Tips and Tricks When Filing Your ERISA Disability Claim - Insider Secrets Regarding the ERISA Disability Claims Process

Welcome to Season 4, Episode 14 of Winning Isn't Easy.  In this episode, we'll dive into the complicated topic of "Tips and Tricks When Filing Your ERISA Disability Claim." 

Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses some tips and tricks anyone suffering from a disability needs to follow when they decide to file an ERISA disability claim. Filing a claim for ERISA disability benefits can be confusing and frustrating; you might feel as though you're ready to throw in the towel. Don't! Disability carriers are not in the business of paying out benefits, and they purposefully make the process as miserable as possible in the hopes of deterring deserving claimants.  In this insightful episode of Winning Isn't Easy, host Nancy L. Cavey will walk through some strategies for counteracting whatever the disability carrier might throw at you as you attempt to navigate your disability claim.

In this episode, we'll cover the following topics:

1 - Giving up before You Even Start - Walking Away from Your Disability Benefits by Never Filing a Disability Claim

2 - Don’t Let the ERISA Disability Application Discourage You and Make You Give up Your Disability Claim

3 - Do You Need to Sign the Releases That the ERISA Disability Carrier Demands?

4 - Why Just Filling out Your ERISA Disability Application as Fast as You Can Is Like Rushing through Your Homework

5 - Do I Have to Tell My ERISA Disability Insurance Company about All of My Medical Problems if I Am Claiming ERISA Disability Benefits?

6 - Why You Must Review Your Application for Disability Insurance before You File Your Disability Insurance Claim

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Speaker A [00:00:11]:
 Hey, I'm Nancy Cavey, national ERISA and individual disability attorney. Welcome to winning isn't easy before we get started, I've got to give a legal disclaimer. This podcast is not legal advice. The Florida Bar association says that I have to say this, so I've said it. But I will tell you that nothing will prevent me from giving you easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go. In this episode today, I'm going to be talking about the tips and tricks that you should know when filing your ErISA disability claim. The disability claims process is full of pitfalls and traps designed to ensnare you and let the disability carrier deny your claim.
 
 Speaker A [00:01:04]:
 In this episode of winning isn't easy, we're going to cover some of the techniques the disability carriers will use to deny claims and some of the strategies you need to know in order to be successful in your claim. I'm going to be talking about six giving up before you even start walking away from your disability benefits by never filing a disability claim, not letting the disability insurance application discourage you and make you give up your disability claim. Answering your questions about whether or not you need to sign releases that the ERISA disability carrier demands that you sign. I'm going to talk about why filling out your ERISA disability application as fast as you can, like rushing through your homework. I'm going to talk to you about whether you have to tell your ERISA disability insurance company or plan about all of your medical problems. If you're claiming ERISA disability benefits and why you have to review your application for your disability insurance policy before you file your disability insurance claim. Got it? Let's take a break. Welcome back to winning isn't easy.
 
 Speaker A [00:02:36]:
 Ready to get started? Giving up before you even start walking away from your disability benefits by never even filing a disability claim. My father was a World War Two naval aviator who came back from the war, went to Johns Hopkins on the GI Bill, and joined the family insurance business in Baltimore, Maryland. Now, he had the foresight to buy a disability insurance policy in the event that he became disabled. However, when he became disabled, it took him six years before he stopped working and applying for his benefits. There were lots of excuses. He was embarrassed that he had survived the war but was now disabled and unable to work. He didn't think his doctor would support his claim. He thought he would improve and would be able to continue to work.
 
 Speaker A [00:03:26]:
 He didn't think there was a right time to stop work and apply for his benefits. Do any of these excuses sound familiar? Well, please don't let these excuses stop you from filing your, your disability insurance claim. After all, you paid premiums for your disability policy or plan just like my dad did. And you pay those premiums to provide you and your family with financial security and a peace of mind if you became disabled. So let's talk about one of the number one things, and number two things you need to do. You have to give timely notice of your claim and timely file your claim. Now, fortunately, my father finally decided that he couldn't work and he actually filled out his disability application after giving notice within days of me graduating from high school. Now, his disability policy, much like yours, required that he give timely notice of the claim to the disability carrier and timely file the application for the disability benefits.
 
 Speaker A [00:04:31]:
 There is no uniform disability policy or plan in the United States. Each carrier has multiple versions of their policy or plan, and they have different limits for giving notice and filing applications. But you got to be aware that that's an affirmative obligation on your part when you suspect that you may have to stop work and apply for benefits. I don't want you to just stop work. It's time for you to get a copy of your disability policy or plan and read it cover to cover, just like my dad did before he stopped working. You need to understand what it is you need to prove. What's the definition of disability? What's the definition of occupation? Are there any other terms in the policy or plan that would impact your benefits? What's the timing of the application? What's the timing of the notice? Does your doctor support the claim? What's in your medical records? Is it good or is it bad? Will your doctor support your claim? Will the doctor fill out forms? You need to understand the answer to all of those questions as you begin to think about filing notice of your claim and ultimately filing the claim. Once you have made that difficult decision to stop work and apply for benefits, I think it's time for you to consult an experienced risk of disability attorney to learn about how to file a winning disability insurance application.
 
 Speaker A [00:05:58]:
 Now, I'm sure many of you are thinking, well, I wouldn't expect her to say anything else, and hopefully you understand why I'm telling you to do that. Based on the laundry list of things that I think you need to be considering before you stop work and apply for your benefits. And many times I represent people who have chronic medical conditions that include cognitive issues, fatigue or pain, and it almost becomes overwhelming for them to get this material, read it, understand it and formulate a strategy. In my view, filing a winning application is all about strategy. Let's take a break.
 
 Speaker B [00:06:38]:
 Have you been robbed of your peace of mind by your disability insurance carrier? You owe it to yourself to get a copy of robbed of your peace of mind, which provides you with everything you need need to know about the long term disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Speaker A [00:07:04]:
 Welcome back to winning isn't easy. Don't let the ERISA disability application discourage you or make you give up your disability claim. As I explain in my book that we just mentioned, the ERISA disability claims application process can be daunting, confusing and discouraging. But there is a roadmap to how we are going to go about this. Let's first talk about what questions are on the ERISA disability application. When you put the disability carrier on notice of the claim, the disability carrier is going to submit to send you a lot of forms to complete. These forms include that actual application, medical release forms, Social Security release forms, income tax release forms, activity of daily living forms, medication forms, work history forms. Every one of these forms are crucial to your claim.
 
 Speaker A [00:08:01]:
 And I know that they can be frustrating to the point that you want to give up. That's letting the disability carrier win. So if you're discouraged, if you're frustrated, if you're ready to give up again, time to get my book. Time to consult with an ERISA disability attorney because you don't want to make a mistake in this application process. You have a duty to cooperate with a disability carrier and the failure to do so can result in a claims denial. You have to fill out the forms, you have to sign the releases, and we'll talk about that in some subsequent sequences here. But the application is crucial. That application is going to ask questions, obviously, about your background, your name, where you live, your date of birth.
 
 Speaker A [00:08:49]:
 It'll ask questions about your occupation, and that's important because you have ensured your ability to do an occupation, not a job. So you need to have that policy or plan to understand how the plan or policy defines the term occupation. It's going to ask you questions about your medical conditions and what you think those disabling medical conditions are. It's going to ask questions about your symptoms and perhaps how those symptoms impact your ability to function. Those answers are crucial because the carrier or plan is going to get your medical records. They're going to compare what you said in your medical records to what's on the forms, then they're going to try to match that up to the occupational duties of your particular occupation that you were doing at the time you claimed that you became disabled. They're also going to ask you, what's the date of disability? And that can be important because you don't want to pick the wrong date. It may ask you about pre existing conditions, and one of the tools in the carrier denial toolbox is the application of a pre existing condition clause that can result in a denial of your claim.
 
 Speaker A [00:09:57]:
 They may ask you questions about your hobbies. Now, you would think that that's none of their business, but it is. They may ask you questions about your social media involvement. All of this is fair game. And we want to be accurate and complete, not misleading. But we also don't want to give the disability carrier a reason to deny the benefits right out of the box because you didn't fill out the forms or didn't fill them out accurately or didn't submit them timely. Got it? Let's take a break. Welcome back to witting.
 
 Speaker A [00:10:46]:
 Isn't easy. Do you need to sign the releases that the ERISA disability carrier demands? Now, there is no doubt that you have to sign the medical release forms and the Social Security release forms. There are times, however, that I will modify these medical releases to provide that they have to submit to you any and all information that they get. I will shorten the time of the validity of the release to normally 60 to 90 days. I will also insist on the release that this does not give them the authority to contact your doctors, and if they do so only in writing, and I will. There are fights about this, but I do try to limit the release. Now, I'm often asked, particularly if I'm representing a doctor or lawyer or other professional. What about my business tax returns? I think that's more problematic.
 
 Speaker A [00:11:40]:
 If you're a professional, you can expect that you'll be asked to complete income tax release forms and even submit copies of your tax returns. Why? Well, if you're a professional within a disability policy, you probably have a benefit called residual disability benefits. That class of benefit will pay you if there's a loss of income. Well, how do you calculate whether there's a loss of income? You've got to calculate the starting point. And the way we get at that is to look at your monthly income, potentially as of the date of you, of your disability. But there are other ways to get at it. Now, many disability policies or plans look at the income tax returns for the five years before you became disabled or it could be that the disability policy or plan uses the highest income for three out of five years, the last two years or the last years. You can see that tax returns and even business documents are really relevant to determining what's called the before monthly income because that's the measure against which any subsequent monthly earnings, loss of earnings is going to be measured.
 
 Speaker A [00:12:46]:
 So what they're going to be doing is determining what that performed monthly income is. Look at the monthly income each month and determine whether or not there's been a sufficient loss of income to entitle you to benefits. And don't forget that the carrier is probably going to do an annual reconciliation of what they paid you by looking at your income tax return for that year. What did you report on the income tax return? What did your monthly profit and loss statement show? And they're going to reconcile that your failure to complete the release will result in a denial of your claim or simply a nonpayment of your benefits. And that's not what we want to happen here. Okay, well, how about jointly filed tax returns? You probably are asked to provide your income tax returns if there are questions about your income or your work activity. But what about giving that carrier a jointly filed income tax return? In my view, the income of your spouse is irrelevant, and I often tell the disability carrier that we will redact the spouse's income and relevant tax information from the return. Now, again, you can be assured that the disciplined carrier plan is going to do a business record search to see if you or your spouse is part of a business.
 
 Speaker A [00:14:03]:
 If you are or your spouse is part of a business that you own, you can expect that the carrier plan is going to demand to see the business returns and understand your involvement in the business and potentially understand your spouse's involvement in the business because they've got to sort out the income issues. You do have a duty to cooperate, and the failure to do so could be grounds for claims denial. What you submit, how you submit it are all valid questions that you need to address. And the way you go about addressing that is to look at the terms of the disability policy or plan and think about how they go about calculating the before monthly income and how they're going to calculate the monthly entitlement to benefits after your date of disability. Expect that you are going to have to submit this documentation and submit it in a form that they understand, and that may include providing information about procedures that you do. It's all fair game. But if you have any questions, that's the time to consult with an experienced ERISA disability attorney got it. Let's take a break.
 
 Speaker C [00:15:14]:
 Are you a professional with questions about your individual disability policy? You need the disability insurance claim survival guide for professionals. This book gives you a comprehensive understanding of your disability policy with tips and to dos regarding your disability application that will assist you in submitting a winning disability application. This is one you won't want to miss. For the next 24 hours, we are giving away free copies of the disability insurance claims survival guide for professionals. Order yours today@disabilityclaimsforprofessionals.com. Dot.
 
 Speaker A [00:15:50]:
 Welcome back to winning isn't easy. Why? Just filling out your ERISA disability application as fast as you can is like rushing through your homework. Were you the kid who rushed through your homework assignments so that you could go hang out with your friends? Or are you so confident in your ability to complete this application that you think that the disability carrier is going to quickly run through it and see that you're disabled and FedEx you a check tomorrow? Okay, which one is it? In my view, in either scenario, you may have destroyed your claim before it even gets out of the gate. There's no doubt that completing an ERISA disability application form is a pain. There's the application for benefits. There's an occupational history. There's a medical history questionnaire. There's an activity of daily living form.
 
 Speaker A [00:16:42]:
 You might even be asked to get documentation from your doctor in the form of AP's, I'm sorry, attending physician statement forms. They may even ask for copies of your tax returns, your w two s, pay stubs, you name it, they're going to ask for it. And you may think, you know, I don't have to produce all this or I'm going to produce it in a just to get this application going because I need the money. Please remember, you have a duty to cooperate in your Arista disability claim. Every ERISA disability policy or plan requires that you document your claim, provide sufficient proof of your loss, and cooperate with the carrier of the plan. The failure to cooperate in and of itself can result in a claims denial, and that can be hard to overcome in court. As I said, you might be tempted to just blow through all these forms to get them done so that you can get the disability benefits you deserve. In fact, you're waiting on your porch for that FedEx truck to arrive.
 
 Speaker A [00:17:40]:
 Please resist that temptation. Each one of these forms has hidden traps in it designed to elicit from you information that can be the basis of a claims denial. While you have a duty to cooperate with a carrier, I think you have a duty to yourself, a duty to take this application process seriously, to document your claim and provide sufficient proof of loss. Now, you may have questions about the application process and you call up the adjuster and ask questions and you may be attempted to rely on them and their explanation to you what you need to do. Disability carriers and plans have a duty to handle your claim in good faith and not mislead you. But that's not always what happens if their answers don't make sense. It's time for you to consult with an experienced EriSa disability attorney to get the right scoop on how to complete these forms. The other thing you need to do is if you choose to believe what the disability carrier or plans adjuster has to say to you, you put it in writing and say, this will confirm our conversation of blah blah blah blah blah in which you told me, blah blah blah blah blah blah blah.
 
 Speaker A [00:18:49]:
 So when they tell you you didn't do what they asked you to do, you've got proof that you in fact did what they told you to do. Now, many times you're going to submit documentation to the disability carrier or plan and find out that they want more information. I call it that we want more information. Game to delay or deny your claim game they're hoping that you'll go away. They hope that you get discouraged. They hope that you make a huge mistake on your form so that they can deny your claim. This delay and deny game is just another reason why, in my view, you need an experienced attorney to help you with the ERISA disability claim application process. Got it? Let's take a break.
 
 Speaker A [00:19:52]:
 Welcome back to winning isn't easy. Do I have to tell my ERISA disability insurance company about all of my medical problems if I'm claiming ERISA disability benefits? Filing an ERISA disability claim involves lots of medical documentation, including your medical records, your test results, and even operative reports. And as a matter of course, I tell my clients that they should tell the disability carrier about all of their medical problems, regardless of whether or not those problems may individually be disabling or even be potentially related to what you think. The primary reason is that you're unable to work. So let me give you an example. You might have a heart condition and diabetes, but your diabetes is under control. Your diabetes, in and of itself may not be disabling for ERISA disability purposes, but the combination of the diabetes and the heart condition very well could qualify you for your ERISA disability benefits. That's why I think it's better to disclose all of your medical problems.
 
 Speaker A [00:20:59]:
 Now, there aren't any rules or regulations that require you to inform the carrier all of your medical problems. But again, as I said, I think it's better as a matter of course to disclose them all and then they can be winnowed out, if you will. What's your attorney's obligation to submit medical evidence? Now, you may have retained an attorney to represent you, and you may be wondering what the attorney's obligation is to submit medical evidence, even if it's unfavorable. I want you to remember that in the Social Security context, a Social Security attorney who may be representing you is required under the Social Security rules and regulations to obtain evidence and submit all the evidence, including factual information, medical source opinions that relates to the question of whether you are disabled or not. And that includes bad things, and they can get in big trouble if they don't. There's no hiding the ball in the context of a Social Security disability case. Now, in the context of an ERISA case, there's no affirmative obligation by rule or regulation that the attorney has to provide the carrier with unfavorable evidence. But I assure you that you and your attorney is going to be asked to provide the disability carrier with a complete list of your medical providers because they're going to go get the medical records.
 
 Speaker A [00:22:21]:
 If you have cherry picked your medical records, pulled out the bad stuff and sent it to the carrier thinking, haha, fooled them, you're in for a rude surprise because they will get your medical records and they will see the things that you specifically pulled out. The unfavorable records will come with it. I think hiding the ball is hard in an ERISA case and quite frankly, I would rather deal with an unfavorable medical evidence upfront than hide it. I'd rather have us address it in the form of statements or have your doctor address it and hide it. Hiding the ball makes you look like a liar, questions your credibility, and gives the disability carrier a reason to deny the claim, in part because you haven't cooperated and you haven't been truthful. Don't you agree? Let's take a break. Welcome back to winning isn't easy why you have to review your application for disability insurance coverage before you file your disability insurance claim. Now, if you have an individual disability insurance policy, you filled out an application and you probably don't remember what you put on it.
 
 Speaker A [00:23:46]:
 You might have done it yourself, you might have done it with the help of an agent, but what you put on that individual disability application for insurance can make or break your claim. So before you stop work and apply for your benefits, one of the key documents you need to get is that copy of that application. Why? Well, let me tell you the story of one of my clients and why. His failure to get a copy of the application for disability insurance coverage that he completed doomed his claim, and it caused the disability carrier to claim he was committing fraud. The application for disability insurance coverage asked lots of questions, including the nature of your occupation and your past medical history. Unfortunately, he lied about his past medical history. He denied prior problems with his neck when in fact, he had been diagnosed with a herniated disc, had undergone a cervical MRI. He even denied treatment.
 
 Speaker A [00:24:39]:
 And guess what? He had gotten treatment. So when he applied for his disability insurance coverage, based on what he put on that application, the disability insurance company offered him an insurance policy. They made an underwriting decision to offer him a policy and set the premium based on what he put on that disability insurance coverage application. Years go by, he has problems with his neck to the point where surgery is recommended. He has difficulty doing procedures in the office, and so he says, I want to apply for my disability benefits. He did not get a copy of his disability insurance coverage application. He didn't recall what he put on an application. Or if he did recall, he certainly didn't tell us about the truth.
 
 Speaker A [00:25:31]:
 Now, it got worse because his claim for disability benefits was based on that cervical disc herniation that had been observed earlier in the MRI, and the claim was fraudulent. Okay, so what did the disability carrier do? The first thing that carrier did was review a copy of his application for disability insurance coverage. The next thing they did was they got a copy of his medical records and reviewed them cover to cover, which noted a prior history of cervical issues. And then they looked at his disability claim and said, look, you're now claiming that you're disabled as a result of a herniated disc that existed when you applied for disability insurance coverage and you lied about it. And we would never have written this policy had you told us the truth. In fact, we've got the old medical records that document this sort problem. And at this point, the game was over. The carrier rescinded the policy because of the material misrepresentation and fraud.
 
 Speaker A [00:26:34]:
 They refunded years of premiums and they weren't done. They hired an attorney to file what's called a motion to rescind and claimed that the policyholder committed fraud on the application for coverage and in the disability claim, they wanted a judge to determine there was fraud. And they we're going to refer the case to the Department of Insurance for investigation of fraud and a criminal referral. Clearly, you don't want to be in that position, do you? So what do you have to do before you file your disability claim? If you have an individual disability insurance policy, you want to contact your agent or the insurance company. You want to get a copy of your application for coverage. And once you get it, you want to review every question and your answers. Are those answers right? Are they accurate? Are they complete? If not, it's time to call an experienced a risked disability attorney to help you. Now, your agent might have completed that application and you might not have reviewed it before the agent submitted.
 
 Speaker A [00:27:37]:
 If the agent did that based on what you told them, or they paraphrased your answers, there can be material mistakes on that application. And if the agent is still in business, you, the attorney, can contact that agent to discuss the application, how it was prepared, how crucial questions were answered. Sometimes the agent remembers, sometimes they don't, and sometimes they don't tell the truth. Sometimes the agent has died in finding out that information can be impossible. If possible, you want to try to correct those errors before you file your claim. Some aren't going to be correctable, like the misrepresentations my former client made. So you want to obviously review that application for individual disability insurance coverage for errors. And if there are mistakes and there are significant mistakes, the attorney is going to tell you you don't have a claim.
 
 Speaker A [00:28:28]:
 Or you may have a claim, but it might not be for the disabling condition that you forgot to mention on your application. So in this case, if this client had now become disabled as a result of MS, his misrepresentations would not necessarily have resulted in a recension of the policy and a refund of the premiums. So you can see that what you put on that application can help you, or it can hurt you, or it can even destroy a claim. So please tell the truth. I hope you've enjoyed this week's episode of winning isn't easy like our page. Leave a review. Share it with your friends and family. Subscribe to this podcast, please.
 
 Speaker A [00:29:20]:
 That way, every time a new episode comes out, you'll be notified. I hope you tune in to next week's episode of winning isn't easy. Thanks.