Erisa Lawyer banner

All posts by Lisa Martinez

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. Continue reading

Why you should “just say no”

We here at Scott Davis, P.C. have noticed a rather troubling trend with our clients as of late. More and more people are showing up with substance abuse in their medical records (see my post “Your doctor knows more than you Think”). Most people think of substance abuse as just street drugs, but this can include alcohol abuse, and even prescription drug abuse. This is wrong on several levels, but to keep this post shorter than the tax code (and to avoid sounding too much like Mom), I’ll keep this simple: if any person making a decision on your claim deems drug and/or alcohol use a material factor in why you are unable to work they are bound by law to deny your claim. Continue reading

The cake is baked

Frequently, I get asked to explain the importance of getting an attorney involved during the administrative level of review in a short and/or long term disability claim, rather than once a “final denial” is received. A final denial essentially means the claimant has exhausted all administrative levels of review; therefore there is no longer the option of appealing the denial of his/her claim and the next step in his/her claim would be, in most cases, filing a lawsuit in Federal Court.

Since there is no appeal available to the claimant at that time, there is no longer an opportunity to submit additional evidence in his/her claim. We like to use the expression the “cake is baked” because you are unable to add any additional ingredients to your claim file, or your cake.

It is important to retain an attorney prior to receiving a final denial in your claim so we can ensure the evidence contained in your claim file is sufficient to win in front of a Federal Court Judge if a final denial is received.

Although it may appear you have submitted enough evidence in your file supporting your inability to work, there may be additional evidence obtained directly from your insurance company that you were not aware of. Did your company retain a physician to complete a one-sided medical records only review of your claim? Did that physician contact your treating provider regarding your condition? Did your physician complete a form incorrectly that you may not have seen?

These are all questions that are important to know before receiving a final denial in your claim and we can ensure you get all of the correct answers.

To treat or not to treat

One of the toughest questions I have to answer frequently from our clients is “How am I supposed to get medical treatment when I have no insurance, no income, and can’t even pay my bills?” This can be equally frustrating, more so for the client, obviously, but also for us as your representative, because the most crucial support for a Social Security claim is consistent medical treatment. We can receive a glowing letter from a treating physician, but if a person doesn’t have the medical treatment to back it up, he or she can lose a lot of credibility with a judge. Continue reading

“I thought the fight was over, stop harassing me!”

So, after what was probably a pain staking fight for the short term/long term disability benefits you have been paying for and rightfully deserve, you finally received that golden letter from the disability insurance company saying your claim has been approved. Woo hoo, time to relax without that added stressor on your plate and you can finally focus on getting better… so you thought.

Two weeks later you receive a packet of questionnaires to be completed by you and your physicians. Thinking it is not that big of a deal, you complete the forms as requested and return them to the insurance company. Little did you know, these forms will be coming every five (5) to nine (9) months as the insurance company conducts a “review” of your claim.

“I feel like I am being harassed. Can they do this?” Unfortunately, insurance companies have the right to review a claim as frequently as they feel is necessary. If you do not comply with their requests for completed forms, updated medical records and questionnaires completed by your treating physicians, they can (and will) terminate or suspend your monthly disability benefits until the requested documents have been received and reviewed.

With that said, when you receive that packet of documents in the mail take a deep breath and call your attorney who assisted you in the process and ask that they help you complete the documents together. You may have someone assist you in writing the answers you provide them for each question, which will take away some of the pressure of completing the forms.

Make sure to have the requested documents returned to the requesting disability insurance company prior to the deadline provided. If you need additional time to complete the forms or your physician needs additional time, send a written request for an extension of time to the insurance company and make it aware of the status of the documents.

As always, if you need representation, assistance with your claim or help completing the necessary paperwork, give our office a call and we would be happy to assist you.

When your insurance company sends a questionnaire to your doctor

My insurance company has requested my treating physician complete a questionnaire regarding my ability to work and current medical condition, what do I do?

Requesting updated questionnaires be completed by claimants’ treating physicians seems to be a standard in the review process. Usually, these forms consist of yes or no questions, check boxes and requests for comments on restrictions and limitations.

If you know the insurance company has requested such questionnaires from your physicians it is beneficial for you to make an appointment with your physician to discuss and complete the questionnaires together. By completing the questionnaires together, your physician can accurately answer questions regarding your medical condition. If you are not present during completion of the questionnaire, your physician may inaccurately describe how your condition impacts your ability to function, your restrictions and/or your limitations.

It is also important that all questionnaires completed by your physicians are returned directly to your attorney’s office, not sent directly back to the insurance company. When questionnaires are returned to the attorney’s office they can be reviewed for any “red flags” or inaccurately answered questions.

Although your physician may not believe you are able to return to work, he/she may be completing the form in a hurry and mistakenly check a wrong box that can be detrimental to your disability claim.

Keep in mind, although the insurance company requests the forms be completed by your physicians it is ultimately your responsibility to ensure they are returned in a timely manner. Set a reminder for yourself to follow up with your physician’s office every two to three days regarding the status of your questionnaire to make sure it is completed and returned timely.