Medicare Options For the Disability Recipient

One of the greatest benefits of receiving Social Security Disability is that recipients are eligible to draw Medicare benefits early. This helps them maintain medical care and treatment. Our office thinks it’s important to help our clients through this confusing process. Our in-house licensed health insurance agent works with our clients to clearly explain what to expect and options available to them. Medicare includes Part A (hospital insurance) and Part B (doctor coverage). However, it is not full coverage nor does it include prescription drug coverage.

To supplement the charges that Medicare doesn’t pay, you will need to choose between three options:

• Enroll in a Part D prescription drug plan. This plan will have a monthly premium but will provide coverage for prescription drugs. It’s important to confirm that the plan covers your specific medications! The benefit of this option is that you can see any doctor without having to worry about networks. The downside is that this does not offer any medical coverage and you are still responsible for what Medicare doesn’t cover (20% of Part B medical charges).

• Enroll in a Medicare Advantage plan. These plans typically have very low monthly premiums that range from $0-$100 but many include prescription drug, dental, vision, and hearing coverage as well as many other extras. These plans allow you to pay smaller copays for each medical service instead of the higher Medicare coinsurance. The downside is that they are offered through private insurance carriers and are HMOs or PPOs, meaning it could be difficult to stay with your treating physicians because of network issues.

• Enroll in a Medigap policy. These plans work with Medicare Part A and B to cover what Medicare doesn’t, but do not require you to stay in a network. This may be a good option for someone who has frequent medical appointments or needs to see specific doctors. The monthly premiums are higher on these plans and depend on the state you live in. Some states do not offer Medigap to individuals under 65. Pennsylvania does offer these plans and the premiums are not any higher than they are for individuals at retirement age. This option does not include prescription drug coverage or dental, vision or hearing. Premiums for those benefits would be additional.

There are plenty of Medicare agents out there who know which option to push before they even speak to you. Medicare enrollment is not a one-size-fits-all approach. Everyone has unique healthcare needs and should explore all of these options to see which makes the most sense to them. We are happy to help our clients navigate Medicare enrollment and supplemental options so that they get the best healthcare coverage for them.

To speak with someone about your Medicare options, please complete this short form:

LTD Application Tip: Do Not Use Regular Mail!

It costs more money in the short run, but please consider submitting any information to your LTD company, whether it is the application, medical evidence, or other evidence, by some sort of certified mail or (if you can afford it) overnight mail that will provide you with documentation that the information you sent was received. As we discuss in one of the recent articles we filed on our website, LTD companies have been known to “lose” or “forget about” information that claimants send to them.

For more great LTD application tips, download our free E-Book below:

The Adversarial Nature of LTD Claims; Insurance Companies Lookout for Themselves!

Claims for LTD benefits are adversarial cases, where the employer and/or insurance company has claims adjusters, doctors, vocational experts and other experts who provide evidence against the worker’s interest. So, even though the “HR person” at the company may be, in fact, a very nice person, this should not lull the worker into forgetting that, in the end, the employer/insurance company will always look out for itself first.

The process for applying for LTD benefits requires strict adherence to the time frames established in the Department of Labor’s regulations, and all evidence and all medical and vocational opinions should be submitted with the application, if possible. If the LTD claim is denied, the claimant has 180 days to file an appeal; this may seem like a long time, but the last chance to submit evidence is when this appeal is filed. If the claim is again denied after the appeal, the worker’s last chance is an appeal to a federal district court.

Because of the strict procedural deadlines, the need to submit evidence in a timely fashion, and the need to develop a persuasive narrative establishing that the worker is “disabled” based on the law and the evidence, it takes very careful, long term, strategic planning to anticipate the legal arguments and medical opinions that will be brought to bear against the worker. In other words, a worker who thinks they may be entitled to LTD benefits, in our opinion, needs to be guided from the very beginning by someone knowledgeable and dedicated to solving the difficulties of the disabled worker.

What You Need to Know About the Long Term Disability Application Process

You should expect the application process to take between four to six weeks. In order to apply, you will need to submit the application, documentation of your income and a signed release that authorizes your insurance company to obtain copies of your medical records. After you submit the documents to your insurance company, you should be contacted to schedule a phone interview and a paramedical examination.

On the date of your exam, a technician will complete a home visit, take your blood and urine samples and measure your vital signs, height and weight. The results will be sent to the insurance company. Your phone interview will be conducted at the scheduled time. You should be prepared for the questions by getting copies of what to expect from your insurance broker. You should make certain that you have your doctor’s contact information handy in case you need it during the phone interview. The interviewer will ask you questions about your health condition and your lifestyle.

The next step will either be the submission of your information to underwriting for final approval, or the company may instead request that you submit to a functional capacity evaluation or an independent medical examination. It is a good idea to talk to your long-term disability lawyer before attending either an FCE or an IME – we have helped countless clients through this process, and would be honored to do the same for you. Companies often use these types of assessments to provide them with reasons to deny your claim. If your case is sent to underwriting for approval, you should expect to be notified of its approval within two to four weeks. If you are denied, you will receive a denial letter in the mail.

Read more about filing for Long Term disability HERE

Do’s and Don’ts of Long Term Disability Appeals

It is important for you to understand what you should and should not do for your long term disability denial appeal. When you receive your denial letter, you should request a copy of your policy and of your file from the company. The file should contain all of the medical records that the company reviewed in making its decision. It should also include surveillance video, outside doctors’ reports, internal notes and other information that the company relied on to deny your claim.

If you have been approved for social security disability or workers’ compensation, submit evidence that you are receiving benefits as evidence of your disability. You should also supplement your record and submit written reports from your treating doctor and your former employer if you are able to do so. Getting written statements from others who can state how your disability affects your daily life can also be helpful. Finally, make certain to get help from an experienced long term disability attorney.

There are several things that you should avoid doing during your appeals process. You should never send in your appeal without reviewing your policy and your file first. Make certain that the job description accurately portrays the essential tasks of your job, and don’t rely on a description that is generic. Limit communication with your insurance company via telephone. Instead, insist that everything is in writing. Don’t rely on the regular mail to submit documents and send them via certified, return-receipt mail. Don’t miss any of your deadlines because you may be permanently barred from pursuing your claim further if you do. If you have mental or physical disabilities, it is likely that you may need to get an experienced attorney’s help and should avoid representing yourself on your appeal.

While receiving an appeal of your long term disability claim can be disheartening, you may be successful on appeal. With the help of an experienced long term disability attorney like our team at Osterhout Berger Disability Law, it is possible that you may win approval during the internal appeals process without needing to file a lawsuit. If your claim is ultimately denied, then you will have the ability to file a civil complaint in federal court to try to recover the benefits you should rightfully be awarded.

Learn more about Long Term disability benefits HERE

We Write the Appeals Council Briefs; You Get the Remands!

Sometimes it can seem like preparing a Brief for the Appeals Council is an enormous waste of time and effort, since an overwhelming percentage are routinely denied.  But that’s not always the case.  In the last 2 months our referral sources have notified us of 4 remands (two of which are pending and two of which resulted in fully favorable decision at the remand hearing) as well as one case which was actually reversed by the Appeals Council and paid back to the alleged onset date of 2015.

Our Appeals Council brief writing service is available to our referral sources at no cost.  Our experienced staff reviews the ALJ denial, identifies errors of law, and provides you with a succinct, concise brief that you can file with the Appeals Council.  Our concept of brief writing is simple – make it short, to the point, and provide citations to specific errors of law.  In our experience, the ability to quickly identify issues without wading through mounds of extraneous documents is well appreciated by the staff at the Appeals Council.

Applying for LTD? Make Sure the Insurance Company Has the Relevant Evidence!

LTD claims involve many rules that are different from a typical insurance or contract dispute. One of the big differences is that the LTD company must be provided with all of the evidence in support of your claim before it issues its final decision. Otherwise, information not provided will not be evaluated if you later have to file a lawsuit against the LTD company. The application form is often very short, so you must not hesitate to attach additional pages to the application if necessary to fully explain all your medical conditions, your medical history (including all doctors you have seen, all procedures and testing that have been performed) and to describe the full effect of all your medical conditions (including all symptoms related to all medical conditions, as well as lingering effects of surgeries or other procedures, and side effects from medications or other treatments you are receiving).

In other words, it is much less of a problem if you tell the LTD company too much than if you leave out critical information. If you leave out something important, for instance, the LTD company will frequently argue later either that they are not obligated to consider it, or that the fact that you left it out means that it was/is not really a problem in the first place. Either way, of course, this can endanger your case.

What Does Disability Mean According to the Social Security Administration?

Obviously, the Social Security Act, the Regulations, the voluminous policy statements made by Social Security, federal court cases, etc., are far too extensive to completely review in a short article, but it is possible to give some useful information about this question without referring a claimant to law books and the regulations.

If you are under 50 years of age, you must show that you cannot perform any type of work that exists in the national economy to qualify for benefits. When people describe their disability to us, they talk about it by stating they are unable to do the type of work that they used to do, cannot find work they would rather do, or that there are no jobs available where they live. While these are certainly reasonable things to think about during a job search, none of them have any relevance whatsoever to how a Social Security Disability case is decided for a person who is less than 50 years old. This is a difficult standard to meet, but not impossible. This type of case usually requires careful preparation and presentation to be successful, and we recommend that such a person work with an attorney on the case as soon as possible.

Social Security defines “work” as a full-time activity. Therefore, even if there is some type of work a person could do part-time or on a sporadic basis, that person can still claim that he or she is disabled. Also, Social Security Disability law acknowledges that employers expect their employees to show up for work on a regular basis, and to be productive while they are at work at least 90% of the time. So, for instance, if a person would be likely to miss work on a regular basis because of a provable medical condition, then this would present a strong claim for disability. Also, if a person is usually able to make it to work, but cannot stay focused for six to eight hour periods, or needs frequent rest breaks during the day in excess of the typical morning and afternoon break period, that person would also have a strong claim for disability.

Read more about definition of disability for people over 50 HERE.

Disability Benefits for Anxiety

When applying for Social Security disability benefits for anxiety, there are some things that people with anxiety disorders should do to ensure a successful claim.

In order to qualify for SSA benefits, a person must be able to show that they have been unable to work for at least 12 months due to an anxiety disorder. For instance, a person might be unable to work because they become anxious to the point of fainting when in public.

There’s also some medical evidence that a person with an anxiety disorder should be prepared to gather when applying for benefits with the Social Security Administration. First of all, an applicant needs doctor’s notes that show that they’ve been consistently complaining of difficulties with anxiety and any treatments that have been prescribed.

People who want to qualify for Social Security Disability Insurance need to show records from their doctor that they have been diagnosed with an anxiety disorder. Within the documents, there must also be records of at least three of the following symptoms: concentration difficulties, restlessness, tense muscles, irritability, sleep disturbances, or general tiredness.

People who meet at least three of the above criteria must also demonstrate that they have severe problems in at least one or marked problems in at least two of the following areas while at work: difficulties concentrating enough to finish tasks, difficulties socially interacting in appropriate ways, difficulties remembering and learning new things, or difficulties adapting to new situations.

If a person doesn’t meet the above criteria, the SSA will administer a Residual Functional Capacity test to determine which tasks the person can and cannot do. For instance, there might be time limits on certain tasks, depending on the triggers for panic attacks.

How We Can Help

There are several ways in which the team at Osterhout Berger Disability Law can help you receive the benefit you deserve. We help individuals who need to…

• Apply for Social Security Benefits and want to ensure everything is done right the first time
• Appeal an existing denial of Social Security Disability Benefits
• Appeal an existing denial of Long Term Disability (LTD) Benefits

If you are facing one of these situations due to Anxiety, please do not hesitate in reaching out. Our team of experienced attorneys is here to help, and your consultation is free.