Denver Disability Lawyer

Denver Disability Law Attorney

Shawn McDermott and Our expert lawyers team at McDermott Law, LLC have extensive experience in handling denied short-term disability claims and long-term disability claims, including assistance in submitting the applications for those benefits, internal appeals, and litigation, if it becomes necessary. As a skilled Denver disability lawyer, we have handled thousands of these claims. Few attorneys, if any, in Colorado have handled as many disability insurance claims as we have. Such claims may arise from the purchase of an individual disability policy or, as is more often the case, the short-term disability and long-term disability coverage is provided as an employee benefit from your employer. Our attorneys represent clients in matters of individual disability claims, ERISA disability claims, and Colorado PERA short-term disability and disability retirement claims.

This overview of disability insurance is designed to give you an introduction to eligibility and other aspects of disability coverage in Colorado. If you believe you have a case related to short-term disability (STD) or long-term disability (LTD) insurance, nothing can replace the personalized advice of an experienced lawyer

What Is Disability Insurance?

Disability insurance coverage is income replacement coverage that comes in both short- and long-term forms. Disability insurance is either purchased by individuals through private insurance policies or provided by employers for the benefit of qualified employees. Group disability insurance is a benefit of great value to employees and often can be provided at little cost to the employer. Employer-provided disability benefits are specifically included in the “welfare benefits” plan definition and are therefore covered by ERISA.

Are Employers Required To Provide Disability Insurance In Colorado?

In most states, including Colorado, employers are not legally required to provide disability insurance.

Short-Term Disability Insurance Benefits

Group short-term disability (STD) plans are typically designed to provide income replacement benefits after you have missed work for at least seven days, but your plan may be designed differently. STD benefits are usually paid when the employee is unable to perform the material duties of his or her own occupation or even own job, and are payable at a rate of 60% to 100% of the person’s pre-disability earnings. Oftentimes the STD benefit is self-insured, meaning that your employer is ultimately responsible for the payment of the benefit even though, more often than not, a third-party administrator (often an insurance company) actually processes and administers the claim.

Long-Term Disability Insurance Benefits

Long-term disability (LTD) insurance programs typically begin after short-term benefits have been exhausted, usually three to six months after the onset of the disabling illness or an injury has occurred. LTD benefits usually cover 50% to 67% of an employee’s salary and are almost always subject to a monthly maximum, usually $10,000. Some insurance plans categorize the employee participants in relation to these “welfare benefits,” with executives being entitled to higher benefit limits.

If the employee is also receiving other benefits, such as Social Security Disability benefits, the long-term disability insurance benefits may be reduced proportionately, as designated by the policy language. Benefits generally end at age 65 or your Social Security Normal Retirement Age (SSNRA); sometimes they terminate within as little as five years after the disability begins. The age at which the participant becomes disabled also may determine the length of available disability coverage. It is extremely rare to find a group policy providing benefits for life.

“Own Occupation” And “Any Occupation” Eligibility

Most group long-term disability insurance plans define disability in two ways for purposes of benefits eligibility. These definitions are often referred to as “own occupation” and “any occupation.”

Disability is usually initially defined as an inability to perform the material and substantial duties of a person’s “own occupation.” An individual must be disabled from his or her own job or regular occupation for a specified period to begin receiving long-term disability insurance benefits.

If approved for “own occupation” benefits, a transformation of the definition of disability occurs at a certain point in time in the future, usually 24 months after the “own occupation” period begins. The participant’s eligibility is then based on his or her inability to perform “any occupation.” This new definition requires that the person prove both an inability to do the former job and an inability to perform any job for which he or she is capable or qualified, based on past work experience, education and ability to retrain. If deemed disabled under the “any occupation” definition, the claimant may be entitled to benefits for only an additional three years or, more typically, until age 65 or SSNRA.

To determine the eligibility of a plan participant, the claimant and his or her attorney must read the plan documents and the insurance policy. These provide information regarding the exact definitions used, the long-term disability insurance benefits available and the duration of those benefits. Each group policy insurer uses different language, and even the same insurer may use slightly altered language from one group policy to the next. The claimant should also compare the language used in the plan documents with that contained in the group policy, because the language sometimes differs.

When Insurance Companies Seek A Buyout/Lump Sum Settlements

When a disabled individual’s claim has become what many companies call “stable and mature,” the insurance company may seek to buy out (settle) the claim for something less than its total value. There are administrative costs to an insurance company to monitor the disability claim, which includes the annual process (or more often) of collecting claimant information, additional opinions from attending physicians and other administrative functions. For this reason, an insurance company will attempt to take advantage of a claimant and offer a lump sum, which at first may look quite attractive to the disabled individual.

At McDermott Law, LLC, we recommend that individuals in this situation have their disability buyout offer reviewed by an experienced attorney who can offer advice on the reasonableness of the offer presented by the insurance company, and to negotiate a better deal.

Disability insurance companies look at several factors in determining whether to offer a lump-sum settlement. These factors may include:

• Medical and financial information available at the time of the buyout review
• The bond rate as published in the Wall Street Journal or some other barometer of the appropriate discount rate
• General uncertainties of the future such as interest rate fluctuations, unforeseen accidents and other risks
• Morbidity and mortality rates
• The possibility of medical advancements

Managing Your Disability Claim At All Stages Of The Process

Most of our clients contact us after their claim for long-term or short-term disability benefits has been denied. However, the Denver disability insurance lawyers at McDermott Law, LLC, can also assist in the filing of your claim. If you’d like, we can sit down with you to discuss the claim process, the nature of a disability claim in general, and how to file such a claim on your own. We can also assist in the gathering of crucial medical, occupational and testimonial support for the claim.

Working With You To Understand Your Claim

We work with the client, the treating physician, therapists and other professionals to develop the necessary support for your claim to give it the best chance of success from the outset. We can manage the entire claim process if you prefer. Many people do not have the energy or experience to deal with the insurance company’s request for additional information, interviews and the occasional request for an examination. If you prefer to handle the initial claim process on your own, feel free to click on the link below for some quick tips on how to do so.

If you suffer a claim denial and our firm is successful in having those benefits paid, we are here to assist you with the continuing management of the claim into the future. The long-term disability (LTD) insurance company is not going to leave you alone. It will continue to monitor your claim. It will require the completion of multiple forms every six months to a year (or even more often). These forms will need to be completed by yourself and your treating physician. We are here to assist with the ongoing claims management as well, with a goal of guarding against a termination of those needed monthly LTD benefits.

How To File A Disability Claim in Denver, CO?

If you have short-term disability and/or long-term disability coverage by virtue of your employment, or if you have purchased an individual policy, the following is intended to help you pursue a claim with your claim administrator should you become disabled.

The Laws Applying To Your Claim

The Employee Retirement Income Security Act of 1974 (ERISA) protects the interests of participants and their beneficiaries who depend on benefits from private employee benefit plans. Millions of workers in this country are participants and beneficiaries under employer benefit plans that fall under the protection of ERISA. Typically, however, church or government plans are not covered by the act.

The Differences Between Short-Term And Long-Term Disability

A short-term disability (STD) plan is designed to provide income replacement benefits after you have missed work, usually seven, 10 or 30 days, depending upon how your employer has designed your plan. STD benefits are payable for either three or six months. The plan is designed to provide benefits in the event of a minor or serious accident or illness. Most STD plans pay benefits on a weekly basis.

The long-term disability (LTD) plan is designed to provide income replacement benefits typically after six months, again depending upon the plan. Most employers who have established LTD plans also provide STD benefits but not always. The “elimination period” in an LTD plan is that time frame from your last day of work until you may first receive LTD benefits, and is typically the length of the available STD payments. Benefits under LTD plans are typically payable to age 65. The LTD plan is designed to provide benefits in the event of a serious disabling condition due to an accident or sickness that lasts longer than six months. Benefits for long-term disability are typically paid monthly.

The above description for STD and LTD plans is general only. You must consult your employer ’s plan, summary plan description or the policy of insurance that has been purchased by your employer. Many employer-provided STD plans are self-insured, meaning that your employer pays the benefit, but the employer may have retained a third-party administrator (often times an insurance company) to handle the claims processing. Most employers offer LTD benefits through insured plans, meaning that the employer has purchased a group disability insurance policy on behalf of its employees. Your claim will be processed by the insurer of those benefits.

Always Read And Understand Your Benefit Plan

You must read your STD and LTD benefit plans (or policies) and ensure you understand the type of benefit to which you are applying. Most plans provide that you have to be an “active employee” of the company, meaning that you are working an established number of hours per week, usually a minimum of 30. If you are recently enrolled in the plan, perhaps as a new employee, a “preexisting clause” may apply. If you were sick or treating for a condition that eventually became disabling, and you are filing your claim within the first 12 months of enrollment in the plan, your claim may be barred. The most important aspect of your claim is understanding and ensuring that you will meet the definition of disability. You will need to find this definition in your plan or policy. It will ultimately be your responsibility to demonstrate (prove) that your sickness or illness renders you disabled according to this plan language. The opinions of your treating physicians will be very important in this regard. You may want to speak with your physician about the filing of a disability before you do so. (See discussions below) Perhaps your physician is the one who recommended that you seek disability and cease working.

Under most STD and LTD policies (at least for the first two years), you need to prove that you are unable to perform the material and substantial duties of your “own” or “regular” occupation. Under an LTD plan, the definition will likely change after a certain period of time (usually two years) and become more difficult to prove in that you will need to show an inability to perform “any occupation.” All disability policies are slightly different. Thus, the importance of understanding your plan.

FAQ’s

When Should I Report A Claim?

You should report a claim as soon as you believe you will be absent from work for an extended period of time. You need to consult your summary plan description or insurance policy to determine any deadlines that might apply. The general rule of thumb should be to report a claim to your employer as soon as it becomes obvious you will be missing a week or more of work.

Do I Need To Involve A Physician?

Your claim will not likely be successful unless your physician believes you are disabled. However, just because you have one or more physicians who are willing to complete the necessary forms, and say that you are unable to work, does not mean that the plan or insurer will agree that you meet the definition of disability under your policy. It is important to speak with your doctor about these issues and understand your physician’s willingness to cooperate and be an advocate for your claim. Some physicians simply do not want to get involved or will say that they do not do “disability determinations.” It is important to understand, and perhaps speak with your physician who makes such a statement, and explain that you are not seeking a disability determination under workers’ compensation or the Social Security system, where specialized training to perform such determinations is typically required. (Please keep in mind, however, that you may also be pursuing a work comp and/or Social Security Disability claim as well, but that should not dissuade your physician from advocating on your STD or LTD claim) You should also ensure that you are treating with a specialist for the medical condition that renders you disabled. That way, you may end up with the support of one or two specialists and your primary care physician. The more physician support you have, the more likely your claim will be approved.

How Do I File A Claim?

Again, you will need to consult your plan documents. Generally, you will want to contact the human resources person or department at your employer and indicate your absence from work. You will likely be told that you need to submit the claim directly with a claims administrator (not the employer) or an insurance company. Your employer may give you the required application for claim submission or the contact information to the administrator or insurance company.

You will then be provided a disability claim packet. The claim packet or application is typically made up of three forms: an employee statement, an employer statement and an attending physician statement. You will need to have your employer complete and submit the employer statement. You should have your treating physician (or multiple physicians) complete and submit the attending physician statement.

Please keep in mind it is the responsibility of the claimant (you) to prove you meet the definition of disability (either STD or LTD) and not the administrator’s or insurer’s duty to disprove the claim. As part of your burden of proof, you need to ensure that all the claim forms are submitted to the insurance company.

Do I Need To Provide My Medical Records?

The disability claim packet will likely also include an authorization form for you to sign which the administrator or insurer will use to collect your medical records. You should ensure the administrator has the name and address of all medical providers who have treated you for your disability and are willing to complete the necessary forms. The administrator/insurer will then attempt to collect your medical records from these providers. The best way to ensure they are received is to obtain them yourself and submit them directly to the insurer. Document all of these steps.

Do I Need To Notify The State Of My Absence?

You, of course, need to notify your manager or supervisor of your absence. Some states do provide short-term disability benefits such as California, New York, New Jersey, Rhode Island and Hawaii. If your absence from work is due to a work injury, you likely will have already filed a claim for workers’ compensation benefits, which may provide income replacement benefits (such as temporary partial disability, permanent partial disability or permanent total disability).

Will I Receive Confirmation After Filing My Claim?

After you have initiated a claim, the administrator or insurance company will send you a letter confirming the receipt of your claim and assigning a claims representative. They will provide you with the necessary contact information regarding your claim number and how to reach your claims representative.

Should I Talk To The Claims Representative?

Yes. The claims representative assigned to your claim should contact you after he or she has received the claim. You may find during the processing of your claim that these individuals are difficult to get on the phone. They are not likely to provide you with their email addresses either. We always recommend you keep a diary of all communications regarding your claim. If you discuss a matter with a claims representative and have provided important information regarding yourself or your claim, we recommend that you confirm the communication in writing. All written communication and documents generated or received by the claims representative must be maintained in their “claim file.” This claim file is an extremely important document if your claim is denied, and an appeal becomes necessary, or you are required to pursue a lawsuit.

If your claim is governed by ERISA, a denial of your claim must be “appealed” with the same claim administrator or insurer. This appeal phase is by far the most important stage of the case, even more important than subsequent litigation in our opinion.

How Long Do I Wait For A Claim Decision?

Your plan must tell you whether or not you will receive benefits within 90 days after you have filed a claim. If special circumstances exist, an additional 90-day time frame may be needed, but the administrator is required to tell you why additional time is needed and the date by which the plan expects to render a final decision. If your claim is denied, the plan administrator must notify you in writing and explain in detail why it was denied.

Should I Keep A Record?

Absolutely, yes. You should most definitely keep a chronology, summary or diary of all actions you take regarding your claim. Keep copies of all correspondence you send and receive. The same holds true for any emails. It is important to keep an organized file of everything relating to your claim. If your claim is denied, you will want to speak with an attorney who specializes in handling these types of claims who will want to see all of the documentation you have maintained.

What Should I Do If My Claim Is Denied?

First things first: do not panic. There are ways to have the administrator’s decision overturned. Most importantly, if your claim is governed by ERISA, and perhaps even if it is not, you are required to file an internal appeal of the adverse benefit determination.

Do not take this appeal requirement lightly. You will likely be provided 180 days in which to submit this appeal for disability claims, however the appeal deadline can be as short as 60 days for life and health claims. If you have read this far, you already know the importance of the appeal and have perhaps read more about the steps to take. One option is to contact a Denver disability attorney who specializes in this area of the law to obtain advice or representation on how to proceed.

Helping You Face Insurance Companies

McDermott Law, LLC, is considered one of the preeminent law firms in Colorado helping consumers battle their insurance companies over denied claims, particularly those relating to denied long-term disability. Our Colorado disability insurance lawyers have dealt with numerous insurance companies providing individual and group long-term disability insurance policies, as well those offering life insurance, accidental death and dismemberment (AD&D) and long-term care coverage.

Our attorneys are familiar with the tactics employed by many of these insurance carriers, and the various employees and vendors utilized by each to deny your claim. We are here to put this experience and our inside knowledge of these carriers to work for you. Any of our past clients can attest to the tireless and aggressive representation we bring to each case with one goal in mind: to get your benefits paid. We also handle claims in the states surrounding Colorado and across the country. We have taken on all the major insurance companies and won.

Contact Us to Get Defense for Disability Case

If you are facing the disability claims process, we can help. For a free Review of Denied Claims, complete our contact form or call us in Denver at 303-964-1800. We advise and represent clients throughout greater Colorado and the Rocky Mountain region.