Results tagged “Long Term Disability benefits” from Indiana Long Term Disability Lawyer Blog

Disability and the Family Medical Leave Act

February 19, 2014

When a disability causes someone to stop working, they may be unsure of their rights to employee protections or insurance benefits. One common question for disabled employees is whether or not the employer can terminate the employee's job due to a disability. For some employees, they may have limited protection under the Family and Medical Leave Act (FMLA).

Under FMLA, eligible employees can take up to 12 workweeks of unpaid leave a year. FMLA also requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave. After the employee has exhausted 12 workweeks in one year, they are entitled to their same or an equivalent job if they are able to return to work. Unfortunately, if the disabled employee is still unable to return to work after exhausting their leave of absence under the FMLA, the employer may legally terminate his or her employment. More details can be found on the Department of Labor's website.

It is very important to recognize that not all employers are required to provide FMLA protection. FMLA applies to all public agencies (including local, state, and federal employers, and local education agencies) and private sector employers who employ 50 or more employees for at least 20 workweeks in the current or preceding calendar year. Therefore, if your workplace includes less than 50 employees and your employer is private, you may not receive FMLA protection.

Additionally, employees must satisfy several requirements in order to take an unpaid leave under the FMLA. First, they must work for a covered employer as explained above. Second, they must have worked 1,250 hours during the 12 months prior to the start of leave (with special hours of service rules for airline flight crew members). Third, they must work at a location where the employer has 50 or more employees within 75 miles. And fourth, they must have worked for the employer for 12 months.

If a disabled employee is eligible for FMLA protection, they can apply for an unpaid leave of absence due to a "serious health condition." The FMLA defines a "serious health condition" at Title 29 of the Code of Federal Regulations ยง825.113 as a condition involving inpatient care or continuing treatment by a health care provider. In addition, the Department of Labor commented on the meaning of a "serious health condition" in a 1996 opinion letter and stated that "'eligible employees' may take leave for, among other reasons, their own serious health conditions that make them unable to perform the essential functions of their position.

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Disabling Headaches

November 15, 2013

Headaches are an uncommon occurrence for most people. For some people, though, headaches occur frequently, and can be so severe and intense that they are debilitating. When headaches occur frequently, they can force a person to stop working altogether.
Disabling headaches are a non-specific symptom and may be caused by a range of conditions. Therefore, it is crucial for a person to seek medical treatment to learn the cause of their headaches. If a family doctor cannot diagnose the condition causing headaches, then the patient will likely be referred to a neurologist.

Objective testing that explains the cause of the headaches may strengthen the disability claim, so it is important for the patient to undergo any sort of applicable testing. However, the cause of headaches is often not detectable in CT scans or other testing. If the headaches are not explained by test results, then the patient should work with their physicians to determine if any environmental factors are contributing to their headaches.

In cases where the headaches are severe, a patient may be experiencing migraine headaches. Migraines are characterized by moderate to severe headaches along with some of the following symptoms: photophobia (sensitivity to light), phonophobia (sensitivity to sound), pulsating, pain on one side of the head, and nausea/vomiting. Again, it is essential for a patient to explain his or her symptoms to their physicians so that the best course of treatment can be planned. Treatment for migraines may include prescription medications, injections, and attempting to remove trigger sources.

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Multiple Sclerosis Disability Claims

May 14, 2013

Multiple Sclerosis is an autoimmune disease that affects the brain and spinal cord. The symptoms and severity of Multiple Sclerosis (MS) can vary among those afflicted with the disease, but it is not uncommon for the condition to prevent a person from working. Symptoms can include fatigue, loss of balance, muscle spasms, numbness, weakness, tremors, problems with coordination, difficulty walking, vision problems, bowel/bladder difficulties, inability to concentrate, memory problems, and speech impairments.

When MS prevents a person from working and they file a disability claim with their insurance company or the Social Security Administration, there are a few things that can help prove that MS is disabling. The first step is to make sure that the patient has been diagnosed properly. That includes undergoing exams like MRIs of the brain and spine, nerve function studies, and lumbar punctures. These objective test results are essential to ruling out other conditions and determining whether a patient has MS. Moreover, these test results can also indicate the severity level of a patient's MS.

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Northern District of Illinois Finds that Liberty Life's Termination of Disability Benefits was Arbitrary and Capricious

April 15, 2013

The Northern District of Illinois recently ruled in favor of the Plaintiff's summary judgment motion in a long term disability lawsuit. In Krupp v. Liberty Life Assurance Company of Boston, the court found that Liberty Life's termination of Ms. Krupp's long term disability benefits was arbitrary and capricious. Krupp's long term disability benefits were provided through her employee benefit plan and accordingly, the case was examined under the rules and regulations of the Employee Retirement Income Security Act ("ERISA"). To read the full opinion, see the link here.

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Overpayment in Long Term Disability Insurance Cases

December 19, 2012

Unfortunately, there is a common surprise for claimants who have been approved for long term disability ("LTD") benefits through an employee group benefit plan. LTD benefits are usually subject to a list of offsets that will reduce the amount that a claimant receives in disability insurance benefits.

One of the most frequent offsets is when a claimant is approved for Social Security Disability Insurance ("SSDI") benefits. When a claimant receives both LTD insurance benefits and SSDI benefits, the claimant's LTD benefits will be reduced by the amount that they receive from the Social Security Administration.

For example: assume a claimant has been approved for LTD benefits and receives $2000 per month. If that claimant has also been approved for SSDI benefits at $1500 per month, then the claimant's LTD benefits will be reduced to $500 per month. The net effect is that the claimant still receives $2000 per month - the amount they were owed under the long term disability policy - however, the monthly long term disability benefit is now much lower.

The most significant result of this offset occurs when a claimant has been approved long term disability benefits soon after they stop working, but then has to wait for a hearing with the Social Security Administration to determine whether or not they will receive SSDI benefits. In some cases, a claimant can wait two years or longer for a hearing with the Social Security Administration. If a claimant is approved for SSDI benefits at the hearing level, they will likely owe the long term disability insurer for "overpayment" due to the offset provision in their long term disability policy.

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