Why Does Your Insurance Company Often Terminate Benefits When the Definition of Disability Changes ?

A dirty little secret in ERISA disability claims is that benefits are frequently terminated when the definition of disability in the policy changes.

We receive phone calls every week from confused individuals who tell us their benefits were terminated after several years of the insurance company paying the claim.  Individuals who are receiving disability benefits are often never aware that at some point (i.e. usually after 24 months and sometimes 12 months) in the overwhelming majority of ERISA disability policies, the reason for the termination of benefits is because the definition of disability changes to one that is much more difficult to meet. Continue reading

They Paid My Short-Term Disability Benefits – Why Was My Long-Term Disability Claim Denied?

One issue that has developed over the last several years in disability insurance cases is the scenario where your insurance company approves your short term disability claim for a period of time (perhaps the maximum time frame, usually no more than 180 months) but then, turns around and denies your long term disability claim.

Rightly so, individuals do not understand how the same insurance company, reviewing essentially the same evidence, and using what is frequently the same definition of disability, can make such a contradictory finding? Continue reading

How to Prove That You Are Unable to Work and Entitled to Disability Benefits to Your Insurance Company

The fundamental issue in every disability claim is whether you meet the definition of disability in the disability insurance company’s policy.  What do you need to prove in order to get benefits?

In literally all employer provided disability policies, which are governed by a broad complex Federal law known as ERISA, in some variation you must prove you are unable to work in the occupation you worked in when you initially became unable to work.   It is important to note this definition applies for a given period of time – usually the first 24 months of your disability. Continue reading

Failing to comply with your doctor’s treatment can affect your case

Social Security’s decision to award you benefits depends a lot on the credibility of your statements. In other words, Social Security needs to believe that you truly are disabled. They need to believe that you experience the symptoms you claim to experience, in example, pain, weakness, or memory loss. They also need to believe that your symptoms make it impossible to carry out daily tasks entailed in basic work situations, as in, walking, sitting, lifting, or communicating.

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The most important thing to know about disability claims

When someone receives a denial letter or letter informing them their disability benefits are going to be terminated, there is one important step that should follow immediately – checking your deadline to appeal the determination.

One of the most important things to remember about your disability claim is that there are deadlines to appeal determinations and statutes of limitations for filing lawsuits. It is very important that you never miss your deadline to appeal or go beyond your statute of limitations because if you do, your claim for disability benefits could be lost forever.

If the letter from your insurance company does not provide your specific deadline for filing an appeal, you should contact your case manager for such information. If you claim is denied, contact our firm so we can discuss the next steps available to you and help ensure you do not miss your deadline.


4-1-1 on appeals

Appeals are offered to claimants at all levels of decisions – except if your current claim is denied at federal court the option at the point for claimants is to start a new claim. Generally, you have sixty days after you receive the notice of decision to ask for any type of appeal.

The first appeal available to a claimant is the reconsideration – which may be requested after the denial of initial claim. The second appeal available to a claimant is the hearing before an admistrative law judge. A hearing may be requested after receiving reconsideration denial. The Appeals Council review process of an admistrative law judge decision begins after an application for benefits has been denied at the initial, reconsideration, and hearing levels. On average, initial and reconsiderations are completed in four months or less, and hearings before a judge are granted about nine months to twelve months after a hearing is requested.

Although appeals process can be a frustrating and lengthy – it’s important to not give up – you must appeal within sixty day deadline to ensure your claim is processed as soon as possible.


We talk a lot here about the critical importance of getting medical care to support your disability claim. What is sometimes not understood, however, is that we still need you to tell us about where you have been. Nearly all medical treatment you receive is likely to have some sort of impact on your claim, but if we are not aware of it, the Social Security office probably will not know about it either. Just as an example, we once had a client who had a double hip replacement but did not tell us until six months later. Why? He thought his back was the only condition Social Security would approve him for. Fortunately we were still able to have the SSA get those medical records, and he eventually won his claim. People tend to have the misconception that they can only be approved for one specific physical or mental limitation, so they often do not inform us of care that is outside the scope of their “main” diagnosis. This is a huge mistake! Social Security can and does approve claims for a number of reasons, whether they are physical, mental, or both combined. Please do not make the assumption that a certain doctor’s records or a procedure is not important to your case – by withholding that information, you could be doing irreparable harm to your claim! Be sure to review your treatment records so we can verify the Social Security office has everything they need to fully develop your claim.


Getting affidavits notarized

Why is it important for my family or friends who write an affidavit on my behalf to have their affidavit notarized?  This is a question I have heard quite a few times from clients. An affidavit by definition is “a written declaration upon oath made before an authorized official”.  Without the notary public’s signature as a witness the affidavit is simply a statement. The notarized document becomes, in a sense, the testimony of your loved ones who know you and your disability or disabilities and how these impairments have affected your daily life.  It significantly increases the credibility of your loved one and yourself to the Administrative Law Judge reviewing your claim when their words have been sealed by a Notary whom is an appointed public official.

Although, it may seem inconvenient for your chosen family and/or friends to have their document notarized and may seem like an unnecessary cost to them, it really is a very resourceful tool in advancing your chances of your claim being approved.

Why you need a disability lawyer

A Social Security disability attorney is a guide to making the disability process much simpler for you; from the initial application, appealing denial to preparing for an administrative hearing. An experienced disability attorney can protect you from making common errors that can harm chances of approval.

Another advantage to having a competent attorney is to help tell your story, your personal struggle with medical conditions, which can be a powerful advantage at an administrative hearing. Your attorney will help prepare you for testimony as well as represent you at your hearing and explain why your impairments prevent you from sustaining employment.

Using an attorney that is familiar with the process can make the difference between a successful and failed claim. Obtaining necessary medical evidence to support you claim, help with filing appeals, assistance in completing SSA forms, and ensuring you are paid correctly when your claim is approved are all benefits of hiring a disability attorney.

Social Media

When filing a disability claim or in the process of receiving disability, it is important to watch the pictures and things you say on social media sites like Facebook, Twitter, MySpace and others. It is possible that some administrative law judges could look at things you put on the internet. If this happens it could possibly be detrimental to you disability claim and even result in a unfavorable decision. The next time you are on a social media site be careful what you are writing and the pictures you may post for they might hurt your disability claim. We would recommend that you refrain from using any social media sites until you claim has been approved.