Winning Isn't Easy: Long-Term Disability ERISA Claims
Nancy L. Cavey, a seasoned attorney with over thirty-nine years of experience, explains the complex world of filing for Long-Term Disability benefits. Filing for disability can be a confusing, life changing event, so with her deft expertise, Nancy will guide you through:
- The ins-and-outs of ERISA (the Employee Retirement Income Security Act), which governs group Long-Term Disability Claims.
- Information regarding the process and lifespan of a claim, from the initial application to the request for hearing stages.
- Traps and tactics disability carriers (such as UNUM, The Hartford, Lincoln, and MetLife) use to hinder or deny your claim, including independent medical evaluations, surveillance, and arbitrary and capricious arguments downplaying the nature of your disability.
- Insights, overviews, and claimant stories regarding disease-specific content (ranging from commonplace ailments such as workplace injuries or accidents, to difficult to diagnose illnesses such as Fibromyalgia, Multiple Sclerosis, and POTS).
- Pertinent news happening in the disability world, and
- Much, much more.
Each episode of our podcast Winning Isn't Easy will expose you to invaluable tips and tricks for surviving the disability claims process (a system that is often wrought with pressures and pitfalls designed to encourage you to give up the benefits you rightfully deserve). As host, Nancy will often be joined by guest speakers who themselves are industry experts, ranging from lawyers specializing in related fields and doctors focusing on the diagnosis and treatment of specific diseases, to our associate attorney Krysti Monaco.
In her late teens, Nancy's father was diagnosed with leukemia. As someone who witnessed firsthand the devastating emotional and financial impact on both individual and family that being disabled and filing for benefits can have, Nancy is not just an attorney, but an empathetic presence who understands what you are going through.
Do not let disability insurance carriers rob you of your peace of mind. As a nationwide practice, The Law Office of Nancy L. Cavey may be able to help you get the disability benefits you deserve, regardless of where in the United States you reside. Remember - let Cavey Law be the bridge to your benefits.
Check out the links below to engage with us elsewhere:
Website - https://caveylaw.com/
YouTube - https://www.youtube.com/user/CaveyLaw
Winning Isn't Easy: Long-Term Disability ERISA Claims
Winning Disability Claims: Lessons From Denials, Appeals, and Carrier Games
Welcome to Season 5, Episode 42 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Winning Disability Claims: Lessons From Denials, Appeals, and Carrier Games."
Most workers assume an ERISA disability claim is straightforward - that if a medical condition keeps you from working, your insurer will pay. But under ERISA, benefits hinge on far more than a diagnosis. Carriers scrutinize the timing of your disability, gaps in treatment, the clarity of your medical records, and even your daily activities. A missing form, vague progress note, or inconsistent timeline can trigger a denial or termination, even when the disability is obvious. ERISA also hides procedural traps. Many policies require continuous proof of disability, and insurers police deadlines and documentation aggressively. Some even reshape the narrative - manipulating the onset date, treating routine activities as evidence of work capacity, or using minor lapses in care to cut off benefits. In this episode, we break down how these claims really unfold. We start with a case where Short-Term Disability was denied right before Long-Term Disability was set to begin - and the key steps to take before filing suit. Then we examine a physical therapy assistant with serious spinal injuries whose disability benefits were terminated, and how she reversed the decision by strengthening her medical evidence. Finally, we look at how carriers like MetLife play games with disability dates, and what you can do to stay ahead. By the end, you’ll see that winning an ERISA disability claim requires more than medical proof - it takes timing, documentation, and strategy to protect the benefits you rely on.
In this episode, we'll cover the following topics:
One - Short-Term Disability Benefits Denied One Week Before the Benefits Switched to Long-Term Disability – Ten Things to Do Before Filing a Lawsuit
Two - Physical Therapy Assistant Wins Reliance Standard Disability Claim After Termination of Benefits
Three - Moving the Goal Line and the Games That Disability Carriers Like MetLife Play With the Date of Disability
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.
Listen to Our Sister Podcast:
We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/
Resources Mentioned in This Episode:
LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mind
LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefits
FREE CONSULT LINK: https://caveylaw.com/contact-us/
Need Help Today?:
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.
Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.
Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.
Nancy Cavey [00:00:00]:
Foreign.
Nancy Cavey [00:00:16]:
Hey, I'm Nancy Cavey, national ERISA and individual disability attorney. Welcome to Winning Isn't Easy. Now, before we get started, I have to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to say this and I've done that, but nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games that carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Now, understanding the rules of ERISA disability claims and benefits can be the difference between getting paid and losing your benefits. And that challenge only grows when carriers will scrutinize the timing, documentation and standards they apply to your claim.
Nancy Cavey [00:01:03]:
Now, you need to understand that disability insurance carriers and plans just don't look at your diagnoses. They're going to look at your medical records, your treatment history, and even activities of daily living form that you are completing at their request. What they want to see is that your condition meets the policy definition of disability. Remember, there is no uniform definition of disability. You've got to look to your particular plan or policy to understand what in fact the definition of disability is. It's not the dictionary definition of disability and it's not what people commonly think of the word disability. It's the disability as defined by the terms of the policy or plan. And then they're going to look to see whether you have met the requirements for submitting documentation and whether you are timely in filing any appeal of a denied or terminated claim.
Nancy Cavey [00:01:57]:
I will tell you that most of risk of disability claims require ongoing proof of disability and carriers can deny or terminate benefits if documentation is missing or incomplete. And I will tell you this is really crucial because Hartford is starting to play some games that I think everybody needs to know about, and hopefully these games aren't going to be adopted by other disability carriers or plans. But I also want you to understand that sometimes the disability carrier or plan may try to manipulate the date of disability or use activity outside of the home to argue that you're capable of working just more games that disability carriers or plans play. That's why today's episode is about navigating that tricky ERISA disability claim claim process and avoiding common pitfalls. I'm going to break this down into three parts. First, I'm going to talk about a case where the short term disability benefits were denied just before the long term disability coverage was to begin, a common game, and what you need to do before filing a lawsuit. Next, I'm going to talk about a physical therapy assistant whose benefits were terminated despite serious spinal injuries and and how ultimately she won her appeal. And lastly, I'm going to discuss games that carriers like MetLife play when the date of with the date of disability and then what you can do to stay proactive and protect your benefits.
Nancy Cavey [00:03:23]:
So my goal is by the end of this episode, you'll understand that winning your disability claim is not just about your medical condition. It's about strategy, documentation and timing. So let's dive in. Number one, one is going to be short term disability benefits denied one week before the benefits switched to long term disability benefits and the 10 things that have to be done before filing a lawsuit. Number two Physical therapy assistant wins Reliance Standard Disability claim after termination of benefits and three moving the goal line in the games of disability carriers like MetLife play with a date of disability. All very important information that you need to understand. But let's take a quick break before we get into this episode.
Speaker B [00:04:10]:
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 to know about the long term disability claims process. Request your free copy of the book@kvlaw.com today.
Nancy Cavey [00:04:30]:
Foreign.
Nancy Cavey [00:04:36]:
Welcome back to Winning Isn't Easy. Let's talk about short term disability benefits being denied one week before the benefits switch to long term disability and the 10 things that should be done before filing a lawsuit. So it's not uncommon for disability carriers to play this game. They will pay short term disability benefits. And just before that period of benefits end and you transition into long term disability benefits, they say, oh no, no, we're not going to pay you the balance of your short term disability benefits. And by the way, you really can't proceed on that long term disability claim until you get paid your short term disability benefits. Now is that really true? And what are the 10 things you should do before you file a lawsuit? Well, I have to tell you that the answer in part is going to come from the language in the long term disability policy or plan. You just heard me say that.
Nancy Cavey [00:05:31]:
The carrier might say you've got to exhaust the short term disability benefits to be eligible for your long term disability benefits. But that's not always true. In fact, many policies don't require you to exhaust your short term disability benefits to be eligible for your long term disability benefits. So in other words, you're your long term disability benefits aren't conditional on the short term disability claim. But I have to tell you, the courts across the United States have held that the denial of the short term disability claim alone does not excuse you exhausting the administrative remedies of both the short term disability claim and the long term disability claims process.
Nancy Cavey [00:06:14]:
So one of the things that's fundamental to ERISA is that the policyholder, the plan beneficiary, has to exhaust their administrative remedy before they file a lawsuit, unless the failure to exhaust those administrative remedies is futile. And I will tell you, the courts will rarely find that exhaustion of remedies is inapplicable. They're going to hold you to those strict criteria. So as a matter, a practical matter, in the context of a long term disability claim, what we want to do is file that long term disability claim, even if the short term disability claim is denied or benefits were terminated. Why? Well, first we have to exhaust our administrative remedies in terms of the short term disability claim. So we're going to file an appeal, but we want to file the long term disability claim and let the claim be denied. Hopefully, it won't be denied. Hopefully they'll pay the benefits.
Nancy Cavey [00:07:10]:
But if it's denied, then we also want to file an appeal of the long term disability claim to its completion. So we want to exhaust the administrative remedies in both the short term disability claim and the long term disability claim, because if we don't, the carrier or plaintiff is going to say, hey, you didn't exhaust these administrative remedies. Too bad. So sad. When you file that lawsuit, we're going to file a motion to dismiss on the basis that you failed to exhaust your remedies. And that is a hard stop. And in fact, the court will most likely agree with a disability carrier after and will dismiss the claim. Now, by that time, the period of time in which you have to file an appeal for both the short term disability and potentially the long term disability claim will have run and you have really messed yourself up.
Nancy Cavey [00:08:00]:
In fact, you won't probably be able to proceed. So how does this work in the real world, in quotes of ERISA litigation? I'm going to tell you the story of Ted Lecter. Now, Ted applied for short term disability benefits under a policy administered by Mutual Omaha Life Insurance Company. Mutual. For the purposes of this discussion, he claimed he was unable to work as of April 18, 2022, because of severe anxiety, depression, panic attacks, sadness, hopelessness and isolation. His doctor diagnosed him with an unspecified obsessive compulsive disorder and related disorders that had begun about the time he had also been infected by COVID 19. Now, his symptoms became significantly worse after receiving the COVID 19 vaccination, and he began to complain of common symptoms of COVID brain fog, chronic fatigue and memory issues. His claim for short term disability benefits was approved, but one week prior to the termination of those benefits, mutual terminated disbenefits because they said, you didn't provide us with satisfactory proof of continuous disability as required by the policy.
Nancy Cavey [00:09:12]:
What mutual did was concluded that there wasn't any functional impairment from either a physical or a mental cognitive perspective. Now, lechner never filed a claim for his long term disability benefits. He only filed an appeal in federal court on the denial of the short term disability benefits. Now, lectner ultimately filed a lawsuit in federal court. It's Lechner versus Mutual of Omaha. It's 2025 West Law 69767, the Western District of Kentucky, March of 2025. Now, Lechner said to the court, look, I don't have to file a claim for long term disability benefits, but I want you to pay me those benefits. That's what I claimed in my lawsuit.
Nancy Cavey [00:09:58]:
And I'm going to argue that filing that long term disability claim, getting it denied, going through the appeals process, all of that would have been futile because mutual of omaha denied my short term disability claim. Now, the court disagreed and said, look, just because a short term disability claim is denied, it doesn't necessarily mean that the claim for long term disability benefits would be futile. You in fact, as I said.
Nancy Cavey [00:10:28]:
You'Ve got to look at the terms of the disability policy or plan. And amazingly, there are times when the definition of disability in the short term disability policy is different than the standard in the long term disability policy. And so the courts will often say, look, there's one standard of disability in the short term disability policy or plan, benefits were terminated. You should have exhausted your remedies by filing an appeal and then ultimately brought your lawsuit. But we're not going to consider that long term disability claim because the standard of disability was different and you never filed a claim. You never let the long term disability carrier, who by the way, might be different than the short term disability carrier or plan administrator make the decision about whether you were entitled to long term disability benefits. So it's apples to oranges. And you didn't let the orange team make a decision on your claim because you never filed a claim or you didn't exhaust your administrative remedies.
Nancy Cavey [00:11:32]:
So what the court did here was to grant summary judgment in favor of mutual of Omaha on both the short and long term disability claim. So in other words, he lost both claims. I think this case is instructive and I think there are 10 lessons that can be learned. Number one, obtain a copy of that short term disability policy or plan and get a copy of the actual claim file from the carrier of the plan. You want to start by reading the policy or plan cover to cover to understand why the benefits were denied or terminated. You want to thirdly, file an appeal of that short term disability claim by referencing what is in that short term disability file. You'd be stunned at what you will find or not find in the disability carrier's short term and long term file. So you want to go about attacking the reasons for the claim denial or benefit termination based on the terms of the policy of the plan and what was in the short term disability carrier or plan administrators file.
Nancy Cavey [00:12:40]:
That's the way you write a winning appeal. But you're not done there because you also want to obtain a copy of the long term disability policy or plan. And you want to understand several things. So number five, you want to understand whether that long term disability policy or plan requires that you exhaust your short term disability benefits to be eligible for long term disability benefits. Now here's my approach. Number six, regardless of whether it does or it doesn't, we always file a claim for long term disability benefits. Number seven, if that long term disability claim is accepted, then we're going to continue to proceed on the short term disability claim and if appropriate, file a lawsuit in federal court on that short term disability claim. Now, number eight, if that long term disability claim is denied, we we want to file the appropriate appeal.
Nancy Cavey [00:13:29]:
We want to exhaust our administrative remedies. We want to get a copy of the long term disability carrier or plans claim file. Want to analyze it, take it apart. We want to submit evidence and we want to exhaust our administrative remedies for both the short and long term disability case. Now, number nine, if that long term disability claim is accepted on appeal, we're going to continue to proceed on the short term disability claim and as I've said, file a lawsuit as appropriate. But here's number 10. If the long term disability claim is denied, you have both a denied claim for the short term disability claim and the long term disability claim. You've exhausted your administrative remedies.
Nancy Cavey [00:14:13]:
So what we're going to do then is we're going to file a lawsuit, one lawsuit, claiming both the payment of short and long term disability benefits, assuming of course, it's the same disability carrier or plan administrator if we have a different one in Other words, there's a let's say it was Mutual of Omaha for the short term disability and Unum for the long term. We're going to file two separate lawsuits in that instance because we have to file a claim or a lawsuit against each individual carrier. You can see that this is complicated, but if your short term disability claim is denied or benefits are terminated before your long term disability coverage is to begin, you need to stop and not try to handle this on your own. Because there's lots of policy terms that can be impacted. There are notice requirements, there are claim requirements, there's exhaustion of administrative remedies, all the kinds of things that need to be reviewed so that a winning strategy can be crafted to ultimately win the appeal on both the short and long term disability claims while meeting the exhaustion remedy requirements, but then to also set this all up for a potential lawsuit. You can see this is not for the faint of heart. Got it. Let's take a break.
Nancy Cavey [00:15:47]:
Foreign.
Nancy Cavey [00:15:52]:
Welcome back to Winning Isn't Easy. Physical Therapy Assistant Wins Reliance Standard Disability Claim After Termination of Benefits now that's great news, but how did we get there? I'm going to tell you the story of Rebecca Wonsang, a physical therapist assistant who had a broad based disc protrusion, mild to moderate spinal canal narrowing and and a moderate disc degeneration that caused, as you can imagine, neck and back pain. She's treated probably thousands of patients with these particular problems and she finds herself in a situation where she's got to apply for her disability benefits. Now, Reliance Standard approved the claim and paid benefits for 24 months. Unfortunately, this case gets more complicated as life does. She was involved in a motor vehicle accident and began struggling with dizziness and brain fog. And in addition to her spinal pain, her neurologist then reports that she's unable to work because of her symptoms of fatigue and poor mental stamina. So guess what? An in house Reliance nurse reviews the records and says, look, you know, I kind of agree that she can't do sustained activity on a frequent basis because of the dizziness, the blurred vision, the mental fogginess, the poor mental stamina, the her headaches and her neck pain.
Nancy Cavey [00:17:10]:
So based on this, Reliance continues to pay her benefits beyond the initial 24 months because she's unable to engage in any occupation. Now remember, it's about 24 months in every disability policy or plan where the definition of disability changes from an inability to do one's own occupation to an inability to do any occupation. But remember, you have the burden of proof and disability carriers Like Reliance Standard are going to get your updated medical records looking for a reason to deny or terminate benefits. And guess what? That's exactly what they did. So they concluded that the medical records and one of the treating physicians noted that while she had chronic neck pain for which she was getting medical care, the most recent exam showed improvement. And notwithstanding the limited range of cervical motion, her test results were negative. So they're going to say, okay, well she's got pain, but guess what? The exam is showing potential improvement and the test results are negative. Number two, the physician who evaluated her after the COVID diagnosis reported that while she claimed she had significant fatigue and difficulty with daily activities, guess what? Her physical exam results were normal, as one would potentially expect with complaints of fatigue.
Nancy Cavey [00:18:36]:
But the doctor said, look, there's full range of motion and when I did my mini mental status exam, there were no signs of cognitive issues and she didn't present with any evidence of fatigue. So the disability carrier seized on what her own doctors had to say. And number three, Woong Sang had authored and published a book. She maintained a blog, she maintained an active reading list. She performed occasional content editing for others. And Reliance said, look, these activities are incompatible with the cognitive deficits that you claim that you have and are also inconsistent with activities involving the use of your neck turning your head side to side. So guess what? They terminated her benefits. She appealed, and Reliance failed to decide this claim within the 45 day deadline under ERISA regulations.
Nancy Cavey [00:19:31]:
You've heard me talk about the concept of exhaustion of administrative remedies, and in this particular case, Wong Sung said, look, you didn't respond timely to my appeal and if I don't get a decision in 10 days, I'm going to file a lawsuit. And she did, because.
Nancy Cavey [00:19:53]:
Reliance did not timely, within 45 days of the filing of the appeal, make a decision. So she filed suit on January 3, 2023, and Reliance issued a decision upholding the termination on March 29, 2023. Now, ultimately, this case was heard by the District Court of Appeal who applied what's called the de novo standard of review because Reliance had forfeited its discretionary authority by failing to comply with ERISA procedural requirements. If I had a choice, I want this de novo standard of review. I want the judge to be able to substitute their own judgment for that of the disability carrier under this arbitrary and capricious standard of review. This case was hard fought and it ended up in the Fourth Circuit of Appeals. And the court noted that every physician who considered her ability to work included she was incapable of working, and that was supported by the multiple MRIs, notwithstanding the liar for hire peer review interpretation of the diagnostic studies. Now, the court said that while Reliance wasn't obligated to credit the opinions of her treating physicians over other evidence, in other words, no treating physician rule, it was at a minimum required to address the conflicting evidence and engage in a deliberate, principled reasoning process, something we rarely see.
Nancy Cavey [00:21:13]:
The court reviewed the denial letter and the medical evidence and noted that Reliance had used its old trick, it cherry picked the medical records to find things that supported or explained, if you will, why they reached the decision to terminate her benefits. Now the court said, look, it doesn't prove much that she can occasionally read or write since it was her claim that it was her spinal injuries that prevented her from consistently engaging in sustained activities. Whether she could do that on an intermittent period of time from the comfort of her home was irrelevant. Why? Well, to perform a job, she would be required to do much more than perform a small subset of her duties for a relatively short period of time. So you can hear in my voice that this was a great win. And what happened in this case was that her attorney was monitoring the ERISA deadlines and because Reliance Standard didn't timely issue a response, the 45 day time bound response to that appeal, they were able to convert what would have been a very unfavorable standard of review, the arbitrary and capricious standard of review, to the de novo standard of review. So these things really matter in an ERISA disability claim. And again, reasons why you you want to have a disability attorney because that attorney handles ERISA cases and was familiar with the rules and regulations and turned those rules and regulations on their head, changing the burden of proof.
Nancy Cavey [00:22:45]:
Got it. Let's take a break.
Speaker B [00:22:50]:
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Nancy Cavey [00:23:31]:
Welcome back to Winning isn't Easy moving the goal line in games that disability carriers like MetLife play with the date of disability.
Nancy Cavey [00:23:40]:
In my many years of handling these claims, I think I have seen practically every game the disability carriers play. But one of them that just drives me nuts is is where the disability carrier will.
Nancy Cavey [00:23:55]:
Play games with the date of disability. And this is often common when a policyholder or plan beneficiary is working while they're disabled and then is terminated. This is a dangerous situation. And I always tell people, look, if you are working while you're disabled, you're going to start reducing your hours or you think you're going to get terminated, it's time for you to call an attorney, like pronto. Because things that happen can destroy your claim. And what is going to happen in cases like this is that the disability carrier plan will say that the policyholder plan beneficiary only became disabled after they were terminated and they no longer had disability coverage. That's very convenient, isn't it? Or they will say, look, under the terms of this disability policy, if you were working and you're claiming you're disabled, you have to have a reduction in your wages before you are terminated, as a matter of proof. And if you don't have that reduction, we don't really care if you were working while you were disabled because your pay doesn't reflect that.
Nancy Cavey [00:25:02]:
That's going to come in the terms of the disability policy or plan. Again, a convenient defense. Now, disability carriers or plans don't always get away with that game. And I'm going to tell you the story of Mr. Dar Messina, who was an electrical engineer who had both kidney disease and a genetic muscular dystrophy. Despite his best efforts, he worked while he was disabled until his employer terminated him on February 4, 2022. So guess what? MetLife looked at the claim and said, look, your disability began on February 7, 2022, three days after you were terminated. And guess what? You weren't an active employee.
Nancy Cavey [00:25:42]:
You didn't have coverage as of February 7th. So too bad, so sad. We're going to deny your claim. Ultimately, this case went in front of a federal judge in California, and the court noted that there isn't always a bright line rule that the employee has to claim disability benefits before being terminated. It was clear, based on the court's review of the medical evidence, that he was disabled and he was pushing himself beyond the limits by the time he was laid off or terminated by his employer. But I will tell you, that was probably a gift that doesn't always happen. In fact, I think it rarely happens. I think the better course of action is to be proactive.
Nancy Cavey [00:26:23]:
So what do I suggest that you do? One, get a copy of your disability insurance policy or plan and read it cover to cover so you understand the definition of disability and what you have to Prove and whether if you're working while you're disabled, whether you can reduce your hours. And that's a problem because many times if you reduce your hours under 30, you lose the coverage. You'll learn whether or not this policy or plan requires a reduction in your wages as part of the definition of disability. And so you'll learn what it is you have to prove. And more importantly, you'll be able to develop a strategy so that the timing works. The next thing you have to do is get a copy of your medical records and read them cover to cover to understand what your doctor has documented about your functional, physical, cognitive or psychological restrictions and limitations. And you've got to think about how that impacts your ability to do your occupation. Again, another reason to read that policy or plan because you have to understand the the definition of occupation.
Nancy Cavey [00:27:28]:
What are the material and substantial duties of your occupation? Is it how this is performed in the national economy, the local economy, pursuant to the Dictionary of Occupational Titles? Or is the definition being unable to do one or more of the important duties, whatever that may mean in the terms of the policy or the plan? Again, as I've said, you don't want to reduce your hours or do anything that can really give them a policy or plan defense argument on the basis that you just didn't satisfy the requirements based on the plain reading of the language of the policy of the plan. Clearly you want to ask your doctor if they would support your disability claim. Now, I do a lot of this work, particularly with doctors and lawyers, and we're creating a path and plan to follow to file a claim for the disability benefits on their schedule. They may not want to reduce their hours.
Nancy Cavey [00:28:25]:
Or they may want to reduce their hours to 30 or more so that they can start claiming residual disability benefits, if in fact that's a benefit under the policy. We also need to deal with other benefits. You might want to be able to move your health coverage to your spouse's coverage. You may want to arrange life insurance alternatives because once you are terminated, you're going to lose your employer provided benefits, group health, life insurance, pension benefits. So there's a coordination here. Sometimes though, we have to move quickly because the employee feels as if they're going to get terminated. So we want to get that note from the doctor taking them out of work. We want to make sure that we've complied with the policy requirements.
Nancy Cavey [00:29:10]:
If we need to have have any lost wages, we want to get our house in order so that again, we're driving the claim and the timing of the claim, not the disability carrier. You can hear in my voice. The failing to plan can result in a disaster because some courts would not have accepted this working while disabled argument, particularly if the plan required proof of loss wages while working disabled. This is a situation where clearly it's complex and carriers are going to test and look for every loophole from short term denials to long term disability appeals to manipulating the onset date. And the key here is to understand the policy of the plan, understand what the potential strategy is going to be on the part of the disability carrier plan in denying the claim, and understanding what documentation you need to submit for a winning claim. It's all about strategy, expert legal guidance, and with careful planning and persistence, these difficult types of claims can be won. So thank you for tuning in. Today's episode of Winning Isn't Easy.
Nancy Cavey [00:30:17]:
If you've liked this episode you found it helpful, take a moment to like our page, leave a review and share it with your family and friends. And of course, subscribe to our podcast. That way, you're going to get notified when a new episode drops. Join us next week for another insightful episode of Winning Isn't Easy. Thanks for listening.