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Mental health disability claims
Mental Disability Claims

Physical disabilities can make it very challenging to function in a work environment. For this, employers provide workers compensation and disability benefits to cover you financially until you are able to return to work. What happens however when you are suffering from a mental disabilities?

As most who have suffered from depression, dost-traumatic stress, or bipolar disorder can attest to, mental disabilities can be just as debilitating as any physical condition and occur more often than people think.

What most people also do not know is that a mental disability in many cases can and should be covered by your disability insurance. The problem however is that a mental disorder can be difficult to prove. Because of this, insurance companies try everything in their power to avoid awarding you coverage.

Additionally, if by some miracle you are awarded a mental disability claim, insurers will often cap the length of coverage to less time than you may need.

Dealing with insurance companies is a full time job and suffering from a mental condition can make it near impossible to manage. If you or someone you know is having trouble receiving the disability coverage they deserve, contact an Employment and Disability Lawyer immediately.

You need help from a long term disability attorney who specializes in obtaining benefits for mental health disabilities. You have been through enough, put your trust in their hands and be confident that you will get the best resolution possible from your case.

LTD benefits for rare disordersAccording to the National Organization for Rare Disorders (NORD), nearly 7,000 rare diseases affect close to 30 million Americans. Applying for long-term disability benefits can be especially difficult if you have an uncommon condition because you need to document the existence of specific symptoms of a medically determinable rare disease. Currently, many people with rare diseases experience devastating delays, most up to three years, because those making the decisions are less familiar with such diseases and their debilitating capacities.

Social Security Administration’s Compassionate Allowances (CAL) is a recent initiative that was designed to fast-track Social Security disability applications for 25 rare diseases and 25 cancers that are deemed to be severe. CAL criteria and conditions were developed due to information received at public outreach hearings, comments received from the Social Security and Disability Determination Service communities, counsel of medical and scientific experts and research with the National Institutes of Health. A few of the conditions that have been included in the initiative are ataxia telangiectasia, numerous cancers and early-onset Alzheimers disease.

Unfortunately, there is a giant number of rare diseases that didn’t make CAL’s cut. Getting long-term disability coverage for rare yet painful and debilitating diseases like carpal tunnel syndrome, fibromyalgia and Lyme disease remains difficult, largely because the Blue Book that is used as a reference when determining whether a person with a condition qualifies for coverage does not put as much focus on such rare diseases and their symptoms – therefore making them subjective and difficult to prove.

How the insurance companies beat your bad faith claim

Defenses Against Bad Faith Claims

Insurance bad faith is the term used to describe a claim that an insured person may have against its insurance company for the insurer’s immoral acts of mishandling of a claim. There are many ways that an insurance company can act in “bad faith” toward a policyholder. For example, the insurer can refuse to settle a case, unreasonably delay payment of benefits, wrongfully deny a claim, along with a myriad of other bad faith practices. In similarly unfaithful behavior, policyholders can falsely sue their insurers for bad faith in hopes of getting the coverage they want or acquiring damages from the insurance company.

In order for an insurer to successfully defend against a bad faith claim, they must focus on confirming three things: coverage, investigation that has lead to evaluation of a claim, and initiation of settlement. There is a number of defenses that an insurance company that is being sued for bad faith can use. Listed below are the more common defenses:

• Statue of Limitations: The length of the applicable statute of limitations depends on whether the state characterizes a bad faith claim as one based in contract (with consent) or based in tort (inflicted without consent). If the insurance policy includes a limitations period, some states will hold that the policy’s limitations period applies.
• Insured’s Breach of Contract: An insured’s noncompliance with a contract with their insurer they cannot use it as a defense to a bad faith action.
• Insured’s Bad Faith (not available in all jurisdictions): An affirmative defense that seeks to apportion fault and damages based on comparative bad faith.
• Lack of Coverage or Policy Defense: In third-party bad faith actions, without coverage there can be no bad faith. Even with an insurer’s improper handling of a case, if there was no coverage the insured did not suffer harm.
• Advice of Counsel (available in some states): The insurer relied on advice provided by counsel.
• Insured’s Failure to Mitigate: If a plaintiff has failed to make an effort to mitigate damages after a breach of contract, this can be used as a defense, although this defense is difficult to use because the insurer will have to prove that the insured was able to avoid any harm they suffered.
• Release: If an insurance company rejects a settlement offer, the insured may assign their bad faith claim to a third party in exchange for the third party’s release or agreement not to execute a judgment against any assets of the insured except for the insurance policy. In some cases, courts rule that a release removes the cause of action against the insurer.

Two defenses that are often used, but rarely permissible in court:
• Election of Remedies: Insurers argue that in cases in which the insured includes breach of contract in their bad faith claim should not be considered because the insured has elected their remedy and thus waived a tort claim. Courts that have addressed this issue, however, have held that a tort claim for bad faith is separate from breach of contract therefore the plaintiff can proceed with both.
• Conformity to Industry Standards: Insurance companies argue that they complied with the standards of the industry, however courts do not generally excuse the insurer’s treatment of the insured for this reason.

Bad faith cases are difficult and expensive to defend against, and if handled without precision can lead to an insurer retaining the image of an untrustworthy practice.

Obtain Damages for extreme cases of insurance bad faithAs a community we have come to embrace the idea that insurance companies exist to benefit us. This is not particularly true, as a for-profit company a insurance company’s number 1 priority is to maximize their profit and reduce loss. This is why you may notice if you are older, a smoker, or have a preexisting health condition your rates may be substantially higher. Generally speaking insurance companies will fulfill their duties as required, but there may be times a policy holder is denied their full benefits when they file a claim. By law all insurance companies must deal in “good faith” and fulfill the benefits of legitimate claims. “Bad faith” occurs when a policyholder’s benefits are in someway intentionally minimized or altogether denied.

Examples of bad faith would be:

-Failure to act within a reasonable time frame

-Attempts to undervalue the claim

-Refusing to give a reasonable explanation to deny the claim

-Settling for less than the policyholder is entitled to

-Refusing to conduct a thorough investigation or misrepresenting the facts of the case

If a policyholder is denied the benefits outlined to them and their claim is legitimate, they can sue the insurance company in a bad faith claim if the denial was malicious and intentionally unreasonable or delayed. This bad faith claim will cover the policy holder’s full claim value, all the damages resulting from the delay or denial and the policyholder’s attorney fees. In particularly egregious cases the policyholder may also be awarded punitive damages, otherwise known as exemplary damages. This will be some sort of payment usually given completely to the policy holder to discourage the insurance company from repeating the same actions and further penalizing them.  Bad faith insurance tort claims are unique in that unlike a standard breach of contract claim, tort claims are entitled to exemplary and punitive damages. The result would be that the policyholder could receive substantially more than the original claim and their losses was worth.

Punitive damages are awarded to compensate for the policy holder’s mental, emotional, physical and monetary distress; and to punish insurance companies who delay or deny claims without a reasonable cause. However bad faith insurance claims and punitive damages can involve costly expert analysis and legal witnesses as well as a thorough understanding of insurance law. If you feel that you may be eligible for punitive damages in a extreme bad faith insurance case speak to a personal injury attorney who specializes in bad faith insurance claims. They have the legal knowledge and resources to make sure that you receive fair compensation for your injuries, distress and loss of past and future income. On average those who hire the services of an attorney receive 3 times more than people who represent themselves.

Living with an invisible disabilityInvisible disabilities are characterized by symptoms that may not be noticeable to those unaffected, but what exactly constitutes an invisible disability? A person with an ID often suffers from debilitating symptoms including excruciating internal pain, fatigue, dizziness, weakness, cognitive dysfunctions, learning differences, mental disorders, and hearing and vision impairments. Those who are unaffected by this class of disability should not discount the suffering people with ID endure, as they are often fighting to mask the pain and other unwanted symptoms.

Examples of Invisible Disabilities:

Back and Spine Problems
Bipolar Disorder
Carpal Tunnel Syndrome
Cerebral Atrophy
Chronic Fatigue Syndrome
Lyme Disease

Living with and managing an invisible disability is a constant battle and unfortunately presents unique challenges for someone attempting to obtain disability benefits. Because of the great variety in symptoms and the difficulty in obtaining a diagnosis, many people suffering from an invisible disability are unable to work. Many disability claimants attempting to obtain long term disability benefits on their own are often met with application denials, filing appeals,unreasonably long delays, and other unethical insurance bad faith practices. Hiring an LTD attorney with extensive experience dealing with insurance companies can give you an advantage over their tactics.

Insurance companies are notorious for their bad faith tactics. Some will go as far as retroactively canceling your insurance policy after you have filed a claim. Unfortunately for policy holders, insurance companies are in the business of quickly generating profits and denying pay outs to those who qualify for the benefits outlined in their contracts. The following acts by an insurer are examples of First-Party and 3rd-Party Bad Faith.

First party bad faith deals with claims made by policy holders. The refusal of an insurance company to pay a claim without a reasonable basis, or failure of an insurer to properly investigate the claim in a timely manner, can constitute a case in first party bad faith. Specifically, the insurer’s actions can include the following:
• Deceptive practices or deliberate misrepresentations of records or policy language to avoid paying claims
• Inadequate claims processing and failure to follow the standard investigative guidelines of verifying the insured’s proof of loss, investigating the claim and inspecting the site of the loss, determining the coverage, appraising the amount of the loss and paying or denying the claim
• Improper or inadequate claim investigation (in many cases this means that the insurer will simply believe either party rather than conducting a proper investigation)
• Delay in payment
• Unreasonable denial of claim, which may be based on an equally unreasonable demand for proof of loss.

Third party bad faith claims are made when a policyholder has been sued and the policyholder’s insurance company has failed to act reasonably to settle the claim, or has failed to properly and timely investigate or defend the claim. The following are things that an insurer can do to act in alignment with third party bad faith:
• Failure to settle a case in which a judgement is entered in excess of the liability protection
• Failure to defend an policyholder if a contract exists that includes provisions which require the insurer to act in the policyholder’s defense
• Negligent handling of defense

There are three levels of enforcement against bad faith. Firstly, Common Law is the implied duty of good faith and fair dealing. Half of all states recognize a common law tort for bad faith in first-party insurance claims. Second comes State Legislation. Some states have general statutes that prohibit bad faith, some have Unfair Claims Practices Acts which carry further specifications, and others have an insurance commission which regulates insurance claims. Thirdly is the Federal Legislation that governs insurance practices with laws like the Employment Retirement Income Security Act (ERISA) and the Racketeer Influenced and Corrupt Organizations Act (RICO).

If your insurance claim has been unreasonably delayed, or has been denied without justification, or your insurance policy has been canceled by your insurer, you may be a victim of bad faith. Bad faith insurers can be responsible for the following damages: statutory penalties, statutory interest, liability for judgements in excess of the policy limits, attorney fees, emotional distress, economic loss and punitive damages. If you think your insurer has acted in bad faith contact an experienced insurance attorney to understand your right to recover.

Ataxia is a neurological condition that impairs the voluntary movements of the muscles, affecting the way a person walks, runs, bends over, stoops, grasps objects, or performs daily tasks. Often times, Ataxia sufferers are unable to work efficiently, making it difficult to earn an income. People who are unaffected by the condition are unaware of the extent of the disability, making it difficult on the Ataxia sufferer and the work environment in general. Insurance providers who carry Ataxia policies, often deny claims based on the fact that the condition is a subjective matter and difficult to measure the impact on your ability to work. Fortunately, Ataxia sufferers can obtain long term disability benefits to cover bills and other expenses.

Common side effects of the condition include:

  • Physical coordination – various areas of the body are affected, particularly walking
  • Balance – ability to undertake normal skills such as walking and stepping may be extremely difficult or impossible
  • Movement abilities – ability to walk,  move the limbs, extend or reach with the limbs, gesture
  • Speech – dysarthria – ability to form words and speak
  • Eye movements –  nystagmus, or ability look from left to right, up and down, etc.
  • Ability to bend down, stoop, grasp object – affects ability to pick up objects from the floor, tie shoes, etc.

Ataxia presents itself in two forms: hereditary and acute.

Hereditary Ataxia depends on the hereditary disorders of the cerebellum. Those with this form often experience a slow development of their symptoms over several years, with the underlying condition most commonly caused by issues with genes.

Acute Ataxia sufferers experience a sudden onset of symptoms, most commonly after significant trauma, injury or the development of another health condition such as a stroke or infection of the brain. Acute ataxia often times occurs due to radiation poisoning.

Unfortunately, there isn’t a specific treatment for ataxia, although doctors have been able to treat the underlying factors attributed to the condition. If you suffer from Ataxia and are unable to work, it may become difficult to pay for bills and related expenses. Ataxia disability attorneys, Burke, Harvey & Frankowski, LLC are seasoned LTD lawyers who will fight for the disability benefits that you are entitled to.

Video surveillance is a tool that insurance companies like The Hartford Financial Services sometimes use to review and validate disability claims in order to protect themselves from fraud. Although this can be a moral and useful tactic, The Hartford is facing numerous claims that they wrongfully terminated disability benefits based on surveillance video produced by private investigators.

It all started when Jack “Rocky” Whitten went on Good Morning America to share his story about how he was spied on while getting into a van, reading a magazine and while eating chips and salsa. He had “no difficulty dipping chips at a restaurant,” The Hartford said. The insurance company used this video surveillance as evidence that Whitten, who was on disability due to a broken neck, could return to work. Following the airing of the GMA segment Whitten’s benefits were reinstated, however it prompted dozens of other policyholders to come forward with their stories.

Policyholders find the correlations of their actions and the actions of their insurance companies to be bizarre and unwarranted. “I mean, they found the least little thing that makes no sense, I mean a chip weighs nothing,” Whitten’s wife, Leigh, said. Eric Neubarth, who suffered a traumatic brain injury, said that his benefits were cut off partially because he was filmed dong his laundry and eating lunch at a deli. Evan Werner severely injured his back in a car accident, and surveillance of him going to a doctor’s appointment and walking his dog was enough to convince The Hartford that he could perform sedentary work.

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, defended The Hartford’s decisions to sever policies, claiming that surveillance is conducted to gather information, not to terminate claims. “My understanding is that the video is never used as a stand-alone tool for decision making. And what I can say is that claims can be appealed,” Pisano said.

Werner and many others have chosen to sue The Hartford, claiming that evidence gathered was absolutely insufficient and that their disability benefits were wrongfully terminated. Werner doesn’t understand why he was staked out after nine doctors told him that he was unable to work. Investigators waited outside his doctors office in order to film him in action. Werner’s lawyer, Mindy Chmielarz who is a partner for the DI Law Group, said “planning surveillance and setting up your investigator in the doctor’s office parking lot is dirty pool, you know you are going to get some type of activity, no matter how minimal it may be.”

The Hartford issued a statement in defense after the GMA piece aired, saying that they conduct surveillance in less than five percent of its long-term disability claims, and that in less than two percent of all of their cases investigated using surveillance are disability benefits terminated. Regardless of the amount of people this investigative surveillance affects, the question remains: Are The Hartford’s tactics fair?  Tell us what you think in the comments section.

Insurance bad faith industriesThe business model for an insurance company should be relatively simple. Individuals pay for coverage in the event that they suffer some form of an accident or financial loss. Being that most people rarely ever need to file a claim but pay for coverage anyway, the insurance company should be capable of awarding those who do file legitimate claims while still operating at a profit.

Unfortunately, insurance companies are in fact businesses. This means that they will often times make decisions not in the best interest for those they insure, but instead in the interest of making the most money they can. The best way for insurance companies to accomplish this is to deny claims even when individuals are rightfully entitled to compensation. Acts such as these are known as bad faith practices and are in fact illegal.

With giant legal teams and vast experience, there are many tricks insurance companies try to swindle their way out of awarding claims. The reason bad faith practices work is because only 5% of denied claims are ever contested. Even if insurers have to endure costly appeals, settlements, and bad faith penalties for that 5%, denying the other 95% of claims still yields higher profits.

Whether you are up against an auto, medical, health, homeowners, disability or life insurance company, do not let you and your family get bullied around. If you have suffered financial loss you know should be covered by your insurer, research a capable and experienced insurance lawyer immediately. Insurance companies need to be held accountable for upholding contractual agreements just like everyone else and an insurance lawyer can help make this happen.

What is ERISA? The Employment Retirement Income Security Act of 1974, otherwise known as ERISA, is a federal law that sets minimum standards for health care and retirement benefits for employees in the private sector. Although it does not require employers to provide any benefits, those who voluntarily do so must meet certain minimum standards.

ERISA thoroughly regulates minimum healthcare, retirement and other welfare benefit plans such as life and disability. ERISA also governs the management and transparency of these accounts. Since its deployment ERISA has been occasionally amended to protect workers in case of unexpected events such as job loss or those with preexisting medical conditions.

Although ERISA was originally constructed to protect employee benefits for group plan participants, this has not always come to fruition. While the majority of individuals are able to obtain long term disability benefits by filing a claim or a internal appeal, some policy holders may continue to be denied the benefits promised to them. A ERISA lawyer can assist you when you have exhausted all internal appeals and methods. Policy holders who are denied their benefits have the right to file a LTD appeal against the insurance company and have their case reviewed by a federal judge.

ERISA court trials differ from traditional trials in that there is no testimony from either party, only the materials in the case file will be reviewed. For this reason it is imperative that a experienced ERISA attorney handle and prepare your case. A lawyer who is thoroughly versed in all aspects of ERISA will be able to identify where it can apply to your case and increase your benefit payout. They will also commonly pay for the experts and doctors needed to prove the extent of your disabilities.

Many people are under the misconception that insurance companies work to help you. But as a for-profit company insurance companies employ their own lawyers to limit their obligation to you and minimize losses. Ensure that your benefits and retirement are protected by hiring a experienced ERISA attorney to handle your long term disability case.