Disability Claims FAQs

We provide comprehensive assistance to employees who are participants in their employer’s disability plan and independent professionals.

While your insurer may consider your doctor’s opinion, they are not bound to it. The insurer in all likelihood will submit your records to an “independent” medical review or examination.

In short, yes. You are required to cooperate with the insurer’s efforts to access your claim. It may be wise for you to bring a friend or family member to such an examination and note the process and interaction with the doctor.

The answer to this question will depend on the policy and the precise facts of each case. Most people want to continue to work, so they make adjustments to or are accommodated by their employer to continue working. At some time, however, the accommodation is no longer enough. Generally, it is not recommended that you quit work or allow yourself to be terminated before filing for benefits as this may give the insurer a defense that your disability arose outside of your term of coverage. On the other hand, if you are working, even with an accommodation, you then give the insurer an argument that you are not disabled. Ideally, you would be on paid leave, FMLA leave or perhaps a medical leave of absence of some kind when filing for benefits.

It depends on your policy and the difficulty of your case. In theory an insurer has up to 105 days to grant or deny benefits. You then have 180 days to submit an internal appeal. The insurer then has up to 120 days to make decision on the appeal. This is over a year even before you enter the litigation phase of the matter. If a case is litigated this could add years to the matter.

The internal appeal process must be exhausted and exhausted timely. The policies are contracts and the law is well settled that parties may contract for such internal appeals before allowing lawsuit. If you fail to appeal, with some small exception, you will lose your right to the claim.

This depends on whether the policy coordinates with other benefits. They usually do. What this means is that the policy deducts offsets from your monthly payment and amount(s) that you are collecting from these and some other sources of income. A majority of policies now require in fact that you do apply for social security disability benefits as a condition of coverage.

There are a number of options to pay for our services – including hourly, contingent and/or a blend of each. Our goal is to set a fair fee for each case that represents the amount of work we must accomplish and still allows you to collect the lion’s share of benefits. Whether attorney’s fees are available from the opposing party depends on the facts and circumstances of the case.