CJ Henry Law Firm - Your Disability Law Partner

Here a simple thing you can do that could have a tremendous impact on your long-term disability claim: Take a picture! Suppose you have a condition that is visible to the naked eye, or you struggle to perform certain activities. How do you convey this to the insurance carrier who is deciding your case? There are many different possibilities:

Day in the Life Video – Have a family or friend take a video of you going through a routine day showing difficulties such as making your bed, combing your hair, using medical equipment if that applies, or capturing a medical condition such as a drop foot.

Videotape a few of the activities you struggle to perform – Ex: transferring from a wheelchair to a shower chair in the bathroom; getting in and out of bed; going up and down stairs.

Pictures of your injury – bruises on your body from falling; Swelling in extremities. Do not use this to manufacture evidence, and if your condition doesn’t lend itself to video, don’t do this, as it could hurt, rather than help, your case. However, do not be afraid to use this it if it will show your limitation. Insurance companies use surveillance all the time to capture your activities, but they do not always show a true picture of what you can do over the course of a day. So why not level the playing field!
Give this a try if you find yourself having to do an appeal or in a dispute with your ERISA disability carrier over your functional ability.

In ERISA long term disability cases there are a number of deadlines. Missing any of them could be fatal to your claim.

>Providing Proof of Loss – Most insurance policies will have a deadline for providing proof of your disability. Some require that you submit proof as soon as you know of your injury/illness or disability resulting from those. Others may extend the time period up to a year from when you became disabled. Failure to notify your insurance carrier in a timely manner could result in a denial of your claim.

I see this often when a disabled individual has another claim such as a workers compensation claim and they fail to put the disability insurance carrier on notice of their disability because someone told them they could not collect both workers compensation and disability. Waiting to notify the disability carrier until the WC carrier stops paying or after settling the WC claim is often too late. Knowing what your policy requires is the key.

>Filing Administrative Appeal – When you receive a denial letter, one of the first things to look for is your time frame for filing an appeal. This is important because ERISA laws require a claimant to exhaust their administrative remedies before filing a lawsuit. Failure to exhaust the administrative remedies may result in a dismissal of a subsequently filed suit. Generally speaking, the policy requires an appeal within 180 days of receipt of the denial. Keep the envelope the denial came in. This will help establish when the denial letter was mailed.

> Statute Of Limitations - The laws of ERISA do not set a specific statute of limitation. However, often the disability policy will. The courts will generally uphold it if it is reasonable. If the statute of limitation is not listed in your policy, the court will look to your state law governing contracts.