Filing for Disability Claims in the U.S.
Get Help from an Experienced Disability Lawyer
Many people make mistakes when submitting their disability claim, taking for granted the disability insurance company will act honestly and fairly. Disability claims can be difficult and time-consuming. Insurance companies frequently request forms be completed by you, your employer, and your doctors.
Some of the information requested by disability insurance companies may include:
- An independent medical examination (IME)
- A functional capacity evaluation (FCE)
- An in-person interview of you
- Medical records
- Financial information
- Authorizations to obtain information about you
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What is a Disability Claim?
A disability claim refers to a formal request for financial assistance or benefits due to a person's inability to work or perform daily activities because of a physical or mental impairment. These claims are typically filed with government agencies, insurance companies, or employers to receive support and compensation for the limitations caused by the disability.
Common types of disability claims include:
- Social Security Disability Insurance (SSDI): This is a federal program in the United States that provides benefits to individuals who have worked and paid Social Security taxes but can no longer work due to a disability. To qualify, individuals must meet specific criteria set by the Social Security Administration (SSA).
- Supplemental Security Income (SSI): Another federal program in the US, SSI provides financial assistance to disabled adults and children with limited income and resources. Unlike SSDI, SSI doesn't require a work history, but applicants must meet strict financial criteria along with disability requirements.
- Long-Term Disability Insurance: Offered by employers or purchased individually, this insurance provides income replacement when an individual is unable to work for an extended period due to a disability. The terms and coverage vary widely depending on the policy.
The process of filing a disability claim often involves providing detailed medical records, undergoing evaluations by healthcare professionals, and proving the extent of impairment and its impact on daily activities or work capacity. Each type of claim has specific eligibility criteria and procedures that applicants must follow to qualify for benefits.
Disability claims can be denied for several reasons, such as:
- Insufficient Medical Evidence: Lack of detailed or updated medical records, incomplete documentation of impairments, or failure to follow prescribed treatment can lead to denials. Clear evidence linking the disability to an inability to work is crucial.
- Failure to Meet Disability Criteria: Claims might be denied if the impairment doesn’t meet the specific criteria outlined by the Social Security Administration (SSA) or other insurance providers. Sometimes, the disability might not be severe enough to qualify under their guidelines.
- Incomplete Application or Forms: Mistakes in filling out forms, missing deadlines, or not providing necessary information can result in denials. It's essential to complete all required paperwork accurately and thoroughly.
- Earning Above the Substantial Gainful Activity (SGA) Limit: SSDI has an earnings limit (SGA) above which an applicant is considered able to perform substantial work and might be denied benefits if their income surpasses this threshold.
- Disability Expected to Improve: If the SSA believes that the disability is temporary or expected to improve within a certain period, they might deny the claim. They often reevaluate cases periodically to determine if the condition has changed.
- Failure to Follow Treatment Plans: If an applicant doesn’t comply with prescribed treatment without a valid reason, it can lead to denial. SSA expects individuals to follow medical advice that could improve their condition.
- Lack of Cooperation: Failing to attend medical evaluations or cooperate during the review process can result in a denial. Cooperation with the SSA and providing requested information is crucial.
- Technical Errors or Procedural Mistakes: Simple administrative errors, missing deadlines, or not providing requested documentation can lead to denials.
- Substance Abuse or Criminal Record: If substance abuse contributes to the disability or if an individual has a criminal record related to their disability, it might impact the claim's approval.
- Insufficient Work Credits: For SSDI, applicants need to have accumulated enough work credits through payment of Social Security taxes. Not meeting this requirement could lead to denial.
Understanding these common reasons can help applicants better prepare their claims, ensuring they meet all criteria and provide sufficient evidence to support their case.
It is important to know what documents you are required to provide and those that the disability insurance company are not entitled to get. It is also important to properly complete and timely submit the forms insurance companies are allowed to receive.
Significant medical conditions and supporting Attending Physician Statements (APS) from doctors may not be not enough to prove disability when submitting a claim. The disability insurance company’s hired doctors may contact your physicians directly, often in an attempt to convince him or her that you are not disabled or able to return to work. Sometimes the insurance company will conduct surveillance video in an attempt to find inconsistencies in your reported abilities.
It is important to know your rights under the law as well as your disability policy. An experienced long-term disability lawyer will protect your rights and properly handle your disability claim. Dabdoub Law Firm, Disability Insurance & ERISA Attorneys, handle disability claims for applicants nationwide.
Do I Need an Attorney to Handle My ERISA Disability Appeal?
It is helpful to have an attorney who can handle your ERISA disability appeal because they will have an insightful glimpse into what the disability insurance company is planning. They also know all of the necessary paperwork and supporting documentation to create an appeal, which is arguably the most important step when fighting for your benefits. For example, in many cases, a doctor will fill out the right forms to say that you can’t work, but the insurance company will still find room to disagree and challenge your claim. With the right documentation collected and presented in a cohesive argument, the odds of the insurer getting away with it should go down.
Once a final decision is made, no additional information can be submitted, so it is even more crucial to ensure your appeal is ready with the right documentation from the get-go. There’s even a risk that you could fill out too much information and hurt your case because of it. Insurance companies often instruct claimants to fill out unnecessary forms with leading or slanted questions for this exact purpose. An ERISA disability attorney on your side can ensure that doesn’t happen, though.
Additionally, if your case goes to court, it will be decided by a federal judge. Unlike other types of cases, in an ERISA disability case, you have no jury. Instead, the judge’s entire decision is based on the insurance company’s file on your disability claim. If your appeal does not include updated medical evidence to support your disability, your chance of winning could be lowered. Similarly, if the file does not address important legal issues, your chances of getting your benefits are lessened. Preparing an appeal the right way the first time thanks to the help of an attorney can eliminate all of these risks.
Managing Your Claim
Once approved, not always approved. Disability insurance companies will continue reviewing your claim for even after it is approved. It is not uncommon for a disability insurance company to terminate disability benefits after 12, 24, or 36 months when the definition of disability changes. Under most disability policies, you must first be disabled from your own occupation and then from any occupation thereafter.
To ensure that you receive the maximum disability benefits under your disability insurance policy, you should speak with a long term disability attorney. At Dabdoub Law Firm, our disability attorneys know each insurance company’s review processes and tactics. Experienced with filing initial claims and monitoring paid claims, we can help ensure your disability benefits are not terminated.
Here's how we can assist:
- Expert Guidance: We provide expert advice and guidance throughout the entire disability claim process. Our team understands the complexities of disability law and stays updated on any changes or nuances in regulations.
- Application Preparation: We assist in preparing disability benefit applications, ensuring all necessary documentation is collected and completed accurately. This minimizes the chances of errors or omissions that could lead to claim denials.
- Medical Evidence Collection: We work with clients to gather comprehensive medical evidence to support their disability claim. This includes obtaining relevant medical records, opinions from healthcare professionals, and other pertinent documentation.
- Representation in Appeals: In cases where claims are denied, we offer representation in the appeals process. We handle the necessary paperwork, prepare for hearings, and advocate for our clients to ensure their case is presented effectively.
- Navigating Legal Complexities: Disability law can be intricate, and we use our expertise to navigate through these complexities. We interpret laws, regulations, and precedents to build strong cases for our clients.
- Communication and Follow-Ups: We handle communication with the Social Security Administration or insurance companies on behalf of our clients. This ensures that all inquiries, requests, and updates are appropriately addressed and responded to in a timely manner.
- Preparing for Hearings: If a hearing is required, we prepare our clients thoroughly. This includes helping them understand what to expect, providing guidance on testimony, and representing them effectively during the hearing.
- Maximizing Benefits: Our goal is to maximize the benefits our clients receive. We strive to ensure they receive the full extent of benefits they are entitled to under disability law.
Call (800) 969-0488 today for a free initial case evaluation with a disability lawyer.
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