Here are the resources that were mentioned during our July 22, 2020 BenefitsChat.
The presentation can be accessed here:
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.
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.
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:
The Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., was enacted to provide minimum standards for voluntarily established plans by employers in the private industry for the benefit of their employees. Despite its name, ERISA also applies to disability benefits an employee may be entitled to if s/he becomes unable to work due to a disability, whether or not it was work-related.
Social Security Disability Insurance (“SSDI”) benefits, in contrast, is a federal government program, and is available to most people, with certain exceptions, who have worked in any industry and contributed to the Social Security trust fund via the FICA tax.
Most ERISA plans encourage, or even require, that an employee seeking long term disability (“LTD”) benefits also apply for SSDI because any amount paid by Social Security is an offset for the insurance company, making its payments substantially less. However, being awarded SSDI benefits does not mean that the claimant will also qualify for LTD benefits because insurance companies are not bound by the Social Security Administration’s (“SSA”) determinations. Similarly, of course, the decision denying SSDI does not mean that the claimant will not qualify for LTD benefits under an ERISA plan. But, an ERISA plan administrator is likely to use a SSDI denial as evidence that a claimant does not meet the ERISA plan’s definition of disability.
In addition to dealing with short term disability benefits, long term disability benefits, and health insurance denials, many of our clients are also tasked with applying for Social Security Disability benefits. On January 17, 2017, the Social Security Administration adopted new rules for evaluating mental disorders. These rules reflect the most comprehensive revision in over 30 years to the criteria used to evaluate disability claims involving mental disorders. Changes to the rules reflect up-to-date standards and practices used in the mental health community. Most notably, the new rules reflect information from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (“DSM -5”), which is the mental health profession’s standard for classifying mental disorders. The new rules also reflect comments from members of the public and the expertise of disability policy experts, adjudicators, psychiatric professionals, and vocational experts.
Among the many changes are three new listings: 12.11 Neurodevelopmental disorders, 12.13 Eating Disorders, and 12.15 Trauma- and Stressor-Related Disorders. Additionally, the titles of the listings have been updated to reflect the terms the American Psychological Association uses to describe the categories of mental disorders in the DSM-5.
|12.02||Organic mental disorders||12.02||Neurocognitive disorders|
|12.03||Schizophrenic, paranoid and other psychotic disorders||12.03||Schizophrenia spectrum and other psychotic disorders|
|12.04||Affective disorders||12.04||Depressive, bipolar and related disorders|
|12.05||Intellectual disability||12.05||Intellectual disorder|
|12.06||Anxiety-related disorders||12.06||Anxiety and obsessive-compulsive disorders|
|12.07||Somatoform disorders||12.07||Somatic symptom and related disorders|
|12.08||Personality disorders||12.08||Personality and impulse-control disorders|
|12.09||Substance addiction disorders||12.09||Reserved|
|12.10||Autistic disorder and other pervasive developmental disorders||12.10||Autism spectrum disorder|
|12.15||Trauma- and stressor-related disorders|
Under the new rules, these new mental health listings will remain in effect for five years. To read the full text of Social Security’s Mental Disorder Listings, click here https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm#12_04 .