The Ten Common Mistakes You Can Make in Your Initial Application for ERISA Disability Benefits

Welcome to Season 4, Episode 43 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "The Ten Common Mistakes You Can Make in Your Initial Application for ERISA Disability Benefits."

Join host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, as she delves into the complexities of the initial application process - an often daunting and error-prone step. While every stage of the disability claims journey can be challenging, the initial application can be especially confusing and frustrating, causing many applicants to abandon the process before they’ve even begun. In this episode, Nancy will thoroughly explore ten common mistakes made during the initial application, providing valuable insights to help you avoid these pitfalls. 

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

1 - Listening to your supervisor who says they have your back.

2 - Listening to your HR department.

3 - Not knowing what your STD / LTD policy or plan says.

4 - Picking the wrong date to be disabled.

5 - Not knowing what is in your medical records.

6 - Not filling out the application correctly.

7 - Screwing up the ADL forms.

8 - Screwing up the Interview.

9 - Doing things you shouldn't, and staying on social media.

10 - Not having an experienced ERISA lawyer represent you.

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

Nancy Cavey [00:00:12]:
 Hey, I'm Nancy Caby, national ERISA and individual disability attorney. Welcome to Winning Isn't Easy. Before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says that. I've got to tell you that. So now that I've said that, nothing will prevent me from giving you an 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.
 
 Nancy Cavey [00:00:41]:
 Are you finding it increasingly difficult to do your occupational job duties? Do you have problems sitting, standing, concentrating? Are you missing time from work? If you have a disability insurance benefits through your employer, I think you should think about applying for your shorter long term disability benefits. But before you do that, you need to understand that you can make mistakes that can make all the difference in whether you're going to get your benefits or whether you get a letter from the carrier plan denying your claim. In this episode I'm going to be Talking about the 10 common and avoidable mistakes that I see people make on their initial ERISA disability benefit application. Any one of these 10 mistakes can destroy your claim before it even gets started. I will tell you that the application is a pain in the rear end and it's full of traps. But these are traps that you need to understand so that you get the disability benefits you deserve. So I'm going to talk about each one of these mistakes. Number one listening to your supervisor who says I've got your back.
 
 Nancy Cavey [00:01:44]:
 Number two, listening to your HR department as if they really know what they're talking about. 3. Not knowing what your short or long term disability policy or plan actually says about what you have to prove to get the disability benefits you deserve. Number four picking the wrong date to be disabled. Number five not knowing what's in your medical records. Number six not filling out that application correctly. Number seven screwing up the ADL forms. Number eight screwing up the interview.
 
 Nancy Cavey [00:02:14]:
 Number nine, doing the stuff you say you can't do and why you should be staying off of social media. And then number 10, why not having an experience or risk a disability lawyer represent you can create all sorts of problems for you that could have been avoided and not caused you the pain and grief of dealing with a disability carrier plan appeal. I'm going to break these into four different sections and in episode one or segment one, I'm going to talk about mistakes one to two. In segment two, I'm going to talk about mistakes three and five. In the third Segment I'm going to talk about mistakes six and eight, and the last episode I'm going to talk about mistakes 9 and 10. Got it. So we've got a very interesting, I think, session that we're going to be talking about and one that you really do need to understand so that you get those benefits. So let's take a break.
 
 Nancy Cavey [00:03:15]:
 Got it. Welcome back to Winning isn't easy. Listening to your supervisor who says they have your back and listening to your HR department can result in a disaster in your initial application. So let's talk about mistake one, listening to your supervisor who says they've got your back. Now, I know that you're probably having difficulties doing all the parts of your occupational duties or your doctor may have even said, look, you need to start thinking about, you know, hanging up, stopping work and concentrating on your recovery. If that's the case, you might be tempted to talk with your supervisor. And I've got some thoughts about that. If your supervisor doesn't know you're having problems, I wouldn't tell them quite yet.
 
 Nancy Cavey [00:04:15]:
 There are lots of things you have to do before you move forward with any application for shorter long term disability benefits. And you don't want to assume that you qualify for your benefits when your employer tells you that they've got your back. On the other hand, I would still say play it cool until everything is in place. Even if your supervisor is sympathetic. However, there's a big exception. If you think you're going to be terminated or your position is going to be eliminated, the game changes. You need to immediately consult with your doctor, get a note taking you out of work. Better yet, if you've got time, you need to consult with an experienced attorney such as myself, because we want to be able to explain to you what it is you need to prove to get the benefits, what the standard of disability is, what the carrier literally expects in your medical records.
 
 Nancy Cavey [00:05:03]:
 But obviously time is of the essence, so there are different ways to play this out. But in my view, you really have to have your ducks lined up, if you will, before you stop work. And I would not necessarily be talking to your supervisor listening to what it is they have unless you've got a really, really, really tight relationship with them. Mistake number two, listening to what your HR department tells you about your disability policy, the right date to claim benefits, the application process, and how there isn't any reason why your benefits won't be paid. Now, I represent many HR people who have ERISA disability policies or plans. They even help pick them out. And I will tell you they don't know what's in the policy or plan or what they have to prove or much less what you have to prove to get your benefits. Now what they are useful for is to get you a copy of the short and long term disability policy or plan in the application documents.
 
 Nancy Cavey [00:05:58]:
 They may or may not submit your application, but remember, at the end of the day you've got the burden of proof. If your employer has a sponsored a short term disability plan, they're probably going to be involved in the decision making process because after all it's coming out of their pocket. If these short term disability benefits are being paid for by an insurance company, then your employer is not going to have any say in whether you get paid these benefits or not. Your employer may also offer you a long term disability policy or plan and I will tell you in that instance the carrier or the plan administrator is going to make the decision to pay or deny your claim. While the HR department can help you understand what's going on in your group health insurance benefit or life insurance benefit world, they can help you with some important decisions. What do I mean by that? At some point you are going to lose your group health and potentially your life insurance benefits. You need to understand how long and under what conditions they may pay your portion of the premium, if any. Whether you have to apply for fmla, at what point you won't be eligible for these benefits, how much is going to cost to COBRA your benefits and life insurance benefits? So I think that the HR folks can be helpful when it comes to the coordination and continuation of benefits like group health and life and maybe even some pension issues.
 
 Nancy Cavey [00:07:21]:
 But at a minimum, what you should be asking them to get for you is a copy of the policy or plan and the application documents. Got it? Let's take a break.
 
 Speaker B [00:07:34]:
 You've 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 to know about the long term disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:07:59]:
 Welcome back to Winning isn't Easy. Let's talk about three more mistakes that you can make in the initial application process. Not knowing what your short and long term disability policy or plan says, picking the wrong date to be disabled, and not knowing what's in your medical records. So mistake number three not knowing the terms of your disability policy or plan can be disastrous. Why? There's no uniform disability or policy or plan and many Carriers or plans have multiple versions of their policy or plan and there are really crucial terms that you need to understand before you stop work and apply for benefits. These include what's the definition of disability? Just because your doctor says you can't work doesn't mean you're disabled under the terms of the policy or the plan. What's the definition of your occupation? You didn't insure a job, you insured your occupation is it occupation is performed in the national economy, the local economy, for your employer pursuant to the Dictionary of Occupational Titles. It hasn't been updated in probably 40 years.
 
 Nancy Cavey [00:08:58]:
 What's the type of proof you have to submit? When do you have to submit the application and what do you have to submit as part of the application? Whether there are any policy limitations that will limit what medical conditions are covered and which are excluded, like a mental nervous policy limitation or subjective medical condition limitation. Are there any policy limitations on how long benefits are paid and are there any reduction in your benefits for things like employer paid leave, the use of vacation pensions, workers comp benefits, Social Security benefits? Filing your application without knowing any of this can be a recipe for disaster. And I will tell you, it can be really hard to fix a claim denial after the fact. What's mistake number four? Mistake number four is not knowing what's in your medical records. And you don't know what the records say about your diagnosis, your symptoms, your restrictions, and even whether your doctor supports your claim. If you don't know whether your doctor supports your claim and you go out and file your shorter long term disability claim, that doctor is going to be asked to fill out an attending physician statement form. If they don't fill it out or they don't support your claim, probably a guaranteed claim denial. Worse yet, many times I look at medical records and they don't document the objective basis of the diagnosis, they don't tell the story of your symptoms, they don't comment on your ability to work, comment on the progression of your symptoms or your restrictions and limitations.
 
 Nancy Cavey [00:10:23]:
 So you really need to understand what's in your medical records because that disability carrier plan is going to get those records, they're going to have their doctors review them and comment on whether or not you meet the applicable definitions of disability or occupation or even restrictions and limitations. So you have to understand what story your medical records are telling you or telling the carrier and whether your physician is going to support your claim. Also, you need to be talking to your doctor about the definition of disability in your occupation. So you and your doctor are on the same page. They may think simply saying you're disabled is enough, when in fact you have to provide proof that you can't do specific occupational duties that are material and substantial to the occupation. You may have to provide objective medical evidence of the diagnosis, objective evidence supporting the symptoms, and an objective basis for your doctor's opinion that you can't work. Obviously, you got to know that before you stop work because that is very hard to fix after the fact. Mistake number five is picking the wrong date to claim that you were disabled.
 
 Nancy Cavey [00:11:42]:
 Now, as I've said, disability carriers or plans are going to look at those medical records for lots of reasons. One of the reasons they're going to look at is to see whether the date you stop working is supported by the medical records. They're going to review all the documentation you submitted. And if you have have a medical condition that's been progressive and you worked one day and didn't work the next day, the disability carrier is going to want to see what's in your medical records. It establishes your symptoms progress to the point that you couldn't work as of this date. Now, if you quit your job and apply for benefits and your medical records don't support your claim, you can expect a claim style and worse. Let worse yet, you lost your job and potentially your group health insurance benefits and your disability coverage. Now, the other thing you need to understand is that many disability policies or plans require that you be disabled for a period of time before benefits are payable.
 
 Nancy Cavey [00:12:37]:
 This is called an elimination period. If you aren't disabled during the elimination period, your claim is going to be denied regardless of how disabled you might subsequently become. Now, you have to pick the right date to be disabled and you have to be disabled long enough. And you wouldn't know any of that without the policy or plan and what's in your medical records. So let me give you an example of cases we've seen where the policyholder plan beneficiary reduced hours because of problems they were having and they dropped below the number of hours that they had to work to maintain the disability coverage. Now, normally you have to work at least 30 hours per week to maintain coverage. But if you've reduced your hours below that and then apply, the carrier is going to say, too bad, so sad you have no coverage because you picked the wrong time to reduce your hours or the wrong time to apply for your disability benefits. Got it.
 
 Nancy Cavey [00:13:29]:
 Let's take a break for a moment. Welcome back to Winning. It Isn't Easy. Let's talk about three more mistakes that you can make in your initial application process that can sync your claim. Number six is not filling out the application correctly. Number seven is screwing up the ADL forms and number eight is screwing up that interview. Okay, so any one of these mistakes can result in a claims denial and we don't want to make any of them. So mistake number six is not filling out your application correctly.
 
 Nancy Cavey [00:14:21]:
 It looks simple, but it's anything but. There are hidden traps of this application that are designed to get you to answer questions in a way that will allow the carrier or the plan to deny the claim. Now, while you should answer these questions truthfully, you also should not exaggerate. But you need to explain things in a way that is consistent with what your doctor's reports have to say and what you're saying on your activity of daily living forms. What information you put on that application should be the truth, as I've said. And it also should be consistent with your social media accounts. Please shut them down. Inconsistencies in what you say, what you tell the doctor and what you are doing or may not be doing on your social media account is one of the easiest ways that or one of the easiest tools that a carrier will say is the basis of a denial.
 
 Nancy Cavey [00:15:15]:
 It's all inconsistent. Our doctors are the ones who actually understand this and our doctors have opined that you can continue to work or you can do your occupational duties so that inconsistency is going to kill you. You're going to be asked to complete these forms repetitively in a different stages of the claim. And when the carrier or plan is re reviewing the file, they're going to be asking you for updated information about your work history, benefits you're collecting, ask you to complete updated activities of daily living forms and those can kill you. Obviously this is just part of being on claim and you can expect that they're going to review each one of the forms, look for inconsistencies, can look for inconsistencies between what you're telling them in phone calls or inconsistencies in your medical records. So consistency is the key. Mistake number seven is screwing up that activity of daily living questionnaire. Now the activities of daily living form ask questions in an open ended manner.
 
 Nancy Cavey [00:16:15]:
 It might say tell us about your daily activities. That's a really broad question and you can answer it lots of ways depending on what's happening in your life, depending on the day, your pain level, medication you're taking, your response, you know what it is you're actually doing. We suggest that you do the Application forms in draft. And of course, as if we represent you, we review them and we approve them after we've reviewed your medical records to make sure everything is consistent. Now, you also might be tempted to use just the forms that the insurance company provides. As an ERISA and a Social Security disability attorney, I see many insurance company forms and I know among the forms that they'll have filled out is the attending physician statement form. And that form doesn't ask the right questions. So we will supplement that form with the Social Security applicable form.
 
 Nancy Cavey [00:17:11]:
 Even though you may not be applying for Social Security benefits, we use these residual functional capacity forms so that we get the answers to the questions that really matter. And one of the questions is going to be symptoms and functionality and restrictions and limitations. That's why again, it's really important that when you're filling out these activity of daily living forms, this is all consistent. In fact, I've written a book about how to fill out these ADL forms and the traps that can occur. And you can call our office at 727-894-3188 and ask for a copy of that book. Now, mistake number eight is screwing up the interview with a disability carrier plan. If you are a high dollar claim, if you are a professional, you can anticipate that the carrier is going to want to take your statement. I will tell you if you expect to complete your disability report, your ADL forms, send in your APS forms and expect that you're going to be FedExed to check the next day.
 
 Nancy Cavey [00:18:13]:
 You're in for a rude surprise. Your application is going to be reviewed by a claims examiner who's going to review the terms of the policy to determine your eligibility. Once they determine your eligibility, they're going to send your medical records to the medical department for review, their accounting department for an accounting analysis, and they're going to do ultimately a claims evaluation roundtable and they will determine whether they're going to pay benefits, whether your claim needs to be reviewed further by their physicians, and whether a statement should be taken from you and if so, what should be in that covered in that statement. So you should be wary of the claim with the adjuster. You have a duty to cooperate, but I always suggest that questions be put in writing so that you can take the time to answer them. And you should watch what you say and watch what you do. If you choose to speak with a claims adjuster, I would suggest you get permission to record the conversation and ask for a copy of the recording. The insurance company or the plan Administrator is not your friend and even the most innocent remark can destroy your claim.
 
 Nancy Cavey [00:19:18]:
 I think you should only make contact with them via email and not by phone. And be very discreet in your email. Don't send them a yelling email, a screaming email. Don't tell them your life story because I will tell you. Even in your emails, even in your conversations, even in any statement, they're going to summarize what they think you said and they're going to interpret what you said in a way to create reasons for a denial or a claim, termination of benefits. And worse yet, if you're driving, if you're in the park, if you're someone loud somewhere where it's loud, the adjuster is going to conclude that you must be out and about and leap to the conclusion that you're capable of working. Now, if you're a high dollar person, you can potentially expect surveillance, and that's true. If there are any inconsistencies between what you say you do in your activities of daily living form, what your physician says, what your social media accounts say, and of course, what you're telling the adjuster.
 
 Nancy Cavey [00:20:15]:
 If you think there's surveillance, please call the local police department and report it and they should come and investigate whether you're being surveilled or harassed. If you do have a conversation with the claims rep or any other insurance company personnel, you should keep a written record of who you spoke with, what was discussed when the call took place, what information they requested, what questions they asked, and always ask for an opportunity to supplement whatever you have talked about in writing. Better yet, you should be represented by an attorney if your statement is going to be taken. Generally, I think these statements are a trap. They're looking for specific information that will justify claims to dial or determination, and you need to be prepared by having an attorney represent you. Got it. Let's take a break.
 
 Speaker B [00:21:02]:
 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 that will assist you in submitting a winning disability application. This is one you don't want to miss. For the next 24 hours, we're giving away free copies of the Disability Insurance Claim Survival Guide for Professionals. Order yours today@disability claimsforprofessionals.com.
 
 Nancy Cavey [00:21:41]:
 Welcome back to Winning Isn't Easy. Let's talk about two more mistakes. In the initial application, it's doing stuff you shouldn't be doing and staying on social media. And then an experienced ERISA disability attorney represents you. You've heard many times about why you should not be on social media is one of the first things that are going to look at in your during the course of the case. What they're looking for is you doing stuff you shouldn't be doing because your doctor told you not to do it or stuff you said you shouldn't be doing and you're doing, particularly as documented on social media. Now, I once had a client who claimed that he was disabled from working because he had migraines as a result of looking at a computer screen. The disability carrier caught him on a gaming site and actually recorded him on several occasions participating in doing gaming activities.
 
 Nancy Cavey [00:22:45]:
 They took that information back to the treating physician and asked the physician whether the physician remained of the opinion that the claimant was unable to engage in computer work. Obviously, having had an opportunity to review the surveillance, the doctor not only retracted his opinions, affirmatively opined the claimant was capable of working and performing his occupation, and the doctor fired him as a patient. You can only imagine this case did not go well. So please, please turn off your social media, tell your relatives and family that you don't even want to be tagged in any kind of activity. That will kill your case and can be practically impossible to fix. Now, another mistake is not having an experienced ERISA lawyer represent you. Now, just because you fill out the application doesn't mean you should. You're going to make mistakes by not getting the disability policy or plan, not understanding what you have to prove, not reviewing your medical records, picking the wrong day to be disabled, completing the paperwork in a fashion that will give the disability carrier plan a reason to denial or turn.
 
 Nancy Cavey [00:23:55]:
 Denial, Deny your benefits being on social media, any of these errors, individually or in combination, can result in a delay or denial of your benefits. And worse yet, you can make mistakes if that claims representative wants to speak with you. Talking to an adjuster is like talking to Freddy Krueger. Now, I will tell you, I know that people are sometimes reluctant to hire lawyers because obviously we charge. But I will tell you, if you've been scheduled for an interview with them, if you've been scheduled for a consultative examination, you're being set up for a claims denial. You need representation certainly at that point. But in my view, before you stop working, apply for benefits, you should be talking to someone like myself who can review your policy and explain what needs to be proven. Review your medical records and explain if those records support your claim or not.
 
 Nancy Cavey [00:24:50]:
 Develop a strategy to get your benefits, help you pick the right date to claim you were disabled. Interact with the Disability Carrier Plan on your behalf. Provide the Disability Carrier Plan with favorable evidence from your employer, your family, your friends, your doctors. Develop as appropriate necessary medical information, including perhaps a functional capacity evaluation or an evaluation by a favorable doctor. Develop appropriate vocational information explaining why you can't perform the material and substantial duties of your occupation. Submit financial documentation that supports your claim, the date you picked as being disabled, and if your claim has been denied or there's they're slow walking this claim, obviously it's time to get an attorney, particularly if that claim has been denied, because you're only going to have 180 days in which to file an appeal, which is the trial of your case. Abraham Lincoln once said that a person who represented themselves had a fool for a client and you should be again talking with a lawyer. Many lawyers, such as myself, offer a free complimentary consultation and we handle these claims on a flat fee or a contingency basis.
 
 Nancy Cavey [00:26:01]:
 So in other words, if you don't get your benefits, we don't get paid. I strongly believe that going in alone should not be your course of action. These claims are complex. They require legal and medical expertise to navigate the process so that you get the disability benefits you deserve. I want you to understand that I come from a family of a disabled breadwinner. My father, who was a pilot during World War II, came back after the war, went to work with our family insurance agency brokerage business, and he purchased a disability insurance policy. Ultimately and unfortunately, he became disabled and our lives were turned upside down as a result of his disability. Changed our financial circumstances, plans for college, all sorts of things got upended and he took that application very seriously.
 
 Nancy Cavey [00:26:50]:
 Now he was an insurance agent and he understood how to fill out an application. But you probably aren't an insurance agent and you probably aren't an ERISA disability attorney. We think that you owe it to yourself to consult with experienced ERISA disability attorneys, regardless of where you live in the United States, before you make a crucial mistake on your initial application that can be impossible to fix. Got it? Well, I hope that you have enjoyed this week's episode of Winning Isn't Easy. Please like our page, leave a review, share it with your family or friends, and subscribe to this podcast. That way you'll be notified every time a new episode comes out. I hope you tune into next week's episode of Winning Isn't Easy. Thanks.