Articles Tagged with “Long Term Disability Insurance”

Kirsti K was an Administrative Assistant for a large manufacturing company for several years until late 2016, when she was in a severe car accident in which a semi tractor-trailer ran a red light and struck her vehicle, ejecting her several feet from the vehicle onto the roadway. As a result of the accident, Kirsti suffered severe and debilitating injuries, including a broken wrist that required surgical repair.

Kirsti missed almost three full months of work after the accident and subsequent surgery, but was able to return to work late in 2016. However, upon returning to work, Kirsti struggled to maintain her previous levels of productivity. Over the next few months, she also began to develop increasingly severe lower back pain, a large lumbar hematoma, painful keloid scarring from her wrist surgery,[1] and psychological impairments including depression, anxiety, and post-traumatic stress disorder (PTSD).

By May of 2017, Kirsti’s condition had deteriorated to the point that she was forced to once again leave work. She underwent numerous injections to treat her lower back pain, but experienced little meaningful relief. She also underwent extensive psychological counseling and therapy, in addition to physical therapy. Unfortunately, her conditions remained severe and continued to prevent her from returning to work.

Katie P was a Customer Service Manager for a small web-based company (“Company A”) for several years. Her employer was acquired by a larger company (“Company B”) in July of 2016, but her job was not impacted by the acquisition. She kept her job, but technically became an employee of Company B. Her employee benefits, including her long term disability insurance coverage, were transferred to Company B’s benefits plan at the time the acquisition was completed.

For years, Katie had been struggling with numerous medical conditions that made it difficult for her to work. These conditions became progressively more severe over time, to the point that Katie became totally disabled and was forced to stop working in February of 2017.

Katie filed a claim for long term disability (“LTD”) benefits under the Prudential Life Insurance Company (“Prudential”) LTD policy provided by Company B’s group benefits plan. However, despite acknowledging that Katie was truly disabled, Prudential denied her LTD claim, arguing that Katie’s conditions were preexisting and therefore excluded from coverage under the LTD policy.

O’Ryan Law Firm, on behalf of the Plaintiff, Dr. B, recently settled a lawsuit against Lincoln National Life Insurance Company (“Lincoln National”) for the denial of Dr. B’s claim for long term disability insurance benefits.

Dr. B was a radiologist at a regional hospital, where he worked approximately 10-14 hour days which consisted primarily of interpreting diagnostic images on a computer monitor. The position demanded absolute accuracy in reading diagnostic images, as even a single mistake or omission could be the difference between life and death for a patient. He also performed interventional procedures (e.g. percutaneous biopsies of various organs, joint injections, and fluoroscopy) and consulted with physicians and patients to review his findings. His position also involved a substantial amount of physical activity, including assisting techs with moving or positioning larger patients, and wearing lead aprons to shield himself from radiation associated with imaging equipment.

Several years ago, Dr. B began to suffer from keratoconjunctivitis sicca (dry eye syndrome), a condition that commonly affects radiologists.[1] Over the next several years, his condition progressively worsened, to the point that he often had to pull over on the drive to or from work to rest his eyes because his vision had become too blurry to drive. While his vision is good when his eyes are well-rested, even a small amount of computer usage causes his eyes to become sore, dry, and itchy, blurring his vision and requiring him to blink excessively and use eye drops to the fullest extent possible.

When a person has a medical problem affecting his heart or circulatory system, he may have work restrictions that prevent the ability to continue working. Depending on the severity of the heart condition, working may put a person at risk of suffering a heart attack or other life threatening cardiac event. In these situations, a person with cardiovascular impairments may qualify for short term disability benefits, long term disability benefits, and/or Social Security disability benefits.

Because a heart condition can be life threatening, it is crucial that a person with a cardiovascular problem seek immediate medical attention. When a patient presents with chest pain, palpitations, syncope, or other cardiovascular symptoms, it is common for physicians to order extensive testing. Testing for heart conditions may include echocardiograms (echo), electrocardiogram (ECG), exercise tests, drug-induced stress tests, Holter monitor tests, cardiac catheterization, cardiac computerized tomography (CT) scans, cardiac magnetic resonance imagings (MRI), chest x-rays, and blood tests.

Following the appropriate testing, treatment with a cardiologist is required to document the severity of the heart condition. If a person is required to undergo surgery, then she may have to see a surgeon specializing in heart operations. A cardiologist may only require a patient to follow-up on an annual basis, which means that it is important for the patient to also maintain treatment with her primary care provider and other doctors.

If a person undergoes a cardiovascular event such as a heart attack or surgery, but then is able to return to normal functioning, then he might only be eligible for short term disability benefits. However, if a heart condition requires the person to miss at least three months of work, then he may be eligible for long term disability benefits. To be eligible for Social Security disability benefits, the disability must last or be expected to last 12 months or longer.
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In both private disability insurance claims and Social Security disability claims, vocational evidence is usually considered when determining whether an individual is disabled or not. Vocational evidence is information about an individual’s occupation or the occupations they may be able to perform when considering their functional capacity, training, education, and work experience. This kind of evidence can consist of job descriptions from the employer, self-reported job duties, information from the Dictionary of Occupational Titles or other similar resources, and the opinions of vocational experts (also known as vocational rehabilitation consultants).

Long Term Disability Insurance

When someone becomes disabled and their employer provides long term disability insurance, then that person often applies for disability benefits under the requirement that they are unable to perform the duties of their “own occupation.” Under this type of definition of disability, the individual must show to the insurance company that because of their medical condition(s), they cannot return to their previous job.

During this stage of the disability claims review, the insurance company may consider the individual’s job duties and may gather information from the employer, the claimant, publications like the Dictionary of Occupational Titles, or a vocational expert. It is most common for the insurance company to at least gather the employer’s job description as part of their claims analysis.

Most private disability insurance policies limit the time for which a person can receive disability benefits under the “own occupation” definition and after a predefined amount of time (often 24 months), the definition of disability requires that the individual prove that because of their medical condition(s), they cannot perform the duties of “any occupation”. At this stage of the disability review, vocational evidence becomes even more important because the claimant has to prove that there are no occupations he or she can perform. The insurance company may use the opinions of vocational experts and resources like the Dictionary of Occupational Titles or ONET (Occupational Information Network) to find other occupations that the claimant may perform.
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