You shouldn’t have to fight for your disability insurance benefits when you’re already struggling to recover after an injury. Fortunately, a Los Angeles disability attorney can do the fighting for you.
Receive the Disability Benefits Your Deserve in Los Angeles, California
Serious injuries can be debilitating and life-altering in every facet of life, from the personal to the professional. After a serious accident, you may be unable to work for a short- or long-term stint. It’s an unfortunate truth, but many workers find themselves with injuries that can put them off the job for a few weeks. Some are even out of work for good.
When you began your job, you might have been provided or purchased disability insurance, but when your accident has left you injured and unable to work, how do you file a claim for those benefits? These benefits can help you keep going after a serious accident, but filing a disability insurance claim can be confusing and difficult, especially when you’re dealing with unfair claim denials.
California disability insurance rules are often strict, and when you have been hurt and left disabled, that can feel overwhelming. But with the help of a Los Angeles disability attorney at Haffner Law, you can get the help you need to handle your disability claim. Give us a call now and let us talk about your case.
What is Disability?
Disability refers to a physical or mental impairment that limits an individual’s ability to perform certain tasks or activities that are considered normal or typical for a person without such impairment. Disabilities can be temporary or permanent, and they can range from mild to severe.
Examples of disabilities include visual impairments, hearing impairments, physical disabilities, developmental disabilities, and mental health conditions. It’s important to note that disabilities are not the same as illnesses or diseases, and they are not inherently negative or a sign of weakness.
Disabilities are simply a characteristic that affects how a person interacts with the world around them, and individuals with disabilities can still lead fulfilling lives and make valuable contributions to society.
Types of Disability Insurance in Los Angeles
After your accident, the first step is to look at what sort of disability insurance you have and what you need for your situation. Disability insurance comes in two main types: long-term and short-term. Your coverage will depend on the plan you have chosen through your employer or purchased through a private insurer, but there are a few key differences between the two.
Short-term disability insurance refers to insurance that covers you for a short period. This insurance usually lasts between three and six months, but in California, your policy may last up to a year. These policies tend to be less expensive, but they will not last as long as a long-term plan.
Long-term disability insurance, on the other hand, can support you for a lifetime. If your disability lasts for longer than six months, long-term disability should cover your needs for as long as your disability lasts. Unfortunately, these policies can be significantly more expensive, and it is common to find yourself waiting for a few months before these benefits are available.
What Are Social Security Disability Insurance (SSDI) Benefits?
SSDI benefits differ from Social Security income that people receive after working for a specific period. SSDI is designed to provide payments to individuals who are unable to work due to a severe injury or illness resulting in an impairment that is expected to last for at least a year or could lead to death within a year.
The amount of SSDI benefits a person receives is determined by their past earnings and is paid to both the individual and their dependents. The formula used to calculate the total disability benefit considers the worker’s income before their disability. Although it may not entirely replace the individual’s income, it can serve as a significant supplement.
To qualify for SSDI, there are strict eligibility criteria in place. According to Social Security law, the applicant must be unable to participate in any substantial gainful activity due to a medically determinable physical or mental impairment expected to result in death or last for at least a continuous 12-month period.
What Are Private Disability Insurance Benefits?
In the United States, there are numerous providers of private disability insurance. Typically, people obtain long-term disability insurance through group coverage or individual policies. Group coverage is generally available through employer-sponsored insurance or professional associations.
Individuals who receive private disability insurance through their employer or association typically do not have to go through the underwriting process. However, if a person obtains a private disability insurance policy on their own, it will typically require underwriting, and their eligibility and premium will be based on their personal health history.
Typically, the insurer will evaluate the person’s medical history over three to five years and may require a medical examination. Regardless of whether a person obtains private disability benefits through their employer or individually through a policy, they will be able to utilize the policy if they become disabled, up to the amount specified in the policy contract.
What Are the Most Common Conditions Covered by Disability Insurance?
There are disabled individuals in California who suffer from either ambulatory or cognitive disabilities. Ambulatory disabilities restrict a person’s ability to walk and climb stairs and may include conditions such as back pain, nerve damage, herniated discs, sciatica, or broken legs.
Cognitive disabilities, on the other hand, affect a person’s ability to concentrate, remember, or make decisions due to physical, mental, emotional impairments, or medication. It’s common for one injury or illness to lead to a series of others, with extreme back pain being an example of a condition that may cause both physical and cognitive disabilities.
Back injuries can restrict a person from walking, standing, sitting, or lying down for prolonged periods, while the pain or medication used for treatment can impair their focus and concentration at work. Some disability plans may only provide limited benefits for common musculoskeletal conditions, like back injuries.
However, by consulting with our Los Angeles CA disability attorney, individuals may discover that they qualify for all their co-morbid conditions. Common injuries and illnesses that may be eligible for benefits include:
Certain disability policies may offer benefits if an individual seeks treatment for substance abuse. Depending on the specific plan, a 12-month rehabilitation program may qualify for short- or long-term individual or group disability benefits. If a person’s disability insurance policy does not cover illegal drug abuse, it may still provide coverage for addictions to prescription medication.
Additional time may be required to find effective alternative methods for pain management related to an underlying injury or illness. To avoid being excluded due to “self-inflicted” causes, it’s recommended to seek assistance from our accomplished Los Angeles disability attorney at Haffner Law, who can help file a strong claim application.
Complications of Pregnancy
If you have experienced childbirth, you are likely aware of the numerous potential complications that may arise during pregnancy. Your doctor may advise bed rest in the early stages of pregnancy, or you may develop a post-surgical site infection after a C-section, or experience postpartum depression. Even individuals in excellent health can encounter complications during and after childbirth.
As an example, tennis champion Serena Williams faced life-threatening blood clots after giving birth to her daughter, and women are at a higher risk of developing blood clots during pregnancy.
The immune system disorder referred to as Multiple Sclerosis causes interference with the communication between the brain and the rest of the body’s nerves. The physical symptoms can range significantly, including numbness, tingling sensations, loss of coordination, vision impairment, and even the inability to walk.
In addition to these physical symptoms, patients may experience difficulties in concentration, cognitive processing, and emotional regulation. While there are costly treatments available, there is currently no cure for this condition. Multiple Sclerosis may potentially prevent patients from continuing in any form of employment while burdening them with significant medical expenses.
Traumatic Brain Injuries
In modern times, athletes, particularly in football, are receiving significant attention due to the high prevalence of Chronic Traumatic Encephalopathy (CTE). While the condition is not yet fully comprehended, research suggests that it may result from recurrent concussions and other severe forms of Traumatic Brain Injury (TBI).
Nevertheless, even a single TBI, particularly those caused by vehicular accidents involving cars, trucks, and motorcycles, may result in long-lasting or permanent disability.
The severity of your medical condition may not be the sole determining factor in your eligibility for disability insurance benefits. Another factor that can influence a successful disability claim application is how your injury or illness affects your capacity to carry out crucial tasks in your present occupation, or any occupation that you are skilled or qualified to perform.
Here are some more disabling illnesses and injuries that might qualify you for individual or group disability benefits:
- Malignant neoplasms, chemotherapy, and radiation
- Car accident injuries
- Spinal, cervical, and thoracic issues
- Surgical recovery
- Heart attacks, strokes, diabetes, COPD, and aneurysms
- Knee problems and knee replacements
- Other self-reported conditions include fibromyalgia, migraines, and chronic fatigue
- SLE and rheumatoid arthritis
- Diseases such as Crohn’s, IBS, and bowel dysfunction
If you experience an injury or illness that results in your inability to work, it is advisable to seek the guidance of our proficient Los Angeles CA disability attorney at Haffner Law. This can help determine if you are eligible for disability benefits.
What Are Disability Insurance Eligibility Requirements?
To be eligible for DI benefits, you must:
- Be unable to perform your usual or customary duties for a minimum of eight days.
- You have lost income due to your disability.
- Employed or actively seeking employment at the onset of your disability.
- During your base period, you earned at least $300 from which State Disability Insurance (SDI) deductions were deducted.
- In the first eight days of your disability, you must be under the care and treatment of a licensed physician or practitioner or accredited religious practitioner. The beginning date of your claim can be modified if it does not meet this requirement. To continue receiving benefits, you must continue receiving care and treatment.
- Complete and submit your Claim for Disability Insurance (DI) Benefits (DE 2501) within nine days of your first day of disability, but no later than 49 days, or you risk losing your benefits.
- Have your doctor complete the medical certification portion of your disability claim.
Am I Eligible for Disability?
Many Los Angeles residents find themselves on disability before they retire, and you may be one of them. The process can take some time, and it does involve several steps, but you may receive a significant portion of the wages you were previously earning. If you believe you deserve disability compensation, you may need to follow a few steps to get it:
Review Your Plan
If your employer offers insurance or you have purchased your plan, now is the time to review it. Be sure you know what type of disability insurance you have, whether you meet the requirements, and whether it will cover your needs.
Visit Your Doctor
A medical professional will review your case and make sure you meet the definition of disabled. The opinion of a doctor can help strengthen your claim and the likelihood that you will receive your benefits.
Submit Your Claim
If you receive disability insurance from your employer in Los Angeles, you will need to submit as much medical evidence as possible, as well as any required supporting documents. Having as much information as possible will typically help you get your claim approved without any need for appeals or denials.
Receive Your Claim Decision
Within roughly forty-five days, you should receive an answer about your claim. This could be an approval for your coverage, a denial, or a delay. You may be asked to provide more information, so be sure you are as prepared as possible.
If you receive an unfair delay or denial after following these steps, call our knowledgeable Los Angeles disability attorney as soon as possible.
What If You’re Offered a Disability Benefit Lump Sum Buyout?
Insurance companies prioritize their profits, so denying disability benefits may be financially advantageous for them. They may also offer a lump sum settlement, which could be beneficial if you require a large sum of money, but it means forfeiting future monthly benefits.
You should carefully weigh the advantages and disadvantages of having a lump sum payment, such as investing or pursuing business opportunities, versus continuing to receive monthly benefits. Keep in mind that insurance companies can still find ways to terminate or reduce your benefits even after you receive a lump sum.
To make the best decision, it is recommended that you seek advice from our knowledgeable Los Angeles disability attorney.
Why Do Disability Insurers in Los Angeles Deny Claims?
Wouldn’t it be great if the benefits you’ve been paying for were there when you needed them? Alas, we’re dealing with insurance companies here, and they care about only one thing: profits. Disability insurers are no different than any other type of insurance company—they will do whatever they can to get out of paying on a claim.
The law doesn’t support the insured. Instead, it allows the insurance companies to issue policies, interpret those policies to their ends, and be the decision-makers on whether you meet their policy requirements. If that sounds crazy to you, that’s because it is. That’s why it’s so important to have a Los Angeles CA disability attorney on your side.
An insurance company is far less likely to take advantage of a claimant who has legal representation. Even when you think you have the most legitimate claim ever filed, you can still be denied, sometimes for the silliest of reasons. Take a look at some of the common reasons disability claims are denied in Los Angeles:
Believe it or not, one of the common reasons insurers deny disability claims is because of paperwork issues. Sometimes, it’s a mistake made on the paperwork; sometimes it’s missing documentation; and sometimes it’s because you didn’t file the paperwork within the set deadline.
Insufficient Medical Evidence
If you’re claiming disability, you will need to have proof that you are disabled. The more medical evidence you can collect, the better. If you fail to provide the insurer with all the medical documentation it is requesting, it will deny you.
You Don’t Meet Their Definition of Disabled
Every insurance policy will have a definition of what is considered “disabled.” If you don’t meet the exact definition, the insurer will deny you. Your attorney can help you prove that your injuries do meet the definition and that you’re qualified to recover benefits.
They Have Evidence That Contradicts Your Disability
Some insurance companies will investigate you and your claim to determine your claim’s legitimacy. They will take photos and videos of you in an attempt to catch you engaging in activities that you’ve said you can’t do.
These are only a few of the many reasons insurers might deny your disability claim. To boost your chance of getting the money you so desperately need, call our competent Los Angeles disability attorney who can protect your rights and fight for you.
Appealing After a Disability Denial
What happens if you have been disabled in an accident, but your Los Angeles disability claim is denied? This does not have to be the end of your claim: Even most private insurance plans give you the option to appeal your denial.
If you received a denial, your insurance company should provide a detailed note on why your claim was denied. This document will be key to getting the benefits you need. When you receive this notice, study it carefully. What is missing? What could you add when you submit your appeal?
Missing evidence is an especially common issue when filing a disability claim. Anything that can show that you have been disabled can help with your claim. If you did not do so with your first claim, be sure to include an official medical opinion in your appeal. This can be used as evidence that you are, in fact, disabled.
It’s the word of a medical professional—a voice of authority may help convince the insurance company of your need. Once you have received notice that your claim has been denied and that you have a chance to appeal, it’s important to review any parts of your policy that you don’t understand, especially if they led to your denial.
If you have trouble with your policy information, a consultation with a Los Angeles disability denial attorney may help. We can decipher your denial and help you gather all the evidence you need.
Your Los Angeles Disability Benefits
Once you are unable to work, you may find that, depending on your plan, you may receive different benefits from long-term and short-term disability insurance. A short-term disability policy is typically meant to handle a few months of disability coverage.
You may receive the full amount of your paycheck for the first few months, covering your time off or your time as you transition into long-term disability if you have both types of coverage. While it sometimes doesn’t cover the full amount of your paycheck, long-term disability is designed to cover your needs for longer.
Most insurance companies will review your pre-tax income and give you a percentage of that. This is typically 60 to 70 percent of your original income before your accident. The benefits of a private disability insurance plan generally cover most of your wages that would be lost during your disability leave.
While these policies generally do not cover healthcare or other care services for your disability, they can provide the peace of mind you need when you’re hurt and in need of help.
What Constitutes Bad Faith Concerning Disability Insurance Claims?
Insurance companies often engage in unethical practices to avoid paying disability claims. For instance, they may employ a doctor to evaluate the claimant’s medical condition. Despite being expected to be impartial, these doctors typically provide diagnoses that favor the insurance company.
In some cases, a doctor may acknowledge that the claimant is disabled, but the insurance company may still ignore their recommendations. In more egregious cases, the insurance company may reject a doctor’s opinion and seek out another doctor who will align with their views. They may also engage in surveillance or unfairly deny claims.
Such actions may be considered bad faith practices and may lead to the insurer being held liable for any damages. Here are a few other examples of insurer conduct that may be classified as bad faith:
Putting Off the Investigation
Once you file a claim for disability benefits, the insurance company is required to investigate and evaluate the claim to determine the appropriate amount of benefits you are entitled to receive. This includes investigating the circumstances surrounding the incident, the individuals involved, and the extent of your injuries by reviewing your medical records and bills.
However, some insurance companies may try to prolong the investigation process to delay or avoid paying out benefits.
Absence of Investigation
Insurance companies have a legal obligation to investigate claims and determine coverage. If an insurance company fails to investigate a claim or take any action to assess it, it could be held liable for bad faith. The company cannot be passive and must take active steps to fulfill its obligations.
Refusing the Claim Without a Reasonable Justification
Disability insurance policies must include precise language in the contract and ensure that the insurer is aware of their rights. This indicates that the disability insurance company cannot make any significant misrepresentations.
If the insurance company does make a significant misrepresentation, whether related to a fact or a specific coverage policy, the affected party can hold the insurance company accountable.
Cancellation of the Insurance Policy
You may be able to hold your insurance company accountable if they have terminated your coverage without a valid explanation.
Delaying Disability Benefit Payments
The insurance company may investigate to determine the number of benefits you are entitled to, but they may also delay the actual payment. However, the insurance company must have a valid reason for the delay, and if they do not, you may be able to hold them responsible.
Providing Insufficient Disability Benefits
If your insurance company pays only a partial amount of the determined disability benefits that you are owed, you may be able to hold them accountable.
Manipulating the Insurer Into Accepting a Low Settlement Offer
If an insurance company coerces or intimidates you into accepting a lower settlement offer, they may be held liable for their actions and you can take legal action against them.
While the aforementioned cases are the most prevalent forms of bad faith practices committed by disability insurance companies, other circumstances could be considered as such. To determine if your claim falls under bad faith, it is best to seek the assistance of our skilled Los Angeles disability attorney.
With our extensive research and years of experience, we will work tirelessly to hold your insurance company accountable. Our track record of successfully recovering disability benefits for our clients speaks to our commitment to securing justice for those who have been wronged by their insurance providers. Contact us today to discuss your case.
How Do I Establish Bad Faith in Denied Disability Insurance Claims?
Proving insurance bad faith in a disability claim can be challenging for the average person. If you have been denied a claim, you have the right to file an appeal and request an explanation for the denial. If all appeals have been exhausted, it’s time to consider other options.
In California, insurance carriers are obligated to act in good faith and fair dealing with their policyholders. They should promptly investigate claims and pay out legitimate claims in a reasonable amount of time. However, bad faith insurance practices can occur in various ways, and it can be difficult to prove them.
If you suspect that your disability claim has been unfairly denied, it is important to keep track of all your paperwork and reach out to a skilled bad faith insurance lawyer as soon as possible. You should also limit further communication with the insurance carrier until after consulting with your disability lawyer.
When an insurance company acts in bad faith, the policyholder may have legal recourse to demand fair payment, accrued interest, and even punitive damages. At Haffner Law, we have an in-depth understanding of bad faith insurance law and can help you identify instances of bad faith and hold the responsible parties accountable.
Contact us today for a free case review with our qualified Los Angeles disability attorney to discuss your legal options.
What Does a Los Angeles Disability Claim Attorney Do for You?
Many people believe that filing a claim on their own will be easy and they can’t possibly imagine that their claim would be denied—that only happens to frauds and cheats, right? Unfortunately, a claim denial can happen to anyone, and you may find yourself angry and frustrated when it happens to you.
If you hire our Los Angeles CA disability attorney before you even begin the claim process, you have a better chance of avoiding a denial entirely. However, even if you hire a lawyer after your claim has been denied, we can still help you. Our skilled Los Angeles disability attorney will do the following and more to ensure that you receive the disability benefits you need to provide for your future:
Help You Understand Your Policy
Disability insurance policies can be confusing, and we can help you decipher the legal jargon so that you will understand what benefits you’re entitled to and how to go about filing your claim.
Assist You With Filing All Paperwork to Ensure It’s Accurate and Complete
Filing the paperwork is an important part of the claim process. If you make errors or omissions, your claim will surely be denied. Partnering with our skilled Los Angeles disability attorney will mean the paperwork will be done correctly, and you’ll be taking away one of the common reasons insurers deny disability claims.
Gather Medical Evidence and Documentation to Prove Your Disability
You will need a lot of medical evidence of your disability. Our Los Angeles CA disability attorney will walk you through this process of evidence collection. We will also work with your doctor to confirm that your injury is properly documented in a way the insurance companies will accept.
Help You Fight a Claim Denial
We aren’t afraid to fight for you. We will review your case, including all the paperwork and evidence you’ve submitted thus far, and we’ll determine what else the insurance company will need. If negotiations completely break down, we won’t hesitate to head to court.
Contact a Los Angeles Disability Attorney
When you’re injured and unable to work, disability insurance can help you get back on track or sustain you during a permanent illness or injury. Disability insurance is there to help you, and when you need that coverage, getting help with your claim is for the best.
Understanding disability insurance laws can be difficult—first applications for disability coverage are often rejected. When this happens, you will likely need someone who understands the appeals process and who can make sure you get the compensation you need to maintain your quality of life.
If you are having trouble with your disability claim or believe you have a case we can help with, give us a call. Our lawyers can also assist you with Bad Faith Insurance, Property Damage, and Class Action Lawsuits. Schedule an appointment with us now.