Farrell Disability Law firm helps disabled individuals get their disability benefits back after they have been denied. We focus in the areas of social security disability denials and private disability insurance denials, including ERISA plans.
Disabling injuries can come on at any time and devastate a person physically, mentally, emotionally, and financially. Fortunately, many employers offer an insurance policy – Long-Term Disability (LTD) – which helps employees by providing financial support during the time of their disability. For those whose employers do not offer this (and even if an employee wants to augment the policy provided by his/her employer), insurance companies offer LTD policies for purchase by anyone who meets their requirements. However, like all insurance policies, the insurance company will examine each claim thoroughly so as to ensure that only those who meet their definition of disability receive benefits. Accordingly, using an experienced disability benefits attorney can be crucial to ensuring that a claim for benefits has the best opportunity for success. Another issue that may cause concern is that, typically set forth in the policy documents, most LTD policies provide for potential cancellation and/or termination.
As mentioned above, LTD benefits are typically offered as part of an employee’s overall benefits package, or, alternatively, purchased as an individual plan. If the LTD plan is part of a benefits package, then the plan is governed by a federal law known as ERISA, or the Employee Retirement Income Security Act. Essentially, LTD plans provide a portion of an employee’s income if they find themselves in the situation in which they cannot work for an extended period of time.
Cancellation and/or Termination
Most LTD insurance policies do have in place procedures regarding cancellation and/or termination of the policy, so it is incumbent upon the benefits recipient to ensure that he/she does not trigger one or more of these procedures, whether purposefully or inadvertently. As would seem obvious, the most common reason for termination is that the individual is no longer disabled. However, some of the other common reasons for termination including the following:
Some policies contain a time limitation on the payment of benefits for disabilities related to mental, nervous, or psychological impairments, such as depression, anxiety, chronic fatigue syndrome, or the like. Although rare, some policies may impose such a limitation on chronic disabilities. The most common time limitations are placed on disabilities relating to alcohol or drug abuse.
Social Security Disability Insurance (SSDI) Benefits. Most LTD policies require individuals to apply for SSDI benefits, and the failure to do so may result in termination of LTD benefits.
Continued Treatment. Most LTD policies require the disabled individual to provide proof of his/her continuing disability, and to engage in a program of treatment. The lack of continued treatment can be interpreted as an improvement of the disability.
Improper Activities. If the LTD insurance company discovers the disabled individual participating in activities which he/she should not able to do if disabled, he/she may have his/her benefits canceled. Included in this is the situation in which the employee returns to work.
Changing Definition of Disability. Some policies may adjust what qualifies as a disability after a period of time. More specifically, some policies may define a disability as an inability to perform an employee’s occupation, and then change it to an inability to perform any occupation after a specific period of time, say, 24 months.
LTD benefits will typically end when a disabled individual reaches Social Security retirement age.
If you are currently receiving LTD benefits (or looking to file), and are curious about possible cancellation or termination of benefits, contact an experienced disability benefits attorney as soon as possible. The Jacksonville long-term disability legal team at Farrell Disability Law has years of experience in advising their clients in every aspect concerning LTD benefits, including situations in which benefits may be canceled or terminated. Insurance contracts are not written to be understood by the average person, and insurers use this to their advantage. Level the playing field and get legal advice. Contact us today.
Submitting an application for Social Security Disability Insurance (SSDI) benefits can be an exhausting process, as the Social Security Administration (SSA) thoroughly vets each and every application for sufficient evidence of total disability. There are a great many nuances that must be addressed in an SSDI application, and retaining the services of an experienced disability benefits attorney can be essential to giving an application the best chance at success. As this article illustrates, individuals today stand a greater chance of becoming disabled than ever before. Consequently, it is important to understand the ins and outs of the SSDI application process, including being prepared for any issue that may arise. One issue that may arise is whether two spouses can receive SSDI benefits simultaneously.
Social Security Disability Benefits
Under rules the SSA follows, which is the agency that examines SSDI benefits applications, the eligibility requirements for an individual to apply for SSDI benefits are:
The applicant must have a physical or mental condition which prevents him/her from engaging in any “substantial gainful activity;
The physical or mental condition is expected to last at least 12 months or result in death;
The applicant is under the age of 65; and
The applicant has generally accumulated 20 Social Security Credits in the 10 years prior to the onset of the disability (normally four credits per full or partial year), with one additional credit being required for every year in which the applicant’s age exceeds 42
Simultaneous Spousal Benefits
It is important to note that the elements of SSDI eligibility are applied to each applicant separately. Further, there is no eligibility requirement or disqualifier regarding the applicant’s marital status. As a result, there is no prohibition on both spouses collecting SSDI benefits simultaneously. This is primarily because SSDI benefits are means-based (as opposed to other SSA disability benefits programs, which are need-based).
While the third and fourth elements above can be objectively shown, and the second element can be proven by a statement from a medical professional, it becomes clear that the first element becomes the lynchpin on which benefits will be granted. Accordingly, to prove an individual meets this element, each spouse, individually, will need to provide medical evidence which shows that he/she individually meets the criteria under one of the SSA’s impairment listings. Typically, such evidence oftentimes includes:
The applicant’s medical records;
Any treatment notes and outcomes by any and all medical professionals treating the applicant;
Any medical imaging scans and/or laboratory test results; and
Any other pertinent information affecting the abilities or prognosis of the applicant.
If the applicant does not meet the specific criteria in one of the SSA’s impairment listings, the applicant may nevertheless qualify based on a residual functional capacity assessment. This assessment encompasses a review of the applicant’s medical history, and includes an evaluation by the applicant’s medical professionals (or an SSA physician) to determine the applicant’s ability to work. Assuming the assessment indicates that the applicant cannot perform essential working skills, the chances are great that the applicant will qualify for SSDI benefits. Nevertheless, working with a disability benefits attorney, who knows the ins and outs of the SSDI process, provides the best chance at success.
If you are considering filing, or have recently submitted an application, for SSDI claim, and are curious about your chances of success in light of the fact that your spouse is also receiving SSDI benefits, contact a Jacksonville Social Security disability attorney as soon as possible. The legal team at Farrell Disability Law has years of experience in advising their clients in every aspect of the SSDI benefits process, including the potential of simultaneous benefits for spouses. We are available to review your application and advise you on the likelihood of qualifying for benefits. Contact our Jacksonville office today.
Suffering a disability (or long-term injury) can be debilitating, and not just physically. The mental strain of a disability can be just as painful as the physical strain, particularly an inability to work. In fact, it oftentimes increases the mental strain, as the disabled individual now has no means to earn income. Fortunately, a number of programs exist which can provide financial assistance to these individuals. One program is Social Security Disability Insurance (SSDI), a federal program administered by the Social Security Administration (SSA). The SSA reviews each SSDI application thoroughly. Accordingly, it is wise to engage the services of an experienced disability benefits attorney, who understands the ins and outs of the SSDI application process. Unfortunately, many SSDI applications are denied, and the disabled individual left to decide how to proceed.
Appealing a Denial
In the majority of cases, appealing a denial is the best option. One of the primary reasons for this choice is that allows the applicant to maintain the filing date of the SSDI application. This date, which the SSA establishes as the date on which it was first made aware that the applicant intended to file for SSDI benefits, is the date used to calculate the potential backpay due to a successful applicant. In other words, upon approval of an SSDI application, the applicant/beneficiary will receive any money that would have been paid to him/her as if his/her benefits had started on the date the application was filed.
It is an incorrect assumption that an applicant must file a new SSDI application to have the SSA Examiner consider new evidence. In reality, applicants are allowed to submit new evidence during the appeals process. Doing so can be advantageous to the applicant, as certain evidence may not be available until after a claim has been filed, and, in some cases, the new evidence can bolster an applicant’s claim for disability benefits, and possibly improve his/her chances of obtaining benefits.
Finally, the filing of a new SSDI application may result in a further denial, and, in some cases, based on the same rationale on which the originally-filed application was rejected. The applicant will be in the same position he/she was in before, but will have lost the filing date of the original application.
Refiling an Application
In some cases, however, filing a new SSDI claim may be an applicant’s best option. For example, if the applicant has taken the original application through the appeals process to the point of a hearing in front of an administrative law judge, the applicant cannot submit a new claim if he/she decides to appeal the decision. In this case, it may be in the applicant’s best interest to file a new claim rather than continue to appeal the original claim.
The appeals process can take a very long time, leaving the applicant without the benefits he/she needs. If there is evidence supporting his/her disability that was not part of the original application, the possibility of a new application getting approved may be greater than the appeal. Plus, while the appeals process can take a year or more, an initial decision on a new application often takes considerably less time.
Finally, it may be advantageous to file a new application if the applicant’s condition has significantly worsened since the original application. If so, the new application will most likely be reviewed differently, potentially leading to an approval.
If your SSDI claim was denied, and you are curious about the options you may have going forward, contact a disability benefits attorney as soon as possible. The legal team at Farrell Disability Law has years of experience in advising and educating their clients in every aspect of the SSDI benefits process, including what you can do in the unfortunate case of a denial. We will be able to help you understand the SSDI benefits process, as well as provide some strategies for overcoming a denial. Contact our Jacksonville office today.
Social media is quickly becoming an integral part of the lives of many Americans. From vacations to family memories to even pictures of dinner, many Americans photograph, document, or otherwise record every aspect of their lives and put it online for all to see. However, as a simple review of news articles has evidenced, doing so does not come without consequences. In some instances, houses have been burglarized when criminals have found out that its residents are on vacation. In other cases, marriages have been ended because of online posts of infidelity. The takeaway from these examples is that whatever is posted to social media can come back to haunt the poster – and applicants for disability benefits are not immune. Both insurance companies (in the case of Long-Term Disability (LTD) benefits) and the Social Security Administration (the SSA, the agency charged with processing Social Security Disability Insurance (SSDI) applications) will review an applicant’s social media postings to ensure that they are, in fact, disabled. Retaining the services of an experienced disability benefits attorney can help not only to ensure that an applicant has the best chance at success in his/her disability benefits application, but also to avoid some social media traps that have befallen other applicants. In fact, a recent article has noted that the SSA is developing tools to monitor the disabled status of SSDI applicants by their social media posts.
In general, individuals can receive benefits if they become disabled in the course of their working life. More specifically, disability benefits programs are intended to pay employed individuals a calculated amount if the individual suffers from a condition that is expected to last at least one year and which prevents him/her from continuing his/her employment. Disability benefits typically manifest in two programs – an LTD policy, which is typically a private insurance policy either offered by an employer or purchased by an individual, or an SSDI policy, which is a federal government funded benefits program offered by the SSA. In both cases, there are eligibility factors which are then used to determine the amount that is paid out. Further, the regulator of the policy – the insurance company or the SSA – in an effort to ensure that no fraud is occurring, will vet each application thoroughly. Part of this vetting process now necessarily includes reviewing social media posts to ensure that the applicant is not fabricating his/her injury.
The Effect of Social Media Posts
As mentioned above, in an effort to curb false claims, it is important to understand that, when a disability application is filed, the appropriate agency will most likely be searching social media accounts to gather additional information for review as part of its determination of the applicant’s eligibility for benefits. Accordingly, while an applicant’s medical professionals may provide evidence and opinion on the inability to work, and an applicant may provide detailed narratives of his/her daily restrictions and limitations, a search of the applicant’s social media posts could lead to a denial of benefits if the images seem to contradict medical opinion and/0r the applicant’s claims. In other words, the insurance company and the SSA will give a great deal of weight to visual proof and evidence of activity, as opposed to what they are told by the applicant or his/her physicians.
It should be understood that, while the SSA has rules prohibiting examiners and judges from searching online for information about SSDI applicants, this is merely a prohibition that an applicant’s social media activity cannot be cited as the primary reason for denial. In reality, perception about you by the examiner and judge can be affected by what can be seen. Further, as alluded to above, these rules may be changed in the near future.
If you have recently suffered an injury which has prevented you from continuing working, and you are contemplating applying for disability benefits, contact a disability benefits attorney as soon as possible. The legal team at Farrell Disability Law has years of experience in assisting clients in applying for disability benefits, including representing them in front of the SSA and private insurance examiners. We will be able to educate you about the disability benefits application process, as well as provide some strategies related to posting on social media. Contact our Jacksonville office today.
Suffering a disability that prevents an individual from working can be a very frustrating experience. For many people, their career is a big part of their identity and represents years of education and hard work. Being young when a disability arises adds another layer of frustration to this experience, because key working years may be lost. Fortunately, the federal government administers a program in which these individuals can receive disability-based benefits – the Social Security Disability Insurance (SSDI) program. Questions about eligibility for the program are best asked of an attorney experienced in disability benefits law. Although the Social Security Administration (SSA), the federal agency tasked with administering the SSDI program, provides an outline of the eligibility requirements for applying for SSDI benefits, retaining the services of an experienced attorney can ensure the best possible chances of success for an individual’s application.
SSDI is a federal program designed to provide supplemental income to individuals who are physically or mentally restricted in their ability to work because of a disability. Generally, the disability must be total, i.e., preventing any type of gainful employment, and expected to last for at least one year. Other specific eligibility requirements include:
The applicant is under the age of 65; and
The applicant has accumulated 20 social security credits in the last 10 years prior to the onset of the disability, with one additional credit being required for each year in which the worker’s age exceeds 42.
The last element is waived for applicants who can prove that they became disabled at or before the age of 22.
Accordingly, while there is an age maximum, as is apparent, there is no age minimum for receiving SSDI benefits.
Age as a Factor
Although there is no age minimum, age is a factor for individuals who otherwise are eligible for SSDI benefits. Specifically, the SSA categorizes individuals by age and expected levels of work (i.e., sedentary, light, medium, or heavy) they should be able to perform. With respect to age, the classifications are as follows:
60 and over is considered closely approaching retirement age;
55-59 is considered advanced age;
50-54 is considered closely approaching advanced age; and
Those below 49 are considered younger individuals.
The SSA uses these categories when ascertaining an individual’s ability to adapt to new work. That is, the SSA maintains that younger individuals are usually able to adapt to new work, which means that they must be able to show that they cannot perform any type of work, not just the type of work done in the past. On the other side, if an SSDI applicant has the same work history and physical impairments, but is 55 years or older, then he/she would automatically be considered to be disabled pursuant to the SSA guidelines because he would no longer be considered able to adapt to new work. Those individuals that fall within 50 and 54 years of age are in middle of these standards and will be evaluated on more of a case-by-case basis.
If you have suffered an injury which is preventing you from working, and you are contemplating applying for SSDI benefits, but you are curious as to whether you are old enough to receive benefits, contact a disability benefits attorney as soon as possible. The legal team at Farrell Disability Law has years of experience in representing clients applying for SSDI benefits in front of the SSA, and can educate you about the age-related and other eligibility requirements of SSDI benefits. Upon a review of your situation, if you are eligible, we will work to ensure that you are approved for benefits. Contact our Jacksonville office today.
The Social Security Administration (SSA) is the federal agency responsible for providing a social insurance safety net to many Americans. One of the benefits provided by the SSA is Social Security Disability Insurance (SSDI). SSDI is a program which provides benefits to individuals who have suffered a disabling condition. Getting approved for SSDI benefits is a complex endeavor, and retaining the services of an experienced disability benefits attorney can be crucial to ensuring the success of an application. One advantageous aspect of SSDI benefits involves benefits which can be paid to certain members of the recipient’s family. Specifically, SSDI benefits may be paid to a recipient’s spouse (current or divorced) and children (including disabled minors as well as adult disabled children who became disabled before reaching the age of 22). A discussion of the benefits available for dependents of an SSDI benefits recipient will follow below.
As stated above, certain individuals may be able to receive SSDI benefits as a result of another individual’s application. These certain individuals, referred to as dependents of the SSDI benefits recipient, include the following:
The spouse of the disabled individual, if the spouse has a child under the age of 16, has a disabled child in his/her care, or is at least 62 years old;
The divorced spouse of the disabled individual, if the marriage lasted at least 10 years;
A minor child of the disabled individual;
An adult disabled child of the disabled individual, who became disabled before the age of 22; and
A high school student under the age of 19.
For purposes of SSDI benefits, a “child” includes adopted children.
Additionally, if the disabled individual has grandchildren or step-grandchildren, they may be eligible to receive dependents benefits through the disabled individual. In order to receive these benefits, each of the following factors must be satisfied:
The parents of the grandchild (i.e., the disabled individual’s child) must be themselves deceased or disabled;
The grandchild himself/herself must have been living with the disabled individual before he/she turned 18 years old; and
The grandchild must have received at least half of his/her financial support from the disabled individual in the year before the disabled individual became eligible to receive SSDI benefits.
Finally, parents of a deceased disabled individual may also collect SSDI benefits, if each of the following are true:
The parent is at least 62 years old;
The parent has not remarried since his/her child’s death;
The parent is not entitled to his/her own, higher SSDI benefit; and
The parent was receiving at least half of his/her financial support from the disabled individual at the time of the disabled individual’s death.
An eligible dependent may receive up to 50% of the disability benefits paid to the disabled individual. However, there is a family limit on benefits. SSDI will only pay 150-180% of the disabled individual’s benefits for the entire family, the exact percentage being determined by a formula. Further, if the amount the family would receive is greater than that percentage, the benefits to the dependents are reduced equally.
If you are the dependent of an individual who is receiving SSDI benefits, or if you are currently receiving SSDI benefits and have a dependent, and are curious as to potential benefits for the dependent individual, contact a disability benefits attorney as soon as possible. The legal team at Farrell Disability Law has years of experience in SSDI matters and can help you learn how a dependent may receive benefits. Upon a review of your situation, we will work to ensure that your dependent receives the greatest possible amount. Contact our Jacksonville office today.
Qualifying for Social Security Disability Insurance (SSDI) benefits is a complex and lengthy endeavor. The Social Security Administration (SSA) must ensure that all claims for disability are accurate. As a result, it has imposed various requirements on an applicant to prove that his/her claimed disability is legitimate. Retaining the services of an attorney experienced in disability benefits law can help ensure that the SSDI application contains all necessary evidence to have the best possible chance at success. One type of disability that is especially problematic to prove is back pain, due to the subjective nature of its symptoms. A recent article illustrates the pain and persistence in symptoms for those suffering from back pain. However, the important question for sufferers is – does this condition qualify for SSDI benefits? A discussion around how to base an SSDI application on back pain will follow below.
SSDI Benefit Requirements
To obtain SSDI benefits, according to the SSA’s Web Page, all an applicant needs to show is that he/she is unable to work because of a medical condition that is expected to last at least 12 months or result in death. While this seems relatively straightforward, in cases in which the applicant is basing his/her application on back pain, the SSA reviews the applicant’s objective symptoms to see whether they match the requirements in SSA’s impairment listing for spinal disorders. If the symptoms do not match, then the SSA will review the applicant’s functional limitations to see what type of work the applicant can do. As an example, the SSA will ascertain whether the applicant’s range of motion is so limited that he/she cannot bend over, has trouble walking, or needs to switch positions on a frequent basis. Finally, in all cases, and since symptoms of back pain are highly subjective, the SSA will analyze an applicant’s credibility.
Credibility is important because, as stated above, symptoms for back pain are subjective. Accordingly, the SSA must analyze an SSDI application to be sure that the applicant’s pain is truly as bad as the applicant claims it is. Thus, the SSA will review the following factors when assessing an applicant’s credibility:
The applicant’s medical records;
A medical professional’s opinion of the applicant’s pain level and, if necessary, his/her limitations;
How often the applicant visits the medical professional;
The applicant’s willingness to entertain different treatments and to stick to a treatment plan;
How the pain affects the applicant’s daily life;
How the applicant’s pain symptoms compared to others with the same condition; and
Any potential evidence of pain exaggeration.
In sum, the more evidence an individual can provide about his/her disability and the limitations he/she is experiencing as a result, the better the applicant’s chances are for getting approved
Conditions That Have a Good Chance at Approval
While most conditions involving back pain are difficult to establish, the following conditions are more likely to get approved because they can be objectively documented more easily, and are included within the SSA’s impairment listing:
Arachnoiditis – a painful condition caused by inflammation of the membrane that surrounds and protects the spinal cord. Symptoms include pain, weakness, painful electrical sensations in the legs, and the loss of bowel and bladder function.
Spinal Stenosis, which is caused by the narrowing of the spinal column that puts pressure on the spinal cord and can cause pain, numbness, and weakness. Severe spinal stenosis in the cervical spine (upper) can even lead to bowel and bladder incontinence.
Nerve Root Compression, which is caused when a bulging or herniated disc, spinal fracture, or arthritis which puts direct pressure on a nerve. Severe nerve root compression can lead to pain, weakness, numbness, and eventually muscle wasting.
If you need to file an application for SSDI benefits, contact a disability benefits attorney as soon as possible. While back pain can be very debilitating and cause agony to the sufferer, the SSA makes it a challenge to get benefits. The legal team at Farrell Disability Law have years of experience in disability matters, and know what you need to prove to obtain benefits. We will work to ensure that your application has the best chance at success. Contact our Jacksonville office today.
In most cases, applications for Social Security Disability Insurance (SSDI) benefits are approved or denied at the hearing phase, after the application has been rejected in the earlier appeal proceedings. The hearing phase typically involves a face-to-face meeting with an administrative law judge, in which the applicant presents arguments in his/her favor, and in opposition to, a government representatives who counters these arguments. Vocational experts are typically involved in these hearings and offer his/her opinion about what jobs the applicant can perform, given his/her limitations. It is important to note that, when giving his/her opinion, the vocational expert may rely on data gleaned from his/her experience, his/her client base, and various other sources of information. Recently, the U.S. Supreme Court agreed to hear a case in which the vocational expert refused to provide the basis for his conclusion, and, as a result, a Michigan applicant was denied SSDI benefits. The applicant maintains that, by the vocational expert not providing this basis, that he/she is not able to scrutinize, or even counter, the data on which the opinion was based. A discussion of the role of a vocational expert at an SSDI hearing, and some ways in which his/her opinion can be challenged, will follow below.
The Role of a Vocational Expert
Generally speaking, a vocational expert (VE) is an individual trained in all aspects of the labor market. As a result, he/she is able to ascertain the effect of a disability on an individual’s earning capacity, based on a determination of the skills needed to perform certain jobs. In an SSDI hearing, the VE gives his/her opinion as to what jobs a disability applicant can do in light of his/her impairments. Accordingly, this opinion is given great deference in determining whether a disability claim is approved.
At the hearing, the applicant will present evidence about his/her disability and work history. The VE will then determine whether the applicant can do his/her past job, and if not, what transferable skills he/she have. Further, the VE will answer a series of hypotheticals to ascertain whether the applicant can do any other job, based on these transferable skills. If the VE determines that the applicant either can do his/her past job, or can transfer skills to another job, then his/her application will most likely be denied. Accordingly, it is crucial to challenge the VE’s opinion.
Challenging a Vocational Expert’s Opinions
An applicant should never accept the opinion of the VE and needs to be prepared to challenge any assertions made against him/her. Common bases to challenge a VE’s opinion include:
For claims the applicant has skills that can be transferred to another job, questions about any physical requirements of the other jobs, to determine if the applicant’s physical challenges would actually eliminate these other jobs.
Demonstrating the applicant did not learn the skill or skills required by other jobs.
To challenge the number of positions available for other possible work, questions about the actual number of positions in the local and national economy for that job should be posed to ascertain whether the job exists in significant numbers. Being able to do another job would be impracticable if, in fact, only a handful of these jobs exists nationwide.
In the end, it should be known that the applicant (or his/her legal representative) has the opportunity to cross-examine the VE after the judge has finished asking his/her questions. This opportunity should not be missed, and an experienced attorney will make the best of this opportunity, so that the VE’s opinion does not automatically form the basis of the judge’s opinion.
If you have filed, or are considering filing, an application for SSDI benefits, contact a disability benefits attorney as soon as possible. The legal team attorneys at Farrell Disability Law have years of experience in disability benefits, and can help to educate you on what you will need to prove. We will also be able to help you understand not only the role of a vocational expert at your hearing, as well how any negative claims by the expert can be countered. Upon a review of your situation, we will work to ensure that your application has the best chance at success. Contact our Jacksonville office today.
A disability can strike at any time, and may affect an individual to the point which he/she may be forced to stop working. In these cases, the individual may wish to take advantage of Long-Term Disability (LTD) Insurance benefits. LTD benefits are typically provided as part of an employee’s benefits offering, although individuals are free to purchase LTD policies on their own. Nevertheless, like any insurance company, filing a claim for LTD benefits is a difficult endeavor. Retaining the services of an experienced disability benefits attorney can help provide the best opportunity to get an approval of benefits. In an effort to ensure that they are only paying out benefits for legitimate disabilities, insurance companies will thoroughly examine every application for benefits. Additionally, LTD insurance companies purchased outside of an employee’s benefits program will review an application to ensure that the individual is insurable under their rules. The recent trend of individuals submitting samples for their own DNA test, unfortunately, can prove to have a negative effect on some LTD applicants. A discussion of how DNA testing can impact LTD coverage will follow below.
Genetic Information Nondiscrimination Act
The Genetic Information Nondiscrimination Act of 2008 is a federal law which protects Americans from being treated unfairly because of differences in their DNA that can impact their health. The law is intended to help ease concerns about discrimination that might keep some people from getting genetic tests that could help them make better medical care decisions. The law also enables people to take part in research studies without fear that their DNA information might be used against them in health insurance or the workplace. Accordingly, it is important to note that this law prevents discrimination only by health insurers and employers, and specifically does not apply to life insurance, disability insurance and LTD insurance policies. Asa a result, it remains legal for insurers to deny coverage not only to the person who underwent the testing, but to everyone in their family currently and in the future.
Strategies to Prevent a Negative Effect
DNA testing, like any test ordered by a medical professional, is most likely considered part of an individual’s medical records. Accordingly, the test, and the results of that test, are most likely required to be submitted to the insurance company as part of an individual’s medical history. Nevertheless, it is important to thoroughly understand the requirements of the LTD insurance policy to be sure that results of a DNA test must be submitted. If it is a requirement, this information will be used by the insurance company as part of their analysis.
Obviously, the best strategy to take to avoid having a DNA test affect an individual’s application for LTD benefits is to never submit for a DNA test, or, alternatively, to submit for a test after obtaining an LTD insurance policy. However, the primary draw of a DNA test is to alert the individual to potential issues in his/her health going forward. As a result, many people may decide it is still worthwhile to obtain a DNA test.
Further, some people may unwittingly make this information easy for insurance companies to find by discussing it on social media. To prevent this, it is important not to discuss this, or any confidential information, on any social media site.
If you are considering purchasing an LTD insurance policy, and you have submitted for a DNA test in the past, contact a disability benefits attorney as soon as possible. The legal team at Farrell Disability Law have many years of experience in disability benefits, and can help educate you on what you need to do to have the best chance at obtaining an LTD insurance policy, including in light of any DNA testing. Upon a review of your situation, we will work to ensure that your insurance application has the best chance at obtaining approval. Contact our Jacksonville office today.
Pain, and, especially, the tolerance of pain, is a very subjective experience. Certain individuals can withstand a greater degree of pain than others. Consequently, injuries and disabilities will affect certain individuals differently than others. This variance will influence whether a particular individual is disabled enough to continue working and, whether it is possible to file for disability benefits, such as those offered by the Social Security Disability Insurance (SSDI) program. In order to have the best chance possible at obtaining SSDI benefits, it is crucial – and advisable – to retain the services of an experienced disability benefits attorney. Recently, the Social Security Administration (SSA) requested input which it will use to potentially revise its pain evaluation procedure. A discussion of the current procedure used to evaluate pain in SSDI applications, and how an applicant can prove his/her pain is debilitating, will follow below.
The SSA maintains that, to receive SSDI benefits, an applicant must be disabled. Specifically, a disability is the inability to engage in any substantial gainful activity as a result of a medically-determinable impairment which is expected to last at least 12 months or result in death. The SSA uses a predetermined process to determine whether an SSDI applicant is disabled under the applicable law. At various steps in the process, the SSA will consider both the medical evidence of an impairment and the applicant’s descriptions of his/her symptoms, including any pain suffered by the applicant.
With specific reference to the evaluation of pain, the SSA currently uses a two-stage process. In the first stage, the SSA will determine whether there is objective medical evidence showing the existence of a medically-determinable impairment which could reasonably be expected to result in pain. If this evidence does not exist, the SSA will determine that the applicant is not suffering from pain. However, if the evidence does point to the applicant having a medically-determinable impairment which could reasonably be expected to result in pain, the SSA will then evaluate the intensity and persistence of an applicant’s degree of pain based on the evidence. The SSA typically considers several factors at this stage, including the following:
The objective medical evidence;
The applicant’s medical history, including any clinical and/or laboratory findings;
Any statements or record about the pain’s effect on the applicant;
The applicant’s ability to conduct activities on a daily basis;
The location, duration, frequency, and intensity of the pain, as well as any aggravating factors contributing to the pain;
The type, dosage, effectiveness, and side effects of any medication taken by the applicant;
Any treatments, other than medication, the applicant is currently receiving or has received for relief of the pain;
Any measures the applicant currently uses or has used to relieve pain (g., lying flat on the back, standing for 15 to 20 minutes every hour, sleeping on a board, etc.); and
Any other factors concerning functional limitations and restrictions due to pain.
The benefit analysis described above is that the SSA lays out exactly what an SSDI applicant needs to do to provide proof of his/her pain. Further, it is important to understand that, although the level of pain is subjective for each individual, the greater the amount of subjective proof submitted, the better. To increase chances of approval, it is extremely beneficial to ensure that the applicant’s medical history is as detailed and comprehensive as possible. An experienced disability benefits attorney will be able to sort through the available evidence to ensure that the most effective evidence is presented to the SSA in its pain evaluation.
If you have filed, or are contemplating filing, an application for SSDI benefits, contact a disability benefits attorney as soon as possible. The legal team at Farrell Disability Law understand the rules that govern the SSDI disability benefits program, and can educate you on the process for receiving SSDI benefits, and how to increase your chances at receiving benefits. Upon a review of your situation, we will work to ensure that your application is as strong as possible. Contact our Jacksonville office today.