evaluate if you are disabled and entitled to benefits.

Disability Appeal – If your claim is denied, you have the right to appeal and legally challenge the denial in a court of law.

E

Effective Date – The day the insurance policy starts.

ERISA – ERISA (Employee Retirement Income Security Act of 1974) is a federal law that regulates the handling of Employee Benefit Plans.

Exclusions – Specific conditions under which a disability will not be covered are outlined in disability policies.

F

Functional Capacity Exam (FCE) – A series of physical tests to see if a claimant can return to work.

G

Group Coverage – Individuals can get group long-term disability coverage through their company, a professional group, or an association.

I

Individual Disability Insurance (IDI) – Disability insurance for individuals can be acquired directly from an insurance broker. The individual is responsible for all costs.

Insured – A person or organization covered by insurance.

L

Long Term Disability Insurance – Long-term disability (LTD) insurance provides monthly benefits (income replacement) if a person is unable to work for more than two years due to illness or injury.

Lump-Sum Payment – Disability benefits are usually paid in a lump-sum on the day after the Elimination Period expires.

Your Long-Term Disability Experts

At Cunnane Law, we are highly experienced in assisting people with their long-term disability claims. Our lawyers work tirelessly to represent you and your interests in your dealings with insurance companies. You need all the facts, all the information, and all the help you can get. We’ll be publishing Part 2 of this guide soon, but in the meantime, if you have questions, contact us. We work with clients in Edmonds, Shoreline, and all across the greater Seattle and western Washington area.

Note: This information was provided not for any specific claim and is written in broad and general terms and may not be the right path to follow for a particular claim or case. This information is not intended to create an attorney client relationship. It is always best to receive direct legal counsel for your legal issues. It is never too early to call the attorney, but it can be too late.

Our clients can relax knowing that the attorneys at Cunnane Law are in charge of their disability claim.

You may hear a lot of contradictory opinions as to whether you need a lawyer as you prepare to file a disability insurance claim. While you may be tempted to put off engaging an attorney, it is usually to your best advantage to speak with one before filing a disability claim, rather than afterward.

You can make or break your disability claim based on your administrative record.

The Employee Retirement Income Security Act of 1974 (ERISA), governs your claim if you file for employer-sponsored disability benefits. You have a limited amount of time under ERISA to submit supporting evidence for your claim.

Once the insurance company has issued a final decision on your claim, the courts will only review the information contained in your “administrative record,” which consists of plan documents, previously submitted proof, and other information that was available to the insurance company. In most cases, the court will not consider fresh evidence, no matter how crucial or relevant it may be.

Unfortunately, we frequently meet with disabled people after their decisions have been made. Many times, vital evidence that might improve their claims is missing from their administrative records—but it’s too late to present it.

If you consult with an expert disability lawyer at Cunnane Law from the start, we’ll carefully evaluate your administrative record and enhance it with material that advances your disability claims. This “data stacking” should place you in the greatest possible position to win your case.

ERISA plans have a lot of complicated terms and conditions.

It’s usually a good idea to read the Plan Document before filing a disability insurance claim. This document outlines the terms, restrictions, exclusions, waiting periods, and filing deadlines that apply to your benefits application. Many of these requirements are stated in complex, difficult-to-understand technical terminology.

It’s very hard to file a successful claim unless you have a thorough understanding of your disability insurance plan’s rules and procedures. An experienced Edmonds disability lawyer, on the other hand, can assist you to identify:

• The waiting, qualification, or elimination phases in the plan
• How much time do you have to submit your claim?
• Whether the concept of disability is based on “own occupation” or “all occupations.”
• The policy’s exclusionary conditions and circumstances
• The benefits to which you may be entitled
• How long you’ll be able to receive benefits

Your disability insurance claim strategy will be built on this information.

Knowledge is a powerful tool.

A disability insurance lawyer at Cunnane Law can help you if you’re feeling overwhelmed by your ERISA claim or worried about insurance company monitoring. Cunnane Law approaches client interactions in a realistic, hands-on manner. We offer emotional support, case-specific information, and results-oriented techniques based on decades of disability law experience.

Respected disability lawyers offer practical advice

Cunnane Law’s disability lawyers have a solid reputation for aggressive advocacy and innovative methods. Moreover, we think that every disability claimant is entitled to client-centered representation and the best possible outcomes. We serve Edmonds, Seattle, Puget Sound, and all of western Washington State. Our clients can relax knowing that the lawyers at Cunnane Law are in charge of their disability claim. Contact us today.

Note: This information was provided not for any specific claim and is written in broad and general terms and may not be the right path to follow for a particular claim or case. This information is not intended to create an attorney client relationship. It is always best to receive direct legal counsel for your legal issues. It is never too early to call the attorney, but it can be too late.

Insurance companies don’t move quickly, but with expert legal help, you have a better chance of getting your claim settled on time and in your favor.

Filing your disability claim can be both a daunting and overwhelming process and once you have submitted your long-term disability claim application, waiting for disability approval or denial may seem like it takes forever. Fortunately Cunnane Law in Edmonds WA may be able to assist you.

Here are some things that you can do to help speed up the approval process.

Be Proactive When Supplying All Your Medical Records

Because you are disabled due to injury or illness, the insurance company want to review your medical records. The more issues you have, the more records they will want to look at.

You will be able to speed up this process by obtaining these records and submitting them as soon as possible, preferably before the insurance company requests them.

Always Respond Promptly and Accurately to Any Requests for Information.

Your claim could be delayed or denied if your application is missing any key information. It can also be delayed if you do not meet the insurance company’s requests for additional information or their deadlines.

As an example, most disability insurance policies may require you to have an Independent Medical Exam (IME) or Functional Capacity Evaluation (FCE). By failing to cooperate, your claim can be denied.

If you cause any delays, the insurance company may be entitled to additional extensions of time as allowed by the law, giving them a longer time to reach a decision.

For this reason it’s important for you to stay on top of every request for information. If you find yourself falling behind, you really should consider speaking to a long-term disability lawyer like Cunnane Law, to ensure you don’t put your claim at risk.

Help Your Doctor Help You

The most important evidence in your long-term disability claim is your doctor’s support. An attending physician statement (APS) is often requested by insurance companies as part of the claim analysis.

By keeping up with your treatment plan and staying in communication with your doctor so they know your current medical condition, you can help your doctor to submit his response on time. Delaying these APS forms can affect how long it takes to get an initial decision.

How Long Does a Long-Term Disability Claim Take?

There is, unfortunately, no definitive answer as to how long it will take to get your long-term disability benefits. It all depends on how long your insurance company takes to reach a decision and if you need to appeal a denial.

The initial application can take up to twelve months for a decision, and then a further nine months for the appeals process.

Do you need help with keeping on top of important deadlines for your long-term disability claim or appeal? Allow Cunnane Law in Edmonds WA, to help you. Contact us today and we’ll walk with you every step of the way.

Note: This information was provided not for any specific claim and is written in broad and general terms and may not be the right path to follow for a particular claim or case. This information is not intended to create an attorney client relationship. It is always best to receive direct legal counsel for your legal issues. It is never too early to call the attorney, but it can be too late.

Long-term disability claims require patience, persistence, and legal knowledge. We can help.

When filing a long-term disability claim with your insurance, you’re probably wondering how soon you’ll begin to receive your benefits. Unfortunately, there is no clear-cut answer as several factors must be considered. Generally the initial decision about your claim can take between 45 to 105 days.

Here are some factors that can influence how long it will take and what you can do to speed up the claim approval process.

Policy Elimination Period

Firstly, the majority of disability insurance policies have an elimination period. This is the period from when you first became ill or injured until you start to receive your long-term disability benefits.

You have to remain continuously disabled during this elimination period in order to qualify for benefits. There is no chance you will ever receive benefits before the policy’s elimination period finishes.

Application Timelines and Deadlines

Generally, the timeline for processing your claim is dependent your type of long-term disability cover.

• Individual Disability Insurance (IDI): If you purchased an IDI policy on your own, the insurer normally has a “reasonable” time frame to review and decide on your claim.
• ERISA Disability: If you are covered with an ERISA disability plan through your employer, your insurer is required to follow tight timelines. These are 45 days for the initial decision, with two extra 30-day extensions if needed by the insurance company.

In other words, receiving your initial decision for an ERISA disability claim can take up to 105 days. It can take even longer for an IDI disability claim.

Challenging a Long-Term Disability Claim Denial

With an ERISA disability plan you must file an appeal within 180 days, in order to challenge a claim denial. The disability insurance company then has 45 days to make a decision. If they need more time, they can extend it by 45 days.

There is usually no appeal requirement with an IDI policy. This means that if you desire you can appeal or take the matter directly to court.

Why It’s Best to Hire a Lawyer to Help You Appeal

If you are appealing a denial under an ERISA disability plan, then this is your very last chance to submit evidence supporting your claim.

You are allowed to seek judicial review if your insurance company denies your appeal. However, only information contained in the insurance company’s claim file is allowed to be reviewed by the court.

This is why preparing your disability appeal for the insurance company is much the same as preparing your case for litigation in court. You have no way of correcting a mistake made at appeal level.

When litigating an IDI policy denial you may submit new evidence in court, however, litigation can be costly. Your chances of success with an appeal will be much greater with the help of an expert long-term disability lawyer.

Get Help from Expert Long-Term Disability Lawyers in Edmonds

At Cunnane Law, we have years of experience and a proven track record in long-term disability claims for clients in Edmonds and all over the Seattle area. This can be a very complicated area, and you don’t want to try to do this on your own. You don’t have to. Contact us today to start talking about your long-term disability claim.

Note: This information was provided not for any specific claim and is written in broad and general terms and may not be the right path to follow for a particular claim or case. This information is not intended to create an attorney client relationship. It is always best to receive direct legal counsel for your legal issues. It is never too early to call the attorney, but it can be too late.

Choosing a long-term disability lawyer can be confusing. It’s an important decision, and you don’t want to get it wrong.

If your insurance company has denied your long-term disability claim, you should immediately hire a long-term disability lawyer. With their powerful legal team and endless resources, your insurance company will try and intimidate you into dropping your claim. This is a battle you should not even attempt to handle on your own.

It is important that you choose the right disability lawyer for your case because it could impact the course of your future. Because it is such a vital decision you might find it somewhat overwhelming, especially when you already have so much to deal with.

Here are some of the main qualities to look for when choosing your long-term disability lawyer in Edmonds, Shoreline, or throughout the greater Seattle area.

Specializes in long-term disability insurance law

With so many rules and regulations, long-term disability insurance law is extremely complicated. This is why it is crucial to choose a disability lawyer with the knowledge of what to expect, as well as the track record to prove it.

If you’re appealing a denied disability claim it will be in your best interests to choose a lawyer who specializes in this area of the law.

Knows the law in your area

Disability laws differ from one state to another, and the procedure for challenging denials can vary from county to county.

To give you an example, the Western and Eastern Districts of Washington State are administrated differently. If you are fighting a disability claim denial in Spokane, your claim may not be subjected to Seattle court rules.

Hiring a lawyer who is familiar with the nuances of state disability laws and local court regulations can make a significant difference in the result of your claim. That is why it is critical to select a disability attorney who is not only licensed in your state but also has extensive expertise and knowledge of the law in your area.

Honest and truthful

Your chosen disability lawyer should be truthful and give you an honest assessment of your case, whether good or bad. Don’t be taken in by any empty promises or guarantees.

Read reviews from past clients to see if your lawyer is trustworthy.

Compassionate and understanding

At a time when you are already finding things difficult you need a lawyer on your side who will be both compassionate and understanding. Find someone who, besides listening, will believe you and give you all the support during the process.

Why choose Cunnane Law?

At Cunnane Law in Edmonds, WA, we know what it takes to fight and beat disability insurance companies. If your disability claim has been denied and you are not sure what to do next, reach out to us and let us fight on your behalf. Contact us today. We take on our clients burdens so that they can concentrate on taking care of themselves.

Note: This information was provided not for any specific claim and is written in broad and general terms and may not be the right path to follow for a particular claim or case. This information is not intended to create an attorney client relationship. It is always best to receive direct legal counsel for your legal issues. It is never too early to call the attorney, but it can be too late.