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Sometimes individuals are unaware of how their conduct may affect the entitlement to benefits that they have secured for their loved ones. I continue to encourage everyone with a group disability policy or group life insurance policy to get a copy and read it. Know what is covered and what is excluded. Recently, I was asked to evaluate the case of a young man who died as a result of participating in a street race. The widow’s attempt to collect the life insurance proceeds was met with denial by the life insurance carrier on the basis that he was engaging in a criminal offense (2nd degree misdemeanor in the state of Florida). The policy excluded coverage for loss caused in…Read More

It’s a fact that most Americans are only a few paychecks away from financial disaster. Disability Income insurance offers some protection by protecting a portion of your income. Most disability plans will only cover up to about 2/3 of your gross income. However, I’ve seen some plans that cover only 40 % of your income. In an ERISA plan where the premium comes out of your paycheck, you’ll want to have your employer deduct the premium after taxes, or out of your net paycheck. The reason is that if you deduct the premium before taxes are taken out, when you have a claim, your benefit will be subject to income taxes. As you can see, if you had to pay…Read More

The answer to this question is yes. However, the real question is Should you? That answer is a resounding NO! I am often contacted by people who have exhausted their administrative remedies and needed someone to file the lawsuit. It pains me to say no, especially to someone who I truly believe is disabled. But where that individual fails to develop the record, often there is nothing that can be done to prove their disability once the case goes to trial. Remember, in ERISA disability claims, at the end of your appeal, the record is closed. Once the record is closed, you cannot introduce new evidence into the record. Therefore, the only evidence the court will see is what is…Read More

Go to the doctor. Regularly. Make sure you are clear with the doctor about new symptoms. If you are shy or nervous and feel uncomfortable about doing this, bring along a family member. Keep a diary of symptoms. Have your client keep one too. We have a sample form on our website here . This is important. It lets the disability carrier know how disabling your condition really is. Send the diary to the LTD carrier and advise the carrier if it is a representative, i.e. typical, week or week for you. Keep a copy. Ask your doctor about the combined effects of your medications. Sometimes your condition alone may not be disabling but the combination of your medications can…Read More

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…Read More

No one is immune from everyday pitfalls and mistakes that everyone is bound to make, but there are some avoidable ones I see over and over again. Applying for disability benefits before reading the disability insurance policy. I tell my clients that applying for disability benefits without reading your policy is like playing baseball where only one team has the rule book. Your disability policy governs your claim. It tell what it means to be disabled, how benefits are calculated, the deadline to provide proof of claim, limitations on benefits and much, much more! Wouldn’t it be devastating to make the difficult decision to leave your job, apply for benefits, and then find out your condition is limited or excluded…Read More

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…Read More

Federal Court refuses to dismiss ERISA claim. Employer’s policy prohibited employees from smoking tobacco products at any time regardless of whether they were in the workplace or not. The plaintiff was fired for having tested positive in a urine test. The purpose of the policy was to save money on medical insurance costs and promote healthy lifestyles among employees. The plaintiff claimed that his termination violated Section 510 of ERISA because the company’s action “interfered with” his participation in the company’s employee benefit plan, which he would have been entitled to had he remained employed. The plaintiff has also filed an invasion of privacy state claim. Rodrigues v. Scotts Co., LLC, 07-10104 (D. Mass. Jan. 30, 2008)Read More

We have all heard the Surgeon General’s warning: smoking is bad for your health. Now, it seems a new label is needed stating that smoking is bad for your job. Recently a Massachusetts employee was terminated form his employment because he tested positive for nicotine. According to the employee, he never smoked on the job or during working hours. He did not smoke during breaks from work or in the presence of other employees or customers of the employer. In his complaint, the employee alleged that the company’s anti-smoking policy violates the Employee Retirement Income Security Act (ERISA) because it discriminates against the participants in the corporation’s health benefits plan for the purpose of interfering with their receipt of medical…Read More