Individual Services:

Your Initial Application for Benefits.

As an experienced claim process expert, I will help you complete all disability claim forms in a clear and honest manner, and one which presents your medical impairment to your claims representative in a positive way. Attempting to get a clear picture of what is being asked is often difficult at a time when you are not feeling your best. The initial application for benefits is very important and may set the stage for all future communication with the disability insurer. This process includes assistance in completing all application forms, communications, and obtaining medical information for submission to your disability insurer.

The Importance of Good Medical Communications.

Unfortunately, your physician may not take the time to honestly, but accurately report restrictions and limitations which prevent you from working. This information is vital to the disability insurer who will use whatever records are available to make decisions regarding your claim. Knowing how to communicate with your physician is important, but even more so, is the ability of your physician to communicate with the insurance company. Advice on how to communicate with your physicians is vital to your claims decision.

Independent Medical Evaluations (IME)

Your insurance carrier may request you to submit to an Independent Medical Evaluation which is often a very intimidating experience. I can provide you with information concerning the evaluation process and what to expect based on the particular evaluation requested by your insurance company. Being prepared and comfortable with the examination process may make the difference between continuing payments or a claim termination. It is important to "be prepared" and remain in control of the IME process and the ultimate results of the evaluation.

Dealing with Claim Denials.

Receiving a disability claim denial letter in the mail is an extremely emotional and devastating experience. What do you do next? How can you prove to the insurance company you really can't work? I will be able to provide you with recommendations and advice as to what steps need to be taken when your claim is denied. Disability insurers deny claims for many different reasons, some legitimate, some not. It is important to you, to understand your rights and the steps you need to take to provide information to the insurance company when your claim is denied. The process is different depending on whether you have an Individual Policy or a claim subject to ERISA. It is extremely important to understand the workings of the appeal or reconsideration process.

Objective vs. Subjective Symptoms, Self-Reported Complaints

Disability insurers often look for you to provide "objective medical evidence" as proof of disability, even when your policy does not require you to do so. For some impairments, there is no known objective evidence other than the recommendations of your primary care physicians. It is extremely important for you and your physician to know precisely what information is required by your insurance company since many claims are denied based solely on the subjective nature of the information you sent them in support of your claim. Does my policy contain a provision for self-reported impairments? If it does, what are the consequences for me and the review of my application?

Contract / Policy Reviews

It is always important to obtain a copy of your disability policy and understand the provisions describing your obligations vs. that of your insurance company. For example, it is crucial to understand the difference between the definitions of "Occupation" given in an ERISA claim, as compared to the definition in an Individual Policy. What does the definition of disability mean in your policy? How will you be paid residual benefits if you return to work part-time? What does the pre-condition provision mean and will the provision apply to me and my claim? What is indexing or "other income deductions?" If I apply for Social Security Disability benefits, will I get to keep my benefit, or will I have to pay back my retroactive SSDI award? These are all important questions you need to know at the time you apply for benefits. Linda can provide you with the answers.

Any Occupation Investigations

The first question asked by most insured is "What is an any occupation investigation?" Am I going to lose my benefits? Who does the Transferable Skills Analysis, and what does "gainful" mean. Any occupation investigations are most common in group LTD policies, an area of expertise for Linda. These investigations by the disability insurers are "milestone" events in the history of each claim and could mean the termination of future benefits after 12, 24, 36, or 60 months.

Surveillance / Data Base Activity Checks

It is a well known fact that all disability insurers contract with private investigators who may be asked to observe your activities for several days. What impact will surveillance reports have on your future benefits? Can your claim be denied solely on surveillance tapes? Based on your particular claim and circumstance, is it likely your insurance company will put you under surveillance? How can you recognize a surveillance team? I will be able to offer invaluable advice concerning possible surveillance and the inevitable outcomes for your claim. Disability insurers may NOT deny your claim only on surveillance obtained.

Residual Benefits/Working Part-Time

For some, it may be possible to return to work in a limited capacity over time. Does your policy contain provisions which allow you to return to work? If so, what will you be paid and for how long? A major concern for those who work part-time is making sure partial benefits received from the insurance company are accurate based on your current earnings level. It is important to ensure your monthly benefit is not being reduced by a residual percentage outside of your policy language. Some insurance providers pay you at a 50% rate even when you are not working. This is unfair, and most likely outside of your contract terms.

Are You Being Paid Accurately?

Does your policy contain a Cost of Living Allowance Provision (COLA)? Or, a Revenue Income Protection Provision which compels the insurer to make pension payments while you are disabled? What is indexing and when should my part-time earnings be indexed? What are benefit offsets, and when can the insurance company reduce my benefit for other income? These are all very important questions, since the accuracy of the amount you are being paid may affect your family and financial situation.