Long-Term Disability Claims Amid COVID-19 Pandemic
Mason Waring: Hi, my name is Mason Waring and I’m an Attorney and Partner at Chisholm, Chisholm and Kilpatrick. I’m joined here today with my colleague Leah Small who’s with me, practices Insurance litigation here. Majority of our practice on handling ERISA and Non-ERISA insurance claims. Many of those are long term disability claims where we represent individuals that have long-term disability insurance coverage through their employer or purchased a policy themselves, in filing claims appeals and handling court litigation of those claims. We’re in challenging times here with the Covid-19 pandemic and like much everything else, the landscape for long term disability claims has changed significantly. We’ve seen new claims, new types of claims related to illness and injury caused by Covid-19 and we’ve had to change the way that were handling claims, appeals and court litigation of these claims to adjust to social distancing and the fact that much of the country’s lockdown now. So today we wanted to spend some time talking to you provide you some information that may help you with your claims and let you know that we’re up. We are fully functional; our firm is fully functioning. Mainly working remote but cases for clients and so we’re here and we’ll provide our contact information later. If you want to reach out to see if we can help you with your claim. But through this video, we hope to give you some helpful information that may help you help yourself as well. So let’s begin. Leah what are some of the claims that we’re seeing related specifically to Covid-19.
Leah Small: So a big group of a kind of new type of claim we’re seeing with this pandemic is, there are people who are at high risk for serious effects if they were to be infected with Covid-19. For example, there are some people who are immunocompromised either because they’re undergoing treatment to something like cancer or they recently completed treatments. Some people have pre-existing serious health conditions like asthma or heart conditions and with these conditions, they’re at a high risk for, as I said severe effects if they were to become infected. Often times people would still be able to continue doing their jobs if it weren’t for this pandemic and now it’s become unsafe for them to be in public and risking exposure. We’re also seeing a lot now, especially with medical personnel like doctors or nurses who are under an intense amount of stress and high demands, they’re developing severe mental health conditions in response to the Covid-19 pandemic. And because of those conditions, they become unable to work.
Mason: And so just picking up on the mental health conditions, this could be a psychiatric injury caused by dealing with the stress or an aggravation of an existing condition caused by the stress and the difficult circumstances. Is that correct? What are the types of things… What are the types of challenges that we’re seeing people face with respect to Covid-19 related long-term disability claims.
Leah: So there are a couple things, one with the people who may, as we said are still able to do their job but have another serious health condition that places them at risk. Potential problem with the disability claim is that as I said, they can still do their job. It’s just they have a condition that makes exposure risky for them. So in those cases they really need to look at their disability policies to understand what kind of coverage they have available to them. For example, there are some policies that exclude coverage or disability benefits for pre-existing conditions. And those are conditions that you had prior to your coverage going to affect that you treated for. And if you treated for it recently and your coverage just won’t effect, you might not be able to get benefits for that condition. Even if you aren’t able to do your job. Similarly, some policies will exclude risk to help all together as a base for disability. So if you’re otherwise capable of doing your job, it’s just risky for you to do so, you might not be covered. Again people have to read their disability policies to understand what kind of limitations or exclusions their policy might have for people who either developed a psychiatric illness or exacerbate a psychiatric illness in response to working during this. Some policies will exclude work-related injuries or illnesses from benefits. And if you only develop this because of your job and working during this pandemic, you might not be until the benefits either. So it’s really important to read your disability policy to really understand what kind of coverage you have available to you.
Mason: So I guess that to digest what the takeaways are; if someone is medically unable to work due to Covid-19, they need to read the policies really carefully. And so in medically enable could be, you otherwise are okay, fine to work but because of the risk of exposure to Covid-19, you cannot work and they may have a claim they can make but they need to read the policies really carefully to understand what coverage they have and what restrictions, limitations might apply. Is that a fair? Okay. And then one thing I guess, one thing we tell people is if you’re not sure get a claim in any way. And so don’t waste time. If you’re not sure and you can reach out to a lawyer. That’s great. If you’re trying to do this alone, don’t delay because there can be deadlines for filing claims and limited time period. So if you’re not in a position where you’re going to engage an attorney and you’re handling this yourselves, don’t delay because that can cause serious claim problems as well. On the topic of timing Leah, there’s the short-term disability benefits and the long term disability benefits. Not everyone has short-term disability benefits. For example in Rhode Island, many employers don’t provide short-term disability benefits but there’s TDI, it’s a government short-term disability program that can be available. But some employers who provide short-term disability and long-term disability insurance coverage and what are some of the time difference is or how do those work together Leah?
Leah: So again, those depend on the policy, so read your policy. Typically, short-term disability will be for a cover a period of 90 to 180 days of benefits. And then, once the short-term disability runs out, long term disability kicks in. If you don’t have short-term disability, then typically your long-term disability policy will say there is a waiting period which again is often 90 to 180 days before benefits will start. Supposed to cover the time period before long-term kicks in.
Mason: So, you know, hopefully this pandemic comes under control soon. But it also may have certainly may have some legs and it’s looking like it’s going to. So if you had like an acute Covid-19 related illness, let’s say you actually were infected and we’re sick that could be a short-term disability situation where it’s a shorter period of time where I work due to the illness, but if you’re one of those individuals that you know that are immunocompromised and not able to expose yourself particularly for a medical provider, and you’re not able to expose yourself to Covid-19, that could be a short-term disability claim followed by a long term disability claim for an extended period of benefits. So those are things to consider. It just underscores why it’s important to understand the benefits that you have and future policies. If you’re employed and you’re not sure what coverage your employer provides, what you purchased through your employer, reach out to your HR and ask for the policies and plan governing documents from the benefits that you have so you can have all the information, so you can make some informed decisions. And of course if you purchase policies yourself, so pull them out and read them and understand those. So in addition to Covid-19 or LTD, long term disability claims resulting from an illness or injury caused by Covid-19, we made changes in the way that we’re handling the initial claims, appeals and litigation of long-term disability claims. Leah, could you talk a little bit more about that and some things we’re seeing?
Leah: Sure. So like you said, this pandemic is affecting everything. So it’s affecting the way we’re handling claims, appeals and court litigation. Again, I know we may sound like a broken record but reading the policy, your disability policy is always a good place to start because that’ll explain what your obligations are. When filing a claim, appealing a denial or anything of that nature. So one big issue we’re seeing right now is for filing a claim or maintaining a claim that you often need to be in appropriate care and treatment for your disability. That’s often a requirement under many of these disability policies. And right now, a lot of doctors’ offices are closed altogether or they’re only seeing emergency patients. And so it’s becoming a lot harder for claimants to get in to see their doctors, which is one important, not just their overall health, but again for their long-term disability claim. And part that also is to establish a claim, you need to have seen a doctor for your disabling condition. And so again, getting in for treatment is going to be really important. If you can’t get in to see a doctor a lot of doctors are offering telemedicine, so either video appointments or telephone appointments. So if that’s an option to you, that’s something the claimant should take advantage of. But you want to be careful. These are often might be seen a little more casual than in office appointment. But you want to make sure your doctor is still documenting it like it were a regular visit. You want to make sure…
Mason: Just to pick up on that. What kinds of things should doctors be documenting?
Leah: So I’ll make sure they’re documenting all your symptoms that you’re experiencing. And how they physically limit you, perhaps mentally limit you, if that’s the nature of your condition. If they can document your prior exam findings. They can’t physically examine you now, but if they can document prior exam findings and if you’re reporting that nothing’s changed since then hopefully they can document that. Usually make sure that you’re reporting everything and that the doctor is recording them accordingly to make sure that’ll be documented in a medical note as if it were a regular in-office appointment. And it’s so it’s possible that insurance companies when you’re filing a disability claim, might kind of relax this need to be in treatment requirement, but you shouldn’t assume that’s going to be the case and you should try to continue treatment for your disabling condition as much as you can. Another concern is for filing a claim or continuing your claim, you often need doctors to complete forms for you. Often, these are called attending physician’s statements, but they can vary a name from insurance company to insurance company. But they typically ask questions about the conditions, your symptoms, what tests or exams you had done, how your conditions or symptom limit you and so forth. We often recommend the claimants make an appointment with their doctor to complete these forms because that helps ensure that the doctor again, is reporting everything and is doing so accurately.
Mason: And it gives them a chance to see the patient in person, which is it’s really important.
Mason: Really be helpful in assessing the person’s condition.
Leah: Right. And again, right now, that might not be possible. So again, we’re recommending, you know, telemedicine appointments via phone or video. Where if possible, to go through those forms with their doctors. And if, they can do that again, make sure your doctor is recording everything and doing so accurately and also be careful of the questions the insurance company is asking. They don’t always get at what your disability is on those forms. And so you want to make sure your doctor fully addresses your disability of why you’re unable to work and should necessary feel limited just to the specific questions the insurance companies’ asking.
Mason: And so fundamentally, what we’re saying that we’re in extraordinary times right now. You can’t go back, go about your normal business as usual. It’s hard. You don’t have the same contact with your doctor’s but you still have the same policy requirements. And so your long term disability insurer is going to ask you about the same evidence of disability. And in the short term, I think we’ve seen some insurance be more lenient. I mean they’ve been sorting out how to continue doing business while social distancing as well. And so we’ve seen some insurers make advanced months benefit payments, put off requests for exams and information requests a little bit, but they’re going to get back to business and start holding your feet to the fire. So if you’re on claim, you can expect that they’ll start back up with the reviews once they get their feet under them and figure out how to do business during the lockdown or as restrictions lift. So it’s important that you’re doing what you reasonably can do to comply with the information requests that you’re given. And comply with what your long-term disability policy says you must do.
Leah: Absolutely. And if you are having difficulty, make sure you’re communicating that and documenting that with the insurance company. Don’t just ignore it or let it go and say they’ll understand with everything that’s going on. Communicate that document that because if you miss deadlines, whether it’s to do an update or in order to submit your claim you could potentially lose out on your benefits. So just make sure you’re communicating with them.
Mason: That’s a great point. Leah. And just to illustrate the point, if you received a request, let’s say you’re on claim and you file… let’s say you file the claim, your on claim and the insurance company is requesting that you have an attending physician’s statement, that’s a form that your doctor, your treating doctor, the doctor that’s saying you’re disabled, needs to fill out. If they’re saying that it must be signed, let’s say you had a telemedicine appointment with your physician and the doctor is, yes, you’re disabled but I can’t get you an in-ink signature. Well, will the insurance company accepts, you know an electronic signature where it’s like where the doctor types their name in and maybe sends an email or something like that secure email. Is there a creative way to get what they’re asking for? I mean, if you’re not able to see your doctor, let’s say normally you’re working with a specialist and a specialist is closed their office for a month. In response to this, you know write to the insurance companies find have a phone, call, but you want to put something in writing to them. Send them an email. If you have an email and say look I got your request. I know you’re looking for this form to be completed, Dr. so and so’s office is closed. My condition is not improved, I’m the same. And as soon as I can get with that doctor and communicate with them and be seen, I will get you what you asked for. But in the meantime, please continue my benefits. It seems like an obvious thing to do, but it’s really important to put that in writing and make a record as to what barriers you may be facing to comply with this information request. You don’t want, the situation is tough enough with Covid-19 and you don’t want it to be used against you, with your claim.
Leah: Right. And similar to the doctor’s forms, we’re also encountering some issues getting medical records. Again, because many doctors’ offices are closed and oftentimes when you’re…
Mason: They’re closed and they’re busy dealing with really hard times and so just like us, it’s totally understandable. They’re working with skeleton crews, they’re seeing sick patients. And so they’re trying to handle their fundamental mission which is caring for people and unfortunately, they don’t necessarily have the bandwidth right now to deal with the information requests. But we’ve been, Leah will explain how we’re working with that.
Leah: Right. And so again, when you’re filing initial claim or an update, often you have to submit medical records in addition to the forms, you have to submit medical records documenting your treatment and again that will document your exams and your symptoms and stuff like that. Oftentimes, the insurance company will request them on your behalf, but ultimately it’s the claimants responsibility to submit them so you can’t assume the insurance company is going to do that. But again, right now, we’re having a little more trouble getting records or if we can get them, it’s taking much longer to do so. Again, as we said, they’re busy, they are open, they’re very busy or they might be closed altogether and just not replying to requests. So again, if you are having trouble, communicate that with the insurance company, say I’m working on it, but I’m having difficulty getting them. I’ll get them to you as soon as possible. You can also consider submitting other types of medical evidence if you can’t get your medical records. One thing you could do is what we call a symptom log which documents what symptoms you experience day-to-day, how long you experience them for in each day, what you did to treat them, how they limited you and just keep a log each day documenting what your symptoms are. So you can demonstrate that timeline, how your disability affects you on a day-to-day basis. Another thing that we use a lot is if you have family, friends or coworkers who have seen how your condition has impacted you, you can get written statements from them explaining what they have observed and submit those as well. Additionally, if you have outwardly visible symptoms, you can take photos or take a video of it, anything that helps you document your disability to the insurance company. So don’t feel limited just to the forms or medical records. If you can get and submit something else, do it.
Mason: And that, yes, that’s great advice. Particularly where it’s so hard to get medical records right now. So that’s good advice. We’ve, I guess I will say too, we can help, right? And we are another experienced, long-term disability attorneys can help. I mean we have, we’re using technology, secure technology to transmit information with physicians’ offices, with the insurance companies. And so we’re up and we’re running and we’re handling these claims for our clients effectively. So if you’re in a position where this is too much to deal with right now, you can reach out to us. Our number is 401-331-6300. It doesn’t cost anything to talk to us to see if we can help and we can help great. But if not, hopefully this video gives you some useful tips. We’ve talked about some Covid-19 related illness and injury, long term disability claims. We’ve talked about some tips if you’re making your claim. And if you need to respond to information requests for insurance companies, if you are unclaimed Leah, can you talk a little bit about appeals?
Leah: Sure. So if your claim is denied or your benefits are terminated, if you’re already on claim, you do have the right to appeal that decision. However, there are specific deadlines associated with appealing. And with everything that’s going on, those are lines that haven’t changed. So if you are denied or terminated and you need to appeal, you should not delay. The appeal is a critical stage for many of these disability claims. Oftentimes, this could be the last opportunity for you to get evidence of your disability into the record before litigation in court. So it’s a really important time to make sure all medical evidence is submitted to the insurance company. Oftentimes, this is a good time to get a lawyer like CCK-involved, because of the importance of the appeal stage.
Mason: Yes. Others underscore the appeal deadline. I mean, they’re what we call jurisdictional deadlines. And more often than not if you don’t file your appeal to the insurance company on time, you lose your rights to your benefits. You may not be able to pursue claims in court. Depends on the way the policies worded. But the consequences of missing a deadline are to be catastrophic and there are instances where you can get extensions. You can reach out to the insurance company and ask them for an extensions, but you don’t always get them and when you do get them you want to get make sure that their the extensions are confirmed in writing. But I wouldn’t count on getting them. And if you didn’t get an extension and you missed your deadline, you’re not going to have the excuse that hey, you know, Covid-19, things were shut down and I wouldn’t count on that being an excuse for delay. You’re really going to meet your deadlines doing that. Okay, Leah, I guess let’s do some bullet point takeaways for the viewers.
Leah: Sure. So as we discussed if you become unable to work due to Covid-19, whether it’s you’re at high risk, if you were to get it because of a pre-existing health condition or you’ve developed something maybe like a psychiatric illness in response to Covid-19 or you have had a worsening of your psychiatric illness. You may be able to file a disability claim. But you need to read your policy in order to understand what kind of coverage you have available to you. If in doubt, file the claim. And you may also either become unable to work or already have disability claim unrelated to Covid-19, but you’re still going to be impacted by this make sure if that’s the case, either if you need to file a claim or you need to continue your claim make sure you’re in communication with the insurance company and again document in writing, phone calls are great. Document your phone calls in writing. If possible use telemedicine or video appointment with your doctor in order to continue treatment, which is great for your health and again will help your disability claim and if someone is struggling with their claim, they should just file the best evidence they can. Medical records and forms from doctors are obviously the ideal but symptom logs, statements from family or friends or photos or videos are also good if you can’t get your medical records or doctors to fill out forms. And if your claim is denied or the insurance company is giving you trouble about your inability to submit medical records or form from your doctor, you might want to consider getting a long-term disability lawyer involved at that point. You have the right to appeal if their claim is denied or benefits are terminated, but there is a limited time to do so, so they shouldn’t delay.
Mason: Thanks Leah. And you know, we are long-term disability lawyers here. It costs nothing to talk to us, to see if we can help you. We represent people sometimes on a contingency basis, sometimes on an hourly basis. But if it’s a contingency basis, you don’t pay us anything out of pocket. We’re in so, if you’re having difficulty with your long-term disability claim, if you have questions, you think you want help I’d encourage you to reach out. If you’re handling this yourself, I hope that some of these tips helped you, or are going to help you out here. I wish you all to stay safe and take care of each other. Thanks very much.
Leah: Thank you.
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