Approved! Supporting Disability Insurance Claims with Evidence

Disability Insurance Claim Lawyer Los Angeles

Living with a disability is rather common. More than a billion people across the globe live with disabilities, many of which were due to a workplace injury, accident, or act of violence. Disability insurance, therefore, is an important type of policy for anyone to have. It serves as a safety net in case a temporary or permanent disability prevents you from working.

However, filing for insurance disability claims remains a challenge for many people. People with legitimate disability claims still get denied, in fact. This may be due to mistakes in their paperwork or the failure to meet the insurer’s definition of a person with a disability.

Hiring experienced disability insurance lawyers in Los Angeles and presenting a solid body of supporting evidence reduces the chances of having your claims denied.

Proper Medical Documentation

Medical documentation is one of the strongest kinds of evidence you can submit to support your disability insurance claim. Records and documents from a licensed health care provider or your primary care physician hold a lot of weight in proving your disability.

Objective Medical Evidence

Objective medical evidence refers to the quantifiable results of procedures or tests. These include diagnostics or imaging tests like X-rays and computed tomography (CT) scans. Blood work results and other findings like blood pressure and pulse rate count as well.

Written Statement from Your Physician

Notes from your doctor, including their diagnosis of your condition and treatment information, strengthen your claims. It’s best to request detailed statements from your physician regarding the effects of your disability and how it interferes with your daily life and full-time work.

Medication Records

Submitting a record of the medications you take for your disability helps validate your claim. Medications, especially those for pain management, are proof of your disability or its effects. A complete record of the medicine you take also reveals possible side effects like impaired concentration, which can support your claims regarding decreased job productivity.

Evidence of Decline in Job Productivity

Aside from medical evidence, you should provide documents proving your inability to perform your assigned work properly. These may include attendance records, records of frequent break or rest periods, and any disciplinary logs. Witness statements from your co-workers or your employer are invaluable, too.

Experts also recommend submitting a detailed job description, preferably from your employer, so that your work requirements are clearly defined.

Timely Submission is Key

Disability insurance claims can be won or lost based on the evidence you provide. Gathering all the medical evidence and supporting statements can be time-consuming, however. It’s especially difficult when you’re still recovering.

This doesn’t mean you are excused from submitting your evidence on time. Take note that having the strongest supporting evidence in the world wouldn’t help if you present it past the deadline. Stay on top of your timeline to avoid this scenario.

Working with Haffner Law will lessen the load on your shoulders. Our experienced disability insurance lawyers will help you gather evidence, understand your insurance policy, and file your claims. We’ll fight for your rights and take your case to court if your claims are unfairly denied.

Contact us today and let us help you get your full benefits.

(This is an attorney advertisement by Joshua Haffner)

Pros and Cons of Lump Sum Disability Settlements

Pros and Cons of Lump Sum Disability Settlements

When you are approved for disability insurance benefits, these benefits are typically paid to you in monthly installments for the duration of your time away from work. Once you are medically cleared to return to work, if ever, these benefits will stop and you’ll still make payments on your disability insurance policy in case of future disabilities.

There are some instances, however, when taking your disability insurance benefits as one lump sum is the best option for you. You may need to speak with your insurer to see if this is even an option. Just like with many financial decisions, choosing to take your disability settlement as a lump sum has both its benefits and its drawbacks.

Why You Might Need a Lump Sum Payment

Some people want to buy out the remainder of their disability insurance policy because they aren’t expected to live for much longer and want to make sure their family members receive the benefits they’ve already paid for. Unlike with life insurance, disability insurance doesn’t get transferred to your dependents in the event that you pass away.

Another reason why someone might want to take disability benefits as a lump sum is simply to avoid having to deal with the insurance company anymore. There are always specific criteria that must be met and rules to abide by in order to keep your benefits when you are still paying on a policy, so buyouts are a often great option for those who want to take their money and run.

Reasons Installments Can Make More Sense

Taking your benefits in standard monthly installments could be the better choice for you if your disability is temporary and you hope to keep your policy once you return to work.

If you take your benefits in a lump sum, you’ll no longer be able to collect additional benefits once the policy has closed; if you get sick or become disabled at a later date and have already exhausted your benefits, you may be out of luck and in a financial predicament.

Getting regular installment benefits is also likely to be a better option for you if you want to rely on regular income while you are out of work. Many people who take lump sum payments fail to budget their funds adequately and discover that it’s easy to spend the funds you’ll need to support yourself later.

Call a Los Angeles Disability Lawyer

If you are considering taking your disability benefits as a lump sum but aren’t sure whether it’s the right choice for you, speak with a capable Los Angeles disability lawyer at Haffner Law. We can advise you in accordance with the specific details of your case.

You can schedule a free case evaluation today by filling out the online contact form at the bottom of this page or giving us a call at 1-844-HAFFNER (423-3637).

(This is an attorney advertisement by Joshua Haffner)

California Disability Claims Accrue When Disability Ends Under ERISA

A recent decision by a federal district court sitting in Los Angeles is a major victory for insureds in California who submit a late claim after the onset of disability, and are denied benefits on that ground.  This adds to another recent decision upholding a California statute, Orzechowski v. Boeing Co. Non-Union Long-Term Disability Plan, allowing for courts to conduct de novo review of ERISA disability claim denials. The combined effect is creating a uniquely favorable legal landscape in California for challenging denials of disability insurance benefits under ERISA.

On May 1, 2017, in Gray v. United of Omaha Life Ins. Co. (C.D.Cal. 2017) a California federal district court judge sitting in Los Angeles held that the time make a disability claim under ERISA begins to run, not “at the onset of the disability,” but rather when the “period of covered disability” ends.  (Id. at *1.)  In doing so, the court upheld the validity of California Insurance Code section 10350.7, as to when a claim accrues under ERISA.

In Gray, the insured employee worked for a Southern California television station, and was badly injured and disabled in May 2011 car accident.  (Id. at *1.)  Through deception and “stonewalling” by plaintiff’s former employer, plaintiff was unable to file a disability claim until August 2015.  (Id. at *1-2.)  The insurer denied the claim on the ground it was “not timely filed,” based on limitation provision in the insurance plan which was tied to “the day disability commences.”  (Id. at 2-4.)  California Insurance Code section 10350.7, however, provides that a proof of loss is not due, and therefore, the limitation period does not commence, until “after the termination of the period for which the insurer is liable.”  Under California law, insurers can use different language in an insurance plan provided it is “not less favorable in any respect to the insured or the beneficiary.”  (California Insurance Code section 10350.)

Gray held that the phrase the “period for which the insurer is liable” in section 10350.7 “refers to the entire period of disability, and proof of loss is not required until that period ends.”  (Id. at *9 (emphasis added).)  Therefore, Gray held that the insurance policy’s language requiring proof of loss “from the date of the disability’s onset” was less favorable, and thus in violated section 10350.  (Id. at *9.)

Pursuant to Gray, in California, the proof of loss requirement, and related time to submit a claim, is dependent on when the disability ends, not when it starts.  This is a critical ruling which significantly extends the time an insured in California can submit a claim for disability benefits under an ERISA policy.  Combined with other recent decisions, Gray demonstrates that the insured-friendly California laws, and the federal courts decision to uphold and enforce them, is creating a uniquely favorable legal environment in California for challenging insurance company denials of ERISA disability claims.

Ninth Circuit Affirms De Novo Review In California Of ERISA Disability Insurance Denials

On May 11, 2017, in Orzechowski v. Boeing Co. Non-Union Long-Term Disability Plan (C.D. Cal. 2017) — 2017 DJDAR 4376 –, the Ninth Circuit Court of Appeals delivered an important victory to insureds in California who have been denied disability benefits under an insurance plan governed by the Employee Retirement Security Act (ERISA).

Orzechowski upholds the enforceability, under federal law, of California Insurance Code § 10110.6, a California statute that provides for de novo review of a denial of benefits under an ERISA plan.  Most states enforce ERISA policy provisions granting the insurer discretion to determine eligibility to benefits and, therefore, review denials under an abuse of discretion standard rather than a de novo standard.  This is an important distinction because the de novo standard of review provides a far more favorable standard, and a much better chance of prevailing in court when challenging an insurance company’s denial. Section 10110.6 invalidates insurance plan provisions providing for discretionary review, and thus requires courts in California to review an insurance company’s denial of ERISA benefits under a de novo standard.

Previous California cases had noted that “the Ninth Circuit ha[d] yet to rule on the applicability of § 10110.6 in ERISA cases.”  (Murphy v. California Physicians Service (N.D. Cal. 2016) 213 F.Supp.3d 1238, 1248.) The decision by the Ninth Circuit in Orzechowski upholding section 10110.6 cements the validity of the law.  It provides a tremendous advantage to California residents seeking to challenge an insurer’s denial of benefits under an ERISA.

The lawsuit in Orzechowski arose from the insurer’s termination of disability benefits under an employee plan governed by ERISA.  The plan included a “broad grant of discretionary authority” to determine eligibility for benefits.  The insured employee developed fibromyalgia and chronic fatigue syndrome, and made a disability claim under the plan.  The insurer initially recognized the disability, and paid benefits, before changing its determination and terminating benefits.  The insurer’s doctor concluded the employee’s “symptoms must be psychiatric in origin.”  The employee appealed the termination with the insurance company, as required prior to filing legal action, but the insurer denied the appeal.  In the subsequent legal action, the trial court “applied an abuse of discretion standard of review . . . rather than a de novo standard,” and affirmed the insurance company’s denial.

In the Ninth Circuit, the insurer argued that the trial court decision should be affirmed because section 10110.6(a), a state law, is preempted by ERISA, a federal law.  The Ninth Circuit in Orzechowski rejected this argument.  It noted that ERISA has a savings clause, saving from federal preemption “any law of any State which regulates insurance.”  The Ninth Circuit in Orzechowski concluded that section 10110.6(a) was within ERISA’s savings clause, and not preempted. The Ninth Circuit also rejected the insurer’s argument that section 10110.6(a) did not apply because the plan was in effect before the law was enacted.  Orzechowski held that because the plan was renewed annually, it came within the ambit of section 10110.6(a).

Orzechowski’s decision upholding section 10110.6(a)’s validity under federal law is a significant win for Californians insured under a plan covered by ERISA.  It means that denials of ERISA benefits to persons insured in California are reviewed de novo by the courts.

Recent California Case Addresses The Mental Health Limitation In ERISA Policies

Many disability policies have a limitation on the amount of time, usually two years, that they will pay policy benefits for a disability caused by mental illness.  Issues regarding the scope and applicability of the mental illness exclusion can arise where a physical injury or illness also results in mental incapacity which contributes to the inability to work.  Common examples of mental health issues associated with a physical injury or illness are depression and anxiety.

On March 27, 2017, a California federal court in Los Angeles ruled that, under an ERISA policy, where mental issues are caused by a physical injury or illness, the 24-month mental illness limitation is inapplicable.  In Doe v. Prudential Ins. Co. of America (2017) WL 1156725, the federal district court addressed a disability policy which limited benefits to 24 months when the disability is caused “in whole or part [by] mental illness.”  (Id. at *1.)  The insured submitted a disability claim for “HIV infection, pain, fatigue, osteoporosis, and severe depression.”.  (Id. at *4.)  Prudential, the disability insurer, approved the claim, but stated that the insured’s disability was caused by his depression and anxiety, not the physical ailments.  (Id. at *5.)  The insured had a history of depression since 1997.  (Id.)  Upon reaching the 24 months, Prudential terminated the insureds benefits.  (Id. at *7.)

The court in Doe v. Prudential Ins. overturned the denial, holding that the insured suffered “disabling cognitive impairments that have a physical etiology.”  (Id. at *14.)  The court stated that the mental illness must be the “but-for” cause of the insureds disability to trigger the mental illness limitation.  (Id. at *12.)  The court emphasized that the insured’s cognitive impairments had a physiological etiology.  (Id. at *14.)  The Court noted that “if Plaintiff’s mental health issues were suddenly resolved, he would still” be disabled.   (Id. at *15.)  The court held that the mental illness limitation did not apply because the insured’s HIV diagnosis, a physical condition, was the but-for cause of his disability.

Along with other courts, Doe v. Prudential adopts a but-for analysis regarding whether a mental illness “in whole or in part” causes a disability, and thus falls under a mental illness limitation.  Insureds who have been subjected to a mental illness limitation in connection with a disability claim may be able to use Doe v. Prudential, and its analysis, to challenge a mental illness limitation.