Sometimes our clients who are physicians diagnose and self-treat their conditions and ask us whether they can establish their disability claim based on their own assessment.  It stands to reason that an insurance company asked to pay benefits will not rely solely on the word of the claimant. In fact, most policies indicate not only that the claimant has to be under “appropriate care” for their condition, but they cannot be treated by a family member.  Weisman v. The Guardian Life Ins. Co. of Am., Civil Action No. 7:22-cv-00595, 2024 U.S. Dist. LEXIS 2807  (W.D. Va. Jan. 5, 2024 ..read more

We commonly work with clients who, aside from suffering from the physical impacts of cancer, are unable to re-engage in their occupation due to long lasting cognitive effects of chemotherapy and other medication treatment.  We are particularly keen on helping women who have endured the impacts of breast cancer, but experience deficits in their memory, and cognitive fatigue during and after chemotherapy.  Insurance companies regularly attempt to limit their liability under a two-year mental health limitation in the disability policies. We recently reviewed a decision against Unum Life ..read more

The need to go out on disability leave is based on one’s inability to perform the duties of their occupation, not on the choice to step away from working. If you obtained disability coverage through your employer, the need to stop working due to a sickness or injury must occur while you are still employed. In our practice, we have noticed a particular “disconnect” between the disabled person’s intention to convey their need to stop working and the impact their choice of words has on the disability assessment. Accepting that you are disabled can be very difficult and uncomfortable. This is espe ..read more

A common thread in disability claims is how active the individual is after filing their claim. Insurance companies require claimants to complete detailed forms describing their activities, asking them how they spend their day from morning to evening, what computer systems they use, even how often they watch TV.  It is important to understand that the real reason insurers want this information to prove that you are doing activities that suggest you are more functional than reported, or to identify an alternative job you can perform, so they can deny your claim. Our clients ask us whether t ..read more

In order to obtain private disability benefits, you must be able to show that you are unable to perform the duties of your occupation due to symptoms of a medical condition. An important component of your claim is determining whether your condition is related to an injury or sickness. Many private individual policies provide for lifetime benefits if the disability is caused by injury. We typically think of an “injury” as occurring during an event such as a fall-down or motor vehicle accident. However, that is not necessarily the case. It is common, for example, that professionals such as denti ..read more

The denial of a disability claim can be incredibly frustrating and confusing for claimants. Insurers typically provide only vague reasoning for the decision, leaving claimants in the dark to figure out why they were denied and what steps they should take to appeal the decision. They are advised of the deadline and procedure for appealing the denial, but often don’t know where to start. If the claim was made under an ERISA plan, the denied claimant is entitled to request a complete copy of their claim file, which will contain “all documents, records, and other information” relevant to his or he ..read more

Insurance companies routinely hire physicians to perform a medical records review and use that review to decide whether a claimant qualifies for disability benefits. The use of reviewing physicians is not always problematic, as they may support the claim. A fair and thorough review can also provide valuable insight and identify evidence that can be provided by the claimant to shore up their case. Those potential benefits, however, are often outweighed by the reviewing physician’s anti-claimant bias. Medical reviewers often work as independent contractors for many different insurance companies ..read more

If you or someone you love suffers from Multiple Sclerosis (MS), you already know how debilitating this progressive and incurable illness can be. Nearly one million people in the United States currently live with MS. In honor of MS awareness month, we highlight this all-too common illness and share tips and resources for succeeding in MS-based disability claims. MS is an autoimmune disorder that attacks the central nervous system – the part of your body that controls your ability to walk and think. It causes unpredictable symptoms such as pain, fatigue, impaired balance and walking, issues wit ..read more

Insurance policies often have different terms of coverage for disabilities caused by “accidental injuries” and “sickness” so it is important that your claim is correctly classified.  A recent case by an endodontist disabled by advanced degenerative arthritis in her hands illustrates the tactics used by insurers to limit coverage.  Chapman v. Unum Life Ins. Co. of Am.  Unum asserted that her claim was based on sickness, which limits disability benefits to age 65.  Dr. Chapman claimed that she was entitled to lifetime benefits under the “accidental injury” clause in ..read more

We are often asked by our disabled clients if they must stop all cease or limit their daily activities in order to prove they are unable to work in their occupation.  The answer is no.  Insurers do poke around, asking claimants on “Activities of Daily Living” forms questions such as how far they can travel, what computer devises they operate, whether they tend to their yard, or clean their home or exercise at a gym.  Detailed prodding often seeks information about how the claimant spends their day from the moment they awaken to when they go to sleep at night. We have handled app ..read more