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LTD Benefits: What You Need To Know

 

Erik Berger, OBL Partner and Long Term Disability Specialist, recently wrote an article for The National Association of Disability:

“According to a 2016 survey, approximately 40% of Americans have a privately purchased disability insurance policy or a disability policy offered through their employer. Since Social Security disability benefits, on average, provide approximately one third of the amount of the average disabled worker’s paycheck, and since many people live paycheck to paycheck without substantial savings, the successful presentation of a Long Term Disability benefits claim (LTD) is absolutely critical to maintaining the worker’s financial and personal stability. For instance, a 2017 study of bankruptcy court records demonstrated that over 40% of mortgage foreclosures are attributed, at least in part, to disability.

LTD benefits obtained as a benefit of employment (and usually paid for by the employer), somewhat like Social Security benefits, are paid to beneficiaries whose disability is expected to last more than a few months; although the terms of the LTD contract control, generally speaking most workers may be entitled to LTD benefits for up to 2 years if they are unable to work at the job they were performing when they became disabled, and even permanently if the worker’s disability results in an inability to perform any gainful employment. In almost all cases involving a disability policy purchased by the company, the worker will be required, as a condition of receiving LTD benefits, that they also apply for Social Security disability. However, if the LTD policy is bought privately most of these policies provide disability benefits on the sole basis that the policyholder is unable to perform their past job.

One way that claims for LTD benefits is vastly different from Social Security claims is that they 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. “

OBL Applauds AALJ Statement Regarding Hearing Scheduling

The Association of Administrative Law Judges (AALJ) is the professional association that 80% or more of Social Security ALJs belong to, and carries as part of its mission statement a commitment to the “independent and honorable administrative judiciary as indispensable to justice in our society.” In the President’s Newsletter dated November 16, 2018, the AALJ responded to a new regulation proposed by SSA to give sole discretion in how hearings are scheduled (in person or by video) to the Agency, thereby taking away the claimant’s ability to opt for an in-person hearing with the ALJ who is going to decide their case. AALJ President Marilyn Zahm commented that ” [t]he Agency’s explanation for these drastic changes is spurious – the Agency already easily moves caseloads from backlogged hearing offices to other locations around the country.  There is no need to force claimants to give up their right to an in-person hearing – the Agency’s own statistics show that only 32% optout of a video hearing. Thus, two-thirds of the caseload can be moved without the need for this regulation.  Where is the need to be able to move ALL hearings and deprive all claimants of the right to in-person hearings?”.

OBL agrees wholeheartedly with ALJ Zahm’s assessment, and applauds her strong words and analysis. We also wonder why it often seems like the AALJ and Social Security representatives’ professional associations are often in a contentious relationship. Plainly, the AALJ’s commitment to the integrity and independence of ALJs is something that all claimants representatives do (or should) support. The AALJ website can be found at https://www.aalj.org/.

Karl Osterhout

Managing Partner, Osterhout Berger Disability Law

Pennsylvania Reinstates General Assistance Program

OBL is delighted to forward the following message from Richard Weishaupt, the Director of Community Legal Services in Philadelphia:

It is with great thanks that I can say that Pennsylvania has reinstated the General Assistance program.  As you may recall, the Pennsylvania Supreme Court unanimously held that Act 80, which eliminated the GA program, had been enacted in a manner that violated the Pennsylvania Constitution.  It has taken several months for the state to revise their computer programs and retrain their staff, but they have been accepting applications while they were reprogramming.  Finally, eligible Pennsylvanians began getting benefits today, just in time for Thanksgiving.

Payments began being authorized beginning Monday, 11/19, and benefits began appearing on people’s Access Cards today, the morning of 11/20.  We began getting reports of this happy news a few hours later.  We have been told that the process of granting benefits to the folks who have already applied will continue for the next few days.  Initial payments should be completed by the end of November.  People who finished their applications a month ago will get a month of benefits ($205 in most counties, including Philadelphia and Allegheny County) while others who finished the application and turned in all of the needed paperwork in August or September will get more.  Those who only recently applied will get less.

People whose applications have been approved will be sent a notice starting around 11/20 saying they are eligible and should check to see if there are benefits on their Card.  If they don’t have an EBT Access Card, they should contact the CAO to get one, but anyone with food stamps should already have one.  People who are approved for GA and already have Medicaid but not Food Stamps will need to get a new card from the CAO.

Here are the numbers we have received from the Department: As of last Friday (11/9) 2458 people have been found eligible and their payments will be issued this week and next week.

Another 6049 cases are pending, meaning something else needs to happen – they need to provide verification, including Employability Assessment Forms (EAF) and/ or they may need to be interviewed. They should check their mail or contact the Department if it is not clear what they need to do.  They can check on the status of their cases by going to the County Assistance Office or by calling the Customer Service Center (215-560-7226 for Philadelphia, and 1-877-395-8930 for the rest of the state) .

13,748 people have been found ineligible – we’re not sure why.  They may not have submitted verification or kept an appointment or who knows what.  They should have gotten or will soon get a letter saying why they were turned down.  They can appeal within 30 days of the date of the turn down.  They can also try to fix the problem by bringing in the needed verification or asking for an appointment.  Under Department rules they can “refresh” their application within 60 days but they will only get benefits back to the day that they provide needed verification or complete their interview.  In either case they should act quickly.  People who live in Philadelphia can contact Community Legal Services (215-227-2400) or Philadelphia Legal Assistance (215-981-3800) for help. People who live in other counties can contact their local legal aid program for help—information is available at https://palegalaid.net.

More detailed information and copies of Departmental policy can be found on the Community Legal Services of Philadelphia website.  www.clsphila.org/GA .  A copy of the most recent DHS policy will be on the CLS webpage shortly.

Osterhout Berger Disability Law Files Brief Before the Supreme Court

In Biestek v. Berryhill the Supreme Court will consider whether a Social Security judge erred when she failed to require the vocational expert to produce evidence that, in part, formed the basis for her testimony that there were a significant number of jobs the claimant could perform despite his limitations. Specifically, when asked on cross-examination by the claimant’s representative (we did not represent this claimant at his hearing) to explain the basis for her opinion that there were a significant number of jobs the claimant could perform, the vocational expert explained that she based her opinion on a combination of sources, one of which was a study she had personally done of the local job market. When asked to produce this study, the vocational expert stated that it was confidential (even though it could have been easily redacted) and the Social Security judge denied the claimant’s request that the vocational expert be ordered to produce it. She then issued her decision denying the claimant’s claim for benefits altogether.

The district court in Michigan and the Sixth Circuit Court of Appeals held that the Social Security judge did not err in failing to require the vocational expert to produce this evidence, which set up a “Circuit split” between the Sixth Circuit’s decision and the Seventh Circuit’s decision 15 years ago in McKinnie v. Commissioner, Social Security. McKinnie held that any data, information, or study, relied upon by the vocational expert to support his/her testimony must be made “available on demand.” As some readers may know, one of the reasons the Supreme Court will take a case (it only takes about 100 cases per year) is when the circuit courts disagree about an issue that the Supreme Court believes is an important one for there to be uniformity among all the circuits.

As mentioned above, OBL did not represent the claimant at his hearing and, technically speaking, still does not represent him. Rather, Karl Osterhout was asked by the National Association of Disability Representatives (NADR) to assist it in filing an “amicus brief,” (a “friend of the court” brief), a brief to the Supreme Court in which an individual or organization with a vested interest in the outcome of the case can submit a brief in support of its position on how the case should be decided. NADR is a professional organization of Social Security representatives which sponsors several events per year geared toward networking and continuing legal education and easily qualified as an organization with a vested interest in the outcome of this case, since Biestek has numerous possible ramifications for how vocational expert testimony is used in Social Security cases, particularly how it is used when the claimant’s claim is denied.

Mr. Osterhout had the distinct privilege of working closely with Wilkinson Walsh + Eskovitz, a Washington DC boutique firm specializing in high-stakes litigation, including Supreme Court appeals. Moreover, WWE graciously agreed to assist in the brief writing without charging its usual fee for doing so. The position taken in the NADR brief is one, we hope, that will be appealing to the Court in that it suggests that there is a very narrow way to decide the case without getting into the significant complexities of vocational expert testimony in Social Security disability claims.

Oral argument is scheduled in Biestek on December 4; at that point, it is anybody’s guess when the Court’s decision will be released, but it should be issued before the Court convenes for the summer in early June 2019.

Cigna Awards Benefits after Osterhout Berger Disability Law File a Lawsuit in Federal Court

Our client, a Patient Services Representative, was forced to stop working in 2016 because of medical conditions to include fibromyalgia, chronic fatigue syndrome, neuropathy, lumbar radiculopathy, and rheumatoid arthritis. She filed a claim with Cigna for Long Term disability benefits and was denied these benefits in early 2017.

The former Patient Services Representative then hired Osterhout Berger Disability Law and following a review of Cigna’s claim file, Attorney Berger obtained medical treatment records and medical opinions from our client’s treating doctors revealing the severity of her impairments.

Attorney Berger filed an appeal but Cigna failed to issue a decision in a timely manner. He then filed a complaint in Federal District Court, which led to Cigna, in short fashion, recognizing that it failed to address her appeal. Cigna immediately initiated a review of our client’s appeal and determined that she was entitled to Long Term disability benefits back to 2016.

If your application for Long Term disability benefits or your appeal of a decision denying or terminating has been denied do not hesitate to contact Osterhout Berger Disability Law for a free consultation.

Software Engineer’s Long Term Disability Benefits Reinstated by The Standard

Our client, a Software Engineer, began receiving long term disability benefits in 2015 because of difficulties with his back. In October 2017 his long term benefits were terminated after The Standard determined that he could return to his own occupation.

The former Software Engineer immediately contacted Osterhout Berger Disability Law. Following a review of the claim file Attorney Berger noted that The Standard failed to adequately evaluate all of our client’s physical and mental difficulties and obtained detailed statements from his treating physicians as to the severity of his medical problems and the limitations they caused.

Following the submission of an appeal, The Standard reversed its termination of benefits and informed our client that the information we submitted in support of his appeal revealed that he could not perform either his own occupation or any occupation. Our client was awarded a substantial amount of past due benefits and his monthly benefits will be reinstated. It was also determined that he remained eligible for a Waiver of Premium of his Group Life Insurance policy.

Please do not hesitate to contact our office to speak with Attorney Berger if you need assistance with your claim for long term disability benefits.

Paralegal whose LTD claim was denied by Hartford gets Approved after Appeal filed by Osterhout and Berger

A paralegal was forced to stop working in June 2016 as a result of a traumatic brain injury, cognitive impairments, and neck, hip and knee pain. She applied for Long Term disability benefits from Hartford but was denied because it was determined that she was never disabled and could perform her own occupation.

The former paralegal retained Osterhout Berger and we agreed to represent her on a contingent basis. We immediately order the claim file and after a review noted that it failed to contain evidence from numerous physicians and an inadequate evaluation of our client’s functional limitations. We obtained medical treatment records from approximately seven different physicians, spoke with her treating doctors and had our client independently examined by a psychologist. We also obtained an evaluation from a vocational expert.

Our reviewing our appeal, Hartford overturned its prior decision and noted that “based upon our review that included additional information received and generated on appeal, it was determined that the information in your client’s file supports her claim for Disability.” In light of this decision, our client received a large amount of past due benefits and she continues to receive benefits.

If you have had a similar situation and Hartford (or any insurance company) has denied your claim, please do not hesitate to contact Osterhout Berger Disability Law for a free consultation.