LongTerm Disability (LTD) Insurance Category Archives — Page 3 of 26 — California Insurance Lawyer Blog Published by Los Angeles, California ERISA, Disability, Health, & Life Insurance Attorneys

July 9, 2020

Can I File Suit if the Insurance Company Takes Too Long to Decide My Long-Term Disability Claim?

The short answer: Yes, depending on how much time has passed since you first submitted your claim.

Consider the following scenario. You work for a company that has an insured long-term disability (“LTD”) plan that is governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). Let us say the insurance company is Prudential Insurance Company of America. You go out on disability due to chronic pain and file a claim with Prudential on July 25, 2019. On August 19, 2019, Prudential acknowledges that it received your medical records, activities of daily living questionnaire, and work capacity questionnaire. But inexplicitly, it says it needs more time to decide your claim and takes a 30-day extension. In the meantime, Prudential reaches out to your doctor to request feedback on its medical evaluation conducted by one of its nurse reviewers. Prudential also seeks clarification from you regarding your medical history. On November 13, 2019, Prudential confirms that the file is complete, but it states it needs more time to decide your claim. It does not explain why it needs more time. Finally, on November 27, 2019, Prudential decides against you. Can you file a lawsuit?

According to Judge Jeffrey White in the Northern District of California, the answer is yes. See Hasten v. Prudential Ins. Co. of Am., No. 19-CV-07943-JSW, 2020 WL 3786229 (N.D. Cal. July 6, 2020).

June 23, 2020

Some SSDI-Related Advice from Your Local Neighborhood Long Term Disability (LTD) Lawyer

by Andrew M. Kantor

Here at Kantor & Kantor we constantly find ourselves working closely with SSDI attorneys on behalf of our clients. Even more often, the evidence we secure on behalf of our clients during their LTD disputes can be utilized by your clients to support their SSDI claim as well. Here are some thoughts on our clients’ intersection between LTD and SSDI.

If we have a mutual client, use us as a resource to fight the substantive disability claim.

We can promptly provide copies of critical case documents, including testing or expert reports we have acquired in support of our client’s LTD fight. Our evidence saying a claimant is completely unable to work in any occupation on even a part time basis should be similarly useful for your SSDI case.

May 29, 2020

Kantor & Kantor, LLP to Establish BenefitsChat, a Live Forum so the Public Can Ask Attorneys About Insurance Benefits

by Kantor & Kantor LLP

Kantor & Kantor has established a regular, live, and interactive Zoom conversation to discuss generally and answer questions from the public about long-term disability, health insurance, pensions, life insurance, casualty (homeowners), and more. BenefitsChat will be live on Wednesday evenings from 5:00 pm – 6:30 pm Pacific Time.

Host Andrew Kantor, his fellow Kantor & Kantor attorneys, and select guests will explain and discuss everything from “big picture” concepts, such as the distinctions between different ways of obtaining insurance, to case-specific concepts designed to help individuals protect their rights.

While there is always a demand for legal information, current events have created an unparalleled need for as many real, live, helping hands as are available to be lent—even if the hand can only be safely lent via webcam. This forum will give people the chance not only to learn from our attorneys and each other; but to do so within the safety and comfort of a like-minded and supportive group of individuals and their families.

May 7, 2020

May is Lupus Awareness Month

by Cari M. Schwartz

The Lupus Foundation of America estimates that 1.5 million Americans, and at least five million people worldwide, have a form of lupus. According to the Lupus Foundation of America most lupus sufferers are misdiagnosed or can go undiagnosed for years. The goal of Lupus Awareness Month is to inform practitioners, patients, care givers, and the general public about how best to diagnose, care for, and live with lupus.

What is Lupus?

Lupus is a chronic (long-term) disease that can cause inflammation and pain in any part of your body. Lupus is a non-contagious autoimmune disease, which means that your immune system — the body system that usually fights infections — attacks healthy tissue instead. According to the Centers for Disease Control and Prevention about 9 out of 10 diagnoses of lupus are in women ages 15 to 44 and most people with lupus develop the disease between the ages of 15-44.

May 1, 2020

Bracing for the Second Pandemic: PTSD, Cognitive Difficulties and Other Possible Mental and Physical Impacts of the Coronavirus

by Elizabeth Hopkins

Even though most of us are still sheltering in place in an attempt to lessen the immediate spread and most severe health consequences of COVID-19, it is not too soon to start considering possible long-term health impacts that may arise in the wake of the coronavirus pandemic.

Because the virus affects many organs and systems within the body – from the lungs and cardiovascular system to the liver, kidneys and likely the brain – it now appears likely that at least some patients will suffer long-term physical symptoms. These long-term and even permanent problems may result from the virus itself, the body’s own immune response or even medical interventions, especially respirators, or a combination of all these factors. But whatever the cause, doctors are already seeing heart damage, kidney and liver damage and, unsurprisingly, lung scarring and damage in a number of COVID-19 patients who are no longer actively infected.

And these are still early days. Some patients present during the illness with serious neurologic problems such as strokes and encephalitis, as well as other more mild neurologic symptoms such as dizziness, headache and loss of smell. There have been reports of some patients suffering from Guillain-Barré Syndrome, an auto-immune disease where the immune system responds to an infection by mistakenly attacking the body’s own nerve cells. It seems possible that at least some of these patients may continue to suffer neurologic and autoimmune issues, and related pain, fatigue and cognitive difficulties for at least some time.

April 28, 2020

Disability Claims in a COVID-19 World

by Stacy Monahan Tucker

The past few months have heralded an unprecedented situation. Millions of Americans are being laid off as COVID-19 shuts down businesses throughout the nation. This is frightening for everyone. It is doubly difficult for workers who have physical or mental limitations. For those workers, the specter of finding a new job in this economy, one that can accommodate their often significant limitations, may be overwhelming.

Workers experiencing health issues — including cognitive issues or mental illnesses — who have been having difficulties performing their jobs because of those limitations but have been fighting through them, may well be among the first to be laid off as underperformers. While these workers are in fact impressive in their drive to keep working in the face of daunting health issues, that very refusal to admit defeat may result in unemployment and a lack of income for them.

If you are among these workers, now is the time to evaluate whether a disability claim makes sense for you. While you still have access to your job-related insurance, you can preserve some of your income and access to health insurance. If you have ongoing medical issues for which you have already been treating that significantly impact your ability to work, be it physical pain, chronic illness, depression, anxiety, or auto-immune issues, talk to your doctor about whether he or she would recommend disability for you.

April 14, 2020

Receipt of Short-Term Disability Benefits May be a Condition for Long-Term Disability Benefits

by Zoya Yarnykh

An employee who becomes disabled while covered by an employer-sponsored disability plan may qualify for short-term disability (STD) benefits and then long-term disability (LTD) benefits, based on the length of the disability and the terms of the plan. However, some LTD policies require that the employee not only apply for STD, but “exhaust” it, meaning receive the maximum amount of benefits allowed under the policy, before they may pursue LTD. If an employee received all but one day of the full STD benefit, they may still have to go through the appeals process or risk eligibility for the more valuable LTD benefit.

Kantor & Kantor was recently retained by a client, who we will refer to as John Smith for anonymity. Mr. Smith was employed by a large corporation as a Material Handler who was responsible for all supplies and materials needed to manufacture medical devices. Unfortunately, he became disabled by degenerative disc disease and painful spondylosis of his lumbar spine. In addition, he suffered from sciatic nerve pain in his back. His painful conditions necessitated medications which also caused side effects and impacted his functioning.

Mr. Smith’s company’s disability plan claim involved the situation described above, except that his STD claim was terminated just a few weeks before he received the maximum duration of benefits. He unsuccessfully appealed his STD denial on his own before hiring the law firm. In evaluating his STD claim and his potential LTD claim, the attorneys identified the following language in his LTD policy:

March 24, 2020

Your Disability Claim and Independent Medical Examinations

by Michelle L. Roberts

If you have a pending ERISA disability claim, the plan administrator or insurance company may schedule an Independent Medical Examination (“IME”) for you. Your first question may be, “do I have to attend?” While every person’s situation is different, and you should consult with your attorney about the specifics of your case, it is recommended that you comply with reasonable requests by the administrator to have you evaluated in person.

Why, you ask? For starters, most disability policies contain a provision that gives the administrator the right to have you examined. Failure to comply may result in the denial of your claim. For example, in Burke v. Pitney Bowes Inc., 392 F. App’x 570, 572 (9th Cir. 2010), the Ninth Circuit Court of Appeals held that it was reasonable for the plan administrator to request a second IME of the plaintiff and that the plaintiff’s refusal to attend prejudiced the administrator’s ability to decide the claim. The Court found that the termination of disability benefits based on the plaintiff’s failure to attend the IME was not an abuse of discretion.

Second, if your matter ends up in litigation, it is important that you appear reasonable and cooperative to the judge. The focus should be on the merits of your disability claim, not on whether you should have attended an exam.

February 24, 2020

My Insurance Company is Claiming an Overpayment; Do I Have to Pay Them Back?

by Michelle L. Roberts

Our law firm receives many inquiries from long-term disability claimants whose insurance companies claim that they overpaid them benefits and insist that the claimants pay them back. Often, these claimants do not have the money to pay the companies back and want to know their legal rights.

First, it’s important to know the common situations in which these overpayment issues arise. Group disability insurance companies that fund employer-provided disability benefits draft their policies to include “offsets.” An offset is a type of other income you might receive (or are eligible to receive) which reduces what the insurance carrier is obligated to pay you. If you receive other income which applies retroactively, the insurance company will require you to pay back the benefits it paid you during the relevant time period. As an example, below is language from a Lincoln National Life Insurance Company group disability policy.

RIGHT OF RECOVERY. If benefits have been overpaid on any claim; then full reimbursement to the Company is required within 60 days. If reimbursement is not made; then the Company has the right to:

January 22, 2020

Tips for Talking to a Lawyer

by Cari M. Schwartz

There comes a time in your life when you will need to consult with a lawyer – whether it be good news or bad news. A good lawyer works with you, helps you understand the situation, and guides you to the best possible result. At Kantor & Kantor we routinely speak with individuals who have had life, health, and disability claims denied by their insurance companies.

As lawyers we are well-versed in the practice of law, but we rely on the information from our clients to steer us in the right direction and guide each case. It takes TEAMWORK to get the best possible result for our clients.

Here are a few tips for talking to your lawyer and telling them what they need to know.