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Who is Eligible for Long Term Disability?

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Who is Eligible for Long Term Disability?

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Who is Eligible for Long Term Disability?

When a serious injury or illness prevents you from earning an income, you need to apply for benefits that can sustain you and your family. However, the application process itself can be fraught with legalities for which you are not prepared. You may even be denied for them if you apply by yourself.

Rather than face the process of pursuing them alone, you need to retain the experience of a long term disability claim attorney to represent you. You can contact the Law Offices of George E. Thompson to find out who is eligible for long term disability and if you have a case that you could win in court.
Terminally or Chronically Ill
People who are terminally or chronically ill are eligible to receive long term disability benefits. Some of the illnesses that qualify people for these payments include pulmonary fibrosis, COPD, bone cancer, lung cancer and advanced multiple sclerosis.

A disability benefits judge will not simply take your word for it that you are chronically or terminally ill, however. You must provide ample proof to establish your illness. Your lawyer will assist you in submitting proof like doctors' reports, prescription receipts, x-rays and even testimony from your doctors and nurses to the court.
Blindness
People who are going or have gone blind also qualify for long term disability benefits. People who cannot see many times cannot work in a meaningful capacity. They also cannot drive or, in some instances, safely take public transportation to and from a job.

Your lawyer can present evidence like you most recent vision exam or proof of a failed vision surgery o show that you are losing or have lost your eyesight. You could receive benefits for as long as your vision impairment persists.

You can find out more about who qualifies for long term disability benefits by contacting our long term disability claim attorney. Reach out to the Law Offices of George E. Thompson today.

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Who is Eligible for Long Term Disability? | Long-term disability lawyer

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When a serious injury or illness prevents you from earning an income, you need to apply for benefits that can sustain you and your family. However, the application process itself can be fraught with legalities for which you are not prepared. You may even be denied for them if you apply by yourself.

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Long-Term vs. Short-Term Disability: What’s the Difference?

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Long-Term vs. Short-Term Disability: What’s the Difference?

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Long-Term vs. Short-Term Disability: What's the Difference?

Disability insurance can ease the tension of lost wages in times of a crisis. If you're someone who has been disabled, then receiving the disability insurance benefits you deserve is a must. There are two forms of employer sponsored disability insurance; short-term disability (STD) and long-term (LTD). While both types of this insurance have the same premise, the way they work is different.

Read on to learn about the difference between short-term and long-term disability insurance and how the law offices of George M. Thompson can help.
What is disability insurance?
If you're unable to perform at your job because of an injury or sickness, disability insurance is a way to protect yourself financially. However, some people may only temporarily need this insurance while others require the coverage for longer periods of time.
Short-term Disability Insurance
Short-term disability insurance will help pay a set amount of your overall income for a limited time. STD policies usually last between three to six months.
Long-term Disability Insurance
Long-term disability insurance can last up to the age of 65 and only pays benefits after a waiting period of short term disability coverage period concludes. Unlike short term disability insurance, long-term disability insurance will also exclude claims for pre-existing conditions and impose monthly benefit limits on most mental health disabilities

Some examples of health challenges that qualify for long-term disability insurance are:

- Cardiovascular issues

- Fighting off cancer

- Have been diagnosed with a mental disorder. Depression, anxiety and bi- polar disorder are fairly common

- You were injured in an accident

- Chronic back pain and arthritis

- Fibromyalgia

- Multiple Sclerosis

- Drug addictions

Having an STD or LTD disability claim approved is not automatic. You might need to enlist the help of our long term disability claim attorney for more information.

If you're in need of disability insurance, contact the Law offices of George E. Thompson today and let us help you get the help you need.

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Long-Term vs. Short-Term Disability: What's the Difference?

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Disability insurance can ease the tension of lost wages in times of a crisis. If you're someone who has been disabled, then receiving the disability insurance benefits you deserve is a must. There are two forms of employer sponsored disability insurance; short-term disability (STD) and long-term (LTD).

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Do I Need an Attorney for Long Term Disability?

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Do I Need an Attorney for Long Term Disability?

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Do I Need an Attorney for Long Term Disability?

Living with a long-term disability is difficult. The physical pain, discomfort, and debilitation is the hardest thing to cope with. Getting the proper financial support you need to live and to manage your condition is also a struggle.

If you have long-term disability insurance through your company or union, it is often subject to the Employment Retirement Income Security Act also known as ERISA. This is a federal law that governs the benefits provided by private sector employees.
The Insurance Company Will Put Up a Fight
The reticence of insurance companies to provide their clients with the financial support and compensation they require is what prompted the passage of ERISA in the first place.

They will scrutinize your medical condition. You can only qualify for disability benefits if your medical condition involves an actual impairment that prevents you from working. The insurance company will aggressively perform a medical and vocational analysis to determine whether you meet this legal definition.

When you apply for disability benefits, the insurance company will investigate your claim. Their investigation will focus on your condition and your work background. You will be required to fill out a range of questionnaires and forms, which you should always answer honestly and carefully. The insurance company will also review your medical records and may compel you to be examined by their own physician.
You Need a Lawyer
You should retain the services of a lawyer when submitting a claim for long-term disability benefits. It is the only way to ensure that your rights and interests are protected. The long-term disability lawyer at the Law Offices of George E. Thompson can provide you with the advice and insight you need to get the money you are entitled to. You should call our long-term disability lawyer at the Law Offices of George E. Thompson today to review your options.
Getting A Lawyer For Life Insurance Claims
Life insurance is an important benefit to have when someone you love passes away. You will be preoccupied with your grief and with figuring out a way to carry on now that this person has passed. Thus, it is best to have life insurance to help take away some of the financial strain that goes along with this event.

Anyone who comes to the law offices of George M. Thompson regarding their life insurance being denied will receive the utmost of representation and respect. The law firm is prepared to go to battle for you to make sure any injustice of a denial is corrected.

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Do I Need an Attorney for Long Term Disability? | insurance claims lawyer

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Living with a long-term disability is difficult. The physical pain, discomfort, and debilitation is the hardest thing to cope with. Getting the proper financial support you need to live and to manage your condition is also a struggle.

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Did Your Long Term Disability Insurance Company Give Little, if Any, Consideration To Your Medical Records? Court Reprimands Prudential Insurance LTD For Conclusory Disability Claim Evaluation and Denial

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Did Your Long Term Disability Insurance Company Give Little, if Any, Consideration To Your Medical Records? Court Reprimands Prudential Insurance LTD For Conclusory Disability Claim Evaluation and Denial

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Did Your Long Term Disability Insurance Company Give Little, if Any, Consideration To Your Medical Records? Court Reprimands Prudential Insurance LTD For Conclusory Disability Claim Evaluation and Denial

Jim Ampe fell and struck his head in the bathroom of his home in August 2011. Following the accident, Jim complained of cognitive fatigue, difficulty concentrating and the inability to focus in a noisy environment. Jim underwent a Neuropsychiatric evaluation in the fall of 2012 which found a significant decline in Jim's physical, cognitive and emotional behavior which was consistent with what is often seen in post concussive syndrome. Notwithstanding his post concussive syndrome, Jim continue to work but took intermittent FMLA leave over the next few years from his employer. His annual performance reviews, however, worsened significantly over time. Following Jim's 2014 performance review, which was worse than he had ever received, his employer informed him that they would not provide any further work place and recommended he apply for long-term disability benefits. Jim applied for long term disability benefits with the Prudential Insurance Company in early February 2015.

In support of his claim Jim submitted all of his medical records which showed that he had suffered a traumatic brain injury in 2011 and according to his Doctor "Jim continued to be limited by post brain injury symptoms especially dizziness, fatigue, headache, nausea, confusion and irritability. He's not able to tolerate work in 32 hours or more of work is not medically feasible." Jim's doctor also opined that up to 5 to 15% of people who suffer concussions continue to suffer persistent post concussive symptoms. Jim also submitted the 2012 neuropsychiatric evaluation that exhibited cognitive decline.

Shortly after the submission of the claim, Prudential's Vice President and Medical Director, Dr. Rajesh Wadhwa, quickly dismissed all of the medical information and faulted the 2012 neuropsychiatric testing for failing to perform validity testing. Jim's disability claim was denied on May 11, 2015. On October 18, 2015 the Social Security administration approved Jim for the award of Social Security Disability benefits. Jim submitted a second appeal with another neuropsychiatric evaluation. His long term disability claim appeal was again summarily denied based on a cursory review of the medical records performed by Dr. Kristin Fiano.

Jim sued Prudential and a Federal Court Judge reversed the denial of long term disability benefits and ordered Prudential to re-evaluate Jim's claim. In reviewing the Prudential disability claim evaluation the Court wrote:

"What concerns the court in this case is the appearance that Prudential gave conclusive weight to Dr. Fiano's opinions based on her file review without giving any substantive consideration to the records and opinions of Ampe's treating physician and the doctors who had examined Ampe to evaluate his neuropsychological symptoms. In its final denial letter, Prudential made several conclusory statements that appear unanchored in the medical records. Prudential, for example, criticized Dr. Bekken's validity testing despite her careful explanation of why the testing convinced her that Ampe was not malingering. The reference to somatization is also troubling. Somatization (also known as Briquet's syndrome) is a discredited clinical diagnosis, derived from the theory that acute anxiety or stress can precipitate real or, more often, imagined physical symptoms in a patient. The reference to somatization underscores the extent to which Prudential's decision relied on Dr. Fiano's personal skepticism regarding the validity of any diagnosis of post-concussion syndrome, and on her apparent, if not overtly stated, conviction that Ampe was a malingerer. While the court is not in a position to address in any definitive fashion the medical validity of post-concussion syndrome as a diagnosis, there is enough support in the medical literature documenting its existence so as to make a denial of LTD benefits based on one skeptical doctor's file review open to question, especially where three examining specialists and a treating physician at different times came to a contrary conclusion."

The Court was also highly critical of the failure of the Prudential's long term disability claim analysis to properly consider even its own concession that Jim's cognitive functioning was not optimal. To that end, the Court wrote:

A second, and perhaps more critical deficiency in Prudential's benefit denial was its failure to analyze Ampe's conceded limitations against the demands of his occupation as an electrical engineer. A benefits determination is not "'reasoned' when the [claims] administrator sidesteps the central inquiry ... [of] whether the claimant [is] ... able to perform the material duties of [his] own occupation." McDonough v. Aetna Life Ins. Co., 783 F.3d 374, 380 (1st Cir. 2015). Plan administrators may not dismiss evidence merely because it is subjective, but must meaningfully address why reported symptoms are either false or exaggerated or do not impede a claimant's ability to work. Miles v. Principal Life Ins. Co., 720 F.3d 472, 487 (2d Cir. 2013); see also Love v. Nat'l City Corp. Welfare Benefits Plan, 574 F.3d 392, 396 (7th Cir.2009) (finding that defendant failed to sufficiently explain the reasons for its denial of disability benefits as required by 29 U.S.C. § 1133, where "neither the initial termination letter nor the subsequent letter denying [the claimant's] appeal explained why the reviewer chose to discredit the evaluations and conclusions of [the claimant's] treating physicians"). In this context, Prudential failed to meaningfully address and properly weigh Ampe's complaints of severe headaches and fatigue. As underscored by Judge Selya in McDonough v. Aetna Life Ins. Co., 783 F.3d 374, 380 (1st Cir. 2015), "medical evidence is only part of the equation. To assess a claimant's ability to perform his own occupation, a decisionmaker must be aware of, and apply, the requirements of the occupation." Here, there is no record evidence that Prudential (unlike the SSA) engaged in an analysis of the impact of Ampe's limitations, whether subjective or substantiated by the clinical examinations and objective testing, on his ability to perform the work of a Senior Development and Test Engineer. 9 See Miller v. Am. Airlines, Inc., 632 F.3d 837, 854 (3d Cir. 2010) (citing Elliot v. Metro. Life Ins. Co., 473 F.3d 613, 619 (6th Cir. 2006) (finding a decision could not be considered "reasoned" where there was no discussion of claimant's duties or her ability to complete them in light of the various diagnoses).

If you or a loved one has suffered from a traumatic brain injury, or if you need representation after your insurance company gives little consideration to your medical records, you need to speak with a Massachusetts insurance claims attorney at The Law Offices of George E. Thompson today.

JAMES AMPE V. THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, ET AL.

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Long Term Disability Insurance give little consideration to medical records?

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Jim Ampe fell and struck his head in the bathroom of his home in August 2011. Following the accident, Jim complained of cognitive fatigue, difficulty concentrating and the inability to focus in a noisy environment.

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When is a Massachusetts’ Insurance Policy Ambiguous? General Legal Principles

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When is a Massachusetts’ Insurance Policy Ambiguous? General Legal Principles

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When is a Massachusetts' Insurance Policy Ambiguous? General Legal Principles

When is a Massachusetts' insurance policy ambiguous? Here are some general legal principles to be aware of:

1. An insurance contract is to be interpreted "according to the fair and reasonable meaning of the words in which the agreement of the parties is expressed." Cody v. Connecticut Gen. Life Ins. Co., supra, quoting MacArthur v. Massachusetts Hosp. Serv., Inc., 343 Mass. 670, 672, 180 N.E.2d 449 (1962). Every word in an insurance contract "must be presumed to have been employed with a purpose and must be given meaning and effect whenever practicable." Jacobs v. United States Fid. & Guar. Co., 417 Mass. 75, 77, 627 N.E.2d 463 (1994), quoting Wrobel v. General Acc. Fire & Life Assur. Corp., 288 Mass. 206, 209-210, 192 N.E. 498 (1934).
Allmerica Financial Corp. v. Certain Underwriters at Lloyd's, London

Mass. 621 (2007).

2. "[T]he construction of an insurance policy is a question of law ...." Lind-Hernández v. Hosp. Episcopal San Lucas Guayama, 898 F.3d 99, 103 (1st Cir. 2018) . "Under Massachusetts law, we construe an insurance policy under the general rules of contract interpretation, beginning with the actual language of the policies, given its plain and ordinary meaning." AIG Prop. Cas. Co. v. Cosby, 892 F.3d 25, 27 (1st Cir. 2018). "The responsibility of construing the language of an insurance contract is a question of law for the trial judge, and then for the reviewing court." Cody v. Conn. Gen. Life Ins. Co., 387 Mass. 142, 439 N.E.2d 234, 237 (1982). We thus must independently determine the construction of the policy. In this inquiry, "doubts about ambiguous insurance policy provisions are to be resolved against the insurance company." J. D'Amico, Inc. v. City of Boston, 345 Mass. 218, 186 N.E.2d 716, 721 (1962). But when the policy is "plain and free from ambiguity, we do not ... construe them strictly against the insurer. Rather, we must construe the words of the policy in their usual and ordinary sense." Barnstable County Mut. Fire Ins. Co. v. Lally, 374 Mass. 602, 373 N.E.2d 966, 968 (1978).

As a general matter, in Massachusetts, the insured bears the "initial burden of showing that the case involves a generally covered risk under the policy." Stor/Gard, Inc. v. Strathmore Ins. Co., 717 F.3d 242, 247 (1st Cir. 2013). Where, as is here, the parties do not dispute that the incident was a generally covered risk, the burden shifts such that the insurer must demonstrate that an exclusion precludes coverage. Clark Sch. for Creative Learning, Inc. v. Phila. Indem. Ins. Co., 734 F.3d 51, 55 & n.1 (1st Cir. 2013). "And if the insurer satisfies that burden, the burden shifts back to the insureds to show an exception to the exclusion holds sway." Stor/Gard, Inc., 717 F.3d at 247.

Where "a term is 'susceptible of more than one meaning and reasonably intelligent persons would differ as to which meaning is the proper one,' the term is ambiguous." U.S. Liab. Ins. Co. v. Benchmark Constr. Servs., Inc., 797 F.3d 116, 119-20 (1st Cir. 2015) (quoting Citation Ins. Co. v. Gomez, 426 Mass. 379, 381, 688 N.E.2d 951 (1998) ). To the extent an ambiguity does exist, it is strictly construed against the insurer. See Metro. Prop. & Cas. Ins. Co. v. Morrison, 460 Mass. 352, 362-63, 951 N.E.2d 662 (2011).

In construing contracts courts often look to dictionaries for assistance in determining ordinary meaning. See, e.g., Norfolk S. Ry. v. James N. Kirby, 543 U.S. 14, ---- - ----, 125 S.Ct. 385, 397-98, 160 L.Ed.2d 283 (2004). Reference to dictionaries in interpreting contracts of insurance is appropriate. Aschenbrenner v. U.S. Fid. & Guar. Co., 292 U.S. 80, 85, 54 S.Ct. 590, 78 L.Ed. 1137 (1934). In particular, Massachusetts courts refer to dictionaries in interpreting insurance contracts. Ellery v. Merchs.' Ins. Co., 20 Mass. (3 Pick.) 46, 48 (1825) (using dictionary to define "bilging" in insurance contract).

If you or a loved one needs representation and consultation for your insurance policy case, contact a Massachusetts insurance claims lawyer at The Law Offices of George E. Thompson.

See Federal Ins. Co. v. Raytheon Co. 426 F.3d 491 (1 st Cir. 2005) (use of dictionary to evaluate the meaning of the word "based")

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When is a Massachusetts Insurance Policy Ambiguous?

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When is a Massachusetts' insurance policy ambiguous? Here are some general legal principles to be aware of: 1. An insurance contract is to be interpreted "according to the fair and reasonable meaning of the words in which the agreement of the parties is expressed." Cody v. Connecticut Gen. Life Ins.

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What Is The Remedy for An Insured Who Does Not Receive a Copy of Their Summary Plan Description for their Long Term Disability, Group Life or Health Insurance Benefits?

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What Is The Remedy for An Insured Who Does Not Receive a Copy of Their Summary Plan Description for their Long Term Disability, Group Life or Health Insurance Benefits?

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What Is The Remedy for An Insured Who Does Not Receive a Copy of Their Summary Plan Description for their Long Term Disability, Group Life or Health Insurance Benefits?

One of the most important documents participants are entitled to receive automatically when becoming a participant of an ERISA-covered retirement or health benefit plan or a beneficiary receiving benefits under such a plan, is a summary of the plan, called the summary plan description or SPD. The plan administrator is legally obligated to provide to participants, free of charge, the SPD. The summary plan description is an important document that tells participants what the plan provides and how it operates. It provides information on when an employee can begin to participate in the plan and how to file a claim for benefits. If a plan is changed, participants must be informed, either through a revised summary plan description, or in a separate document, called a summary of material modifications, which also must be given to participants free of charge. ERISA requires that plan administrators provide beneficiaries with a summary plan description setting forth the general terms of a benefits plan and a summary document providing notice of material modifications. 29 U.S.C. § 1024(b)(1); see also Curtiss Wright Corp. v. Schoonejongen, 514 U.S. 73, 83, 115 S.Ct. 1223, 131 L.Ed.2d 94 (1995).

2. Imposition of a Daily Penalty

Under 29 U.S.C. § 1132(c) an administrator's failure to furnish the summary plan description can trigger a penalty since § 1132(c) states that, "Any administrator ... who fails or refuses to comply with a request for any information which such administrator is required by this subchapter to furnish to a participant ... may in the court's discretion be personally liable to such participant . The "administrator" of a plan is a defined term under ERISA :

(i) the person specifically so designated by the terms of the instrument under which the plan is operated;

(ii) if an administrator is not so designated, the plan sponsor; or

(iii) in the case of a plan for which an administrator is not designated and a plan sponsor cannot be identified, such other person as the Secretary may by regulation prescribe.

29 U.S.C. § 1132(c)(1) provides, in part, that any administrator .... who fails or refuses to comply with a request for any information which such administrator is required by this subchapter to furnish to a participant or beneficiary ... by mailing the material requested ... within 30 days after such request may in the court's discretion be personally liable to such participant or beneficiary in the amount of up to $100 a day. Law v. Ernst & Young, 956 F.2d 364 (1 st Cir. 1992). In very limited circumstances, the First Circuit has also recognized "de facto plan administrators." Under this theory, a court may hold a party liable under § 1132 as a de facto plan administrator if the party assumes control of the plan administrator's function and presents itself as the plan administrator, even if that party is not specifically identified as the plan administrator. This narrow doctrine usually does not apply to insurance companies.

3. The Court Can Disregard the Terms of the Summary Plan Description If The Failure to Distribute Was Willful And Extraordinary Circumstances Are Present

The failure of a plan administrator to ensure timely receipt of the summary plan documents does not necessarily render those documents ineffective. v. Tyco Int'l Ltd. Grp. Bus. Travel Accident Ins. Plan, 386 F. App'x 329, 333 (3d Cir.2010). In order for a court to find that, because of a failure of distribution, a SPD can be found to be ineffective, there must be a showing of "extraordinary circumstances" in connection with the distribution failure. Ackerman v. Warnaco, Inc., 55 F.3d 117, 124-125 (3d Cir.1995). Such circumstances may exist "where the employer has acted in bad faith, or has actively concealed a change in a benefit plan, and the covered employees have been substantially harmed by virtue of the employer's actions." see also Jordan v. Federal Express Corp., 116 F.3d 1005, 1011 (3d Cir.1997). An example of extraordinary circumstances cab found in Ackerman where the court found that the record supported an inference that the defendant actively concealed changes to a severance plan in order to prevent employees from leaving; the fact that meetings that were scheduled to inform the plaintiffs of the change in policy were never held; the fact that the [a handbook noting the changes] was never distributed to the ... employees, and the fact that a letter [from the defendant's CEO] spoke of 'changes' in (rather than the elimination of) the severance plan.

Have you found yourself in the situation where you have not received a copy of your summary plan description for your insurance benefits? Contact an insurance claims attorney in Massachusetts at the Law Offices of George E. Thompson for consultation and assistance.

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Haven't received copy of summary plan description for insurance benefits?

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One of the most important documents participants are entitled to receive automatically when becoming a participant of an ERISA-covered retirement or health benefit plan or a beneficiary receiving benefits under such a plan, is a summary of the plan, called the summary plan description or SPD.