WORKERS' COMPENSATION - SOCIAL SECURITY DISABILITY - MEDICAL MALPRACTICE - PERSONAL INJURY - PERS

Archive for September, 2015

What is Disability Insurance ?

Disability insurance provides income replacement after an injury or illness makes working impossible for a brief time or forever. The best-known forms of disability insurance are workers’ compensation and Social Security. Individuals can also carry private disability coverage through their job, or they can purchase a disability policy in the same way that they get automobile insurance and homeowner’s or renter’s insurance.

Agee Clymer Mitchell and Portman’s Cleveland disability lawyers have addressed Ohio workers’ comp and Social Security Disability Insurance (SSDI) in earlier posts to the firm’s website. Here, we look at privately purchased personal disability coverage plans.

 

Do You Need Your Own Disability Insurance?

Only you can make that determination. Here are four of the factors you need to consider:

  • No one needs any kind of insurance until they do. This, admittedly, is not strictly true. You can get ticketed for not having car insurance, for instance, and denied a loan for not having a policy for a house you want to buy. The points holds, however, that paying premiums on most forms of accident and health coverage can seem like useless expenses until the worst happens. Weighing costs against risks is necessary.
  • Workers’ comp and Social Security do not cover everyone. If you work for the government at any level, for a public school or university, or for yourself, you probably will not qualify for workers’ compensation of SSDI benefits for the simple reason that neither you nor your employer pay into the programs. Payroll taxes and paycheck deductions that rarely affect public employees and independent contractors fund federal and state disability programs.
  • Workers’ comp and SSDI claims often get denied. In 2010, just more than one-third of all SSDI applications got approved. During the state’s 2014 fiscal year, the Ohio Bureau of Workers’ Compensation provided benefits to 97,572 new claimants while still having 858,773 cases under review. Safety nets sometime have large holes.
  • Some jobs come with significant risks for illness and injury. Commercial drivers, construction and maintenance workers, and factory and warehouse workers face more dangers on the job than do people who sit in offices. With workers’ comp and SSDI not guaranteed, carrying private disability insurance can make sense for those in high-risk professions.

 

What Does Disability Insurance Cover?

As noted, disability insurance replaces income. Short-term policies start paying immediately, with benefits set as a percentage of the policyholder’s earnings before he or she got hurt or sick. Long-term policies begin paying benefits several months or a year after a disability becomes apparent.

In general, a qualifying disability can fall into any of the following categories:

  • Temporary, typically considered to be an injury or illness that keeps the person out of work for more than a week but less than six months
  • Long-term, an injury or illness that keeps the person out of work for a year or longer
  • Partial, a condition from which a person recovers enough to start working again but which limits earnings and physical function
  • Permanent, a condition that partially or totally limits earnings and physical function for the person’s entire life
  • Total, an injury or illness that leaves a person completely unable to work

 

The exact provisions of disability insurance policies vary from contract to contract and from insurer to insurer. The terms and benefits also depend on how much a policyholder pays in premiums. Benefits can be paid monthly or in lump sums and used for any expense the beneficiary chooses, from settling medical bills to making mortgage payments.

 

How Does the Disability Insurance Claim Process Work?

A policyholder does not have to get injured or sick due to work-related activities to qualify for private disability insurance payments, but the person does have to present convincing medical evidence of a disabling condition. Doing that often requires getting examined and assessed by doctors and occupational specialists chosen by the insurance company. Periodic reassessments of a beneficiary’s ability to work are also likely.

It is important to note that the condition usually only has to keep a person off the job. Broad exclusions from workers’ comp and SSDI eligibility for common problems like back pain and respiratory diseases generally do not apply under private disability insurance policies.

 

Do You Need Assistance With a Disability Insurance Claim?

Dealing with an insurance company for any reason can leave you confused, frustrated, and uncompensated for a legitimate claim. Any of those outcomes are understandably unacceptable if you find yourself struggling physically, unable to work, and counting on disability benefits you have paid toward.

The experienced disability lawyers in the Cleveland offices of Agee Clymer Mitchell and Portman may be able to serve as your legal champion. We welcome opportunities to help individuals prepare disability claims and appeal denials. Contact us online or call (800) 678-3318 to request a free case consultation.

Why Your Disability Claims Can Get Denied

The clearest answer to why a disability claim gets denied probably comes from a FAQ on the Ohio Bureau of Workers’ Compensation website. The agency states, “If a claim is denied, it is often because of a lack of information.”

Exactly like a nutshell, though, that answer conceals the actual meat of the matter. What information got omitted? Can an applicant and his or her Ohio worker’s compensation attorney provide the missing info as part of an appeal? How must that additional information be presented, by when, and to whom?

We address several of those concerns elsewhere on webpages prepared by Cleveland Social Security lawyers and disability lawyers who practice at Agee Clymer Mitchell and Portman. Here, let’s focus on the specific issue of what evidence an injured or ill person needs to submit in order to have a short- or long-term disability.

Each case and, therefore, every disabled person’s application for benefits will differ in specifics. Still, the general requirement of needing to establish that a temporary or lifelong condition prevents you from working enough to support yourself financially always exists. Accident reports, medical records, expert opinions from physicians and other health care providers, and evaluations from occupational specialists can stand as proof. Disability applicants who can produce multiple forms of such evidence have a greater chance of qualifying for benefits.

To understand how evidence for a disability gets assessed, it makes sense to look at the most-common reasons applications for Social Security Disability Insurance (SSDI) get denied. An audit covering 1992 through 2010 revealed that the majority of people denied federal disability benefits

  • had an impairment that was not expected to last 12 months,
  • had an impairment that was not considered severe,
  • were able to perform his or her usual type of work,
  • were able to perform another type of work
  • had an impairment resulting from drug addiction or alcoholism
  • provided insufficient medical evidence
  • failed to cooperate
  • failed to follow prescribed treatment
  • did not want to continue development of the claim, or
  • returned to substantial work before disability could be established.

 

Two of these reasons merit special consideration, especially as they might apply in workers’ comp and other non-Social Security disability cases.

First, denial on the grounds of being uncooperative points to requirements a disability program places on applicants and beneficiaries to submit to physical examinations and interviews by specialists selected by the program. Refusing to get checked out by program doctors and staff almost automatically flags an application for denial.

Similarly, the mentions of “prescribed treatment” points directly to the reality that receiving Ohio workers’ compensation benefits often depends on participating in occupational therapy sessions. Proof of enrollment and keeping appointments are essential for keeping disability status.

 

Get Help With Avoiding and Appealing Disability Denials

Whether you want to ensure you submit all the information you need to have a first-time disability application approved or you have received notice of a claims denial, an Ohio worker’s compensation attorney or SSDI lawyer with Agee Clymer Mitchell and Portman may be able to help. Anyone who has already heard a “no” should definitely seek legal advice and representation because the deadlines for filing appeals and collecting additional information are tight.

We offer no-cost consultations on even the toughest workers’ comp and Social Security cases. Reach out to us through this site or call (800) 678-3318 to ask your questions.


Cleveland OH Workers Comp Lawyer
Agee Clymer Mitchell & Portman
6100 Oak Tree Blvd., Suite 200, Cleveland Ohio 44131 USA
Tel: (216) 328-2125 Fax: (614) 221-7308 Map