Skilled attorneys protecting New York employees
Our disability lawyers have over 55 years’ combined experience representing our clients with regard to short and long term disability claims involving all of the major disability insurance carriers – CIGNA, LINA, MetLife, Unum, Provident, Standard, the Hartford, Guardian, Reliance Standard, Prudential, Liberty Mutual, Liberty Life, Continental, Paul Revere, ReliaStar, Sun Life, and Mutual of Omaha – as well as union and employer “self-funded” plans.
Some common long-term disability issues
Our attorneys can provide guidance with regard to frequently recurring questions and disputes involving long-term disability claims. Before a claim has been filed, there may be questions regarding eligibility for coverage, entitlement to benefits, and the procedures for filing a claim, such as:
- Have I been employed long enough?
- Will I face problems because of a pre-existing condition?
- Is my illness or injury severe enough for me to receive disability benefits?
- Should I try job modifications or reduced hours, and, if so, can I still make a claim for disability benefits?
- When do I file my claim forms?
- Should my primary doctor or my specialist fill out the physician forms?
- How long will it take for my claim to be approved?
Once a claim is approved, different questions may arise:
- When filling out supplemental claim forms, how detailed should my answers be regarding my activities?
- What happens to my benefits if I make a trial return to work?
- My insurance company has asked me to undergo a functional capacity evaluation, a neuropsychological assessment, or an independent medical examination, should I be worried?
- Is there anything I can do to ensure that the examination is conducted fairly and by an appropriately qualified physician?
Our lawyers can answer these questions and help you to best protect your rights to the long-term disability benefits to which you are entitled.
Long-term disability services
Long-Term Disability generally refers to benefits provided under employer-sponsored disability plans that commence after the period for short-term disability benefits (usually after a 90-day or 180-day elimination period). At the Law Office of Mark Scherzer, our lawyers provide disability claim assistance at every stage:
- Disability assessment and planning — It may seem odd to speak of “planning” with regard to a disability. When disability is mentioned, many people think of a sudden accident or illness. However, for persons suffering with multiple sclerosis, HIV disease, cardiopulmonary disease, degenerative spinal disease, Parkinson’s disease, and other similar chronic progressive illnesses, symptoms may not be disabling at first, but gradually worsen over time so that they increasingly interfere with satisfactory performance of one’s occupational duties. Other persons may suffer a sudden accident or illness, or require a major hospitalization – such as in the event of a heart attack, stroke, opportunistic infection, pneumonia, Guillain-Barre syndrome, or spinal fusion – and file a claim for short-term disability, but then experience a significant, but nonetheless incomplete, recovery. In all of these circumstances, disability is not “total” in the conventional sense, and an employee may have many questions regarding their disability coverage. Will a long-term disability claim be approved in such circumstances? When should the proof of claim paperwork be filed? Is it possible to work on a reduced basis and still make a claim for long-term disability benefits? Does it make better sense to return to work, perhaps earlier than your doctor advised, because short term disability will soon expire, or to instead file a long term disability claim? Our attorneys will review your medical and employment circumstances, in conjunction with your employer’s disability plan, and help you review your options with better confidence.
- Job termination counseling and review of severance agreements — Persons struggling to work despite a progressive disabling illness may find themselves facing employment termination (decreased/poor performance may make them attractive targets for job elimination, whether individually targeted, or as part of a larger staff reduction). Our lawyers can help you decide whether the facts of your termination constitute grounds for a disability claim, and can review any severance and release agreement for the purpose of determining whether you may be inadvertently giving up important disability benefit rights. For a more extended discussion of the issues presented by making a long-term disability claim in the context of a layoff, reduction in force, or severance/separation, see the blog post: Lay-Offs, Reductions-in-Force, Severance Packages and Long-Term Disability Claims: Compatible or Mutually Exclusive?
- Assistance with applying for disability benefits and preparing initial proof of claim forms — Our lawyers can review your claim forms and offer advice about how to complete those forms or provide additional information so as to maximize the probability that your claim will be approved.
- Assistance with supplemental claim forms — Once your claim is approved and in good standing, our attorneys can similarly assist you with the completion of supplemental disability progress reports to best ensure your continuous and uninterrupted receipt of the disability benefits to which you are entitled.
- Responding to insurance company demands for functional capacity evaluations, independent medical examinations, at-home field interviews, etc. — Your insurance company may not be satisfied with your doctor’s records or your disability progress reports, and may ask that you submit to a Functional Capacity Evaluation (FCE), Independent Medical Examination (IME), or an interview at your home by a field examiner or nurse. Or, your disability insurance company may present you or your treating physician with covert surveillance video, and assert that this surveillance film documents activities that are inconsistent with your claimed disability. Our attorneys can evaluate whether these requests are reasonable and intervene, as necessary, to ensure that any FCE, IME or field interview is conducted in a fair manner that fully protects your rights.
- Return-to-work planning — If you have been receiving long-term disability benefits and are considering a return to work, our lawyers can advise about: the impact such work activities will have on your disability benefits; the availability of residual, partial, or rehabilitation disability benefits; the relevance of reduced earnings, job modifications, and decreased hours to your claim for disability benefits while working; eligibility for benefits under your new employer’s life, health and disability insurance plans; and other related issues.
- Assessment of disability benefit settlement offers — Insurance companies sometimes offer lump sum settlement as an option with certain long-term disability claims. Our attorneys can review such a disability claim settlement offer to determine whether the amount offered is reasonable and fair.
- Appealing disability claim denials or disability benefit terminations — If your long-term disability claim has been denied, or a longstanding disability claim has been terminated, it is extremely important that you consider retaining an attorney for the critical appeal process. The importance of legal representation during the appeal process is discussed at greater length on our webpage, “Consulting an Insurance or ERISA Lawyer.”
- Enforcing your rights through a lawsuit — If an appeal has been unsuccessful, and your disability insurance company or disability benefit plan has refused to approve or reinstate your claim for long-term disability benefits, a lawsuit may be your last and only option, as discussed in greater detail on our webpage, “Filing a Lawsuit: Taking your Insurance Company to Court.” Our lawyers have experience in state and federal courts, and are fully prepared to bring a lawsuit to secure the long-term disability benefits to which you are entitled.
Mark Scherzer Law :: Medical Claim Attorneys :: Long Term Disability Lawyers :: Disability Claim Assistance and Planning , New York Long-Term Disability Lawyers (including New York City, Long Island, Hudson Valley, Capital District, Mohawk Valley, Southern Tier, Western New York, Finger Lakes, Central New York, and North Country