At your hearing, you want to provide details about how you spend your time and how your impairment affects what you are able to do.  These details may persuade the judge to rule in your favor.

If you simply describe your daily activities in general terms– saying, for example, that you spend your day “watching TV and doing household chores” – the judge may deny your appeal thinking that you are more than capable of performing sedentary work.

Instead, testimony that is full of details will give the judge a far more accurate picture of your limitations. Tell the judge what household chores you are able to do, how long they take you to accomplish, whether they exhaust you, and whether there are some chores that you cannot do.

For example, your household chores may have been reduced to putting your dishes in the dishwasher and folding laundry while sitting down.  Perhaps your cooking is limited to popping frozen meals into the microwave because you cannot stand for more than 15 minutes and chopping and stirring cause pain in your hands, neck, and back.  Maybe you can sweep the floor or vacuum once a week, but afterwards you have to lie down and rest.

Go into detail about your TV watching.  Tell the judge if you watch TV because you can’t concentrate long enough to read a magazine or newspaper.  Let the judge know if you have trouble following a half hour program because you are in pain.  If you have to recline while watching or if you have to get up and walk around several times during a program, tell the judge about that too.

To be capable of working at a sedentary job, you must be able to perform work-related activities on a sustained basis day after day for a full workday and work-week. Detailed testimony regarding your daily activities can demonstrate that you are not able to meet this threshold.

An experienced Albuquerque disability attorney can help you provide strong testimony at your hearing by eliciting such critical facts. Testimony that highlights these details can make the difference between a denial and an award of benefits.

If you would like to talk with a knowledgeable Albuquerque disability attorney, please call me at 888-896-2033.

As part of the process of determining whether you are entitled to Social Security disability benefits, the Social Security Administration will evaluate your physical residual functional capacity or RFC.  Your physical RFC is a measure of how much exertion you are capable of in a work setting.  It is the most strenuous work you can do despite your medical condition.

Physical RFC is measured in terms of three work levels: medium work, light work, and sedentary work. You have an RFC for medium work if you can stand or walk six to eight hours per day and lift or carry 50 pounds occasionally and 25 pounds frequently. Medium work also typically requires good use of the arms, hands, and fingers, and flexibility of the knees and torso.

You have an RFC for light work if you can stand or walk six to eight hours per day and can lift or carry 20 pounds occasionally and 10 pounds frequently.

You have an RFC for sedentary work if you can sit for up to two hours out of an eight-hour day and can lift 10 pounds and carry small articles. Most unskilled sedentary jobs require good use of the hands and fingers and the ability to do repetitive hand-finger actions.

Occasionally means for less than one-third of an eight hour work day, while frequently means for at least one-third of an eight hour work day.

After assessing your RFC, Social Security applies a set of rules called the Medical Vocational Guidelines, or grids to determine whether you are disabled given your age, education, and experience.

Sometimes, claims are denied because Social Security incorrectly evaluates your RFC and believes you are capable of more exertion than you actually are.  If your RFC is an issue at your Albuquerque disability hearing, you will need to be prepared to testify about your ability to sit, stand, and walk; lift and carry; bend and stoop; pull and push; grasp and turn objects; and manipulate small objects with your hands and fingers.

As an experienced Albuquerque disability attorney, I know how to prepare you to present your best testimony about your physical limitations.  Please contact me if you would like me to evaluate your Social Security disability claim.

 Medical records. Depending on your medical condition, you may need to submit your medical records as evidence of your injuries or illness and the treatment that you received from your physician. Medical records may also be necessary to show that you were in good health prior to the development of your current medical condition and that the condition is not pre-existing.

 Letters. It may be a good idea to submit a letter from you detailing the requirements of your job and how your limitations prevent you from performing it. If you keep a journal or diary describing your symptoms, your Albuquerque long term disability benefits lawyer may recommend submitting excerpts as evidence of your disability. Letters from your family, friends, and co-workers describing their observations of your condition and its impact on your work and life can also help support your claim. Your disability attorney can advise you in more detail about how to prepare these letters.

Social Security disability benefits award letter. If you have applied for disability benefits through the Social Security Administration, and your disability benefit claim has been approved, you should provide a copy of the SSA’s letter of approval to your long-term disability insurer.

If you would like help pursuing a claim for long-term disability insurance, contact Albuquerque disability lawyer Don Vigil at 888-896-2033.

The first step in making a claim for long-term disability benefits is to obtain the proper forms from the insurance company. Typically, the insurance company will require (1) a claim form completed by you, (2) an attending physician statement completed by your doctor, (3) an employer’s statement completed (obviously) by your employer, and (3) an authorization for release of medical information signed by you allowing the insurance company’s claims administrator to obtain your medical records.  The insurer may provide you with all the forms or may send the physician’s statement and the employer’s statement directly to your doctor and employer for completion.

The claim form will ask you to provide information regarding your medical condition, including when the condition began and a description of the condition.

The attending physician’s statement will ask your doctor to describe your condition and the limitations and restrictions that prevent you from performing the material duties of your occupation.

The employer’s statement will request your pay rate and a description of your job duties. It may also ask about any limitations your employer has noticed because of your condition. In addition, if you were injured while on the job, and the injury caused your current condition, the employer may be asked to describe the accident and provide evidence of the extent of your injuries.

Usually, you file the completed forms with the insurance company’s claims administrator. However, you may want to ask about the procedure ahead of time.

In addition to the forms required by the insurance company, an experienced Albuquerque disability lawyer may suggest other materials you can submit in support of your claim.

Most insurance policies require you to submit your claim within a specified period of time after you become disabled.  The actual deadline varies depending on the insurance company. Therefore, it is important to find out how much time you have to submit all relevant information as soon as you can. Failure to complete your documents in a timely fashion may cause a delay in your disability benefits or even denial of your claim. 

 If you would like help making a claim for long-term disability insurance, contact Albuquerque disability lawyer Don Vigil at 888-896-2033.

Several conditions or circumstances may cause the denial of your claim for long term disability benefits. For example, an insurance company may exclude from coverage a disability caused by a pre-existing condition or a mental condition. In addition, self reported medical conditions may be excluded from coverage.

Preexisting conditions

The definition of the term “pre-existing condition” may differ from policy to policy. However, a pre-existing condition usually refers to a condition that you had or sought treatment for at least 3 months prior to starting coverage with the current policy. It is not uncommon for an insurance carrier to make an insured wait up to 12 months before he or she can begin to receive benefits for a pre-existing condition. 

Mental and nervous conditions

If you suffer from a mental or nervous condition, the disability policy may deny coverage. Any such exclusion or limitation will be included in the terms of your policy, so read the terms carefully. Unfortunately, many insurance carriers incorrectly classify mental or nervous conditions, and it may become necessary to hire a New Mexico disability lawyer to enforce the terms of your policy. For example, if you suffer from depression due to a chronic illness and your policy excludes mental illness benefits, you are still eligible to receive benefits for the chronic condition that is causing the depression.

Self-reported injuries

If you self-report your injury to the insurance carrier, you may be excluded from receiving disability benefits. Examples of self- reported injuries include fatigue and headaches. A policy may exclude self-reported injuries because they are hard to prove.  If you suffer from any of these types of conditions, talk to your physician to see if your condition can be verified by medical testing or clinical examination.

If you are considering making a claim for long-term disability insurance, or if your claim has been denied because of an exclusion or any other reason, get help from Las Vegas, New Mexico long term disability lawyer Don Vigil.  Call 888-896-2033 to schedule a consultation.

Own Occupation

Many policies provide disability coverage, at least initially, if the claimant is unable to perform his or her own occupation, even if the claimant is able to work at some other job.  If your policy states you must be unable to perform the duties of your own occupation to receive disability benefits, then your medical condition must prevent you from performing your job’s specific day-to-day duties. Most “own occupation” policies state you must be unable to perform the material and substantial duties required of your occupation.

 Claims are sometimes improperly denied because the insurer used an inaccurate description of the material and substantial duties of the claimant’s occupation.  One way that an experienced Taos disability insurance attorney can assist a claimant is to make sure the insurer uses a correct description of the claimant’s job. 

Any Occupation

After a period of time, many policies require a claimant to be unable to perform any occupation to continue to be eligible for benefits.  Policies typically require the insurance company to examine whether the claimant is able to engage in any gainful employment considering the claimant’s education, training, and experience.  If the insurer identifies an alternative occupation that it alleges the claimant can still do, a long term disability lawyer will carefully assess whether the job is appropriate considering the claimant’s station in life and whether, given the claimant’s age and disability, he or she can actually perform it.  Sometimes, a vocational assessment by a vocational rehabilitation counselor can help with this evaluation.  A Taos long-term disability attorney can assist in obtaining such an assessment from a qualified counselor in appropriate cases.

 Residual/Partial Disability

A long term disability policy may include a residual or partial disability provision that pays partial benefits to a claimant who can still work, but who cannot earn his or her prior salary.  Sometimes to qualify for the benefit, the claimant must no longer be able to work full time. While not all policies assist individuals who are able to engage in part-time work, most policies provide some level of benefits to encourage participants to return to work. A Taos long-term disability lawyer can review the policy to determine whether the insurer is interpreting it correctly and properly calculating the residual benefits.

If you need help making a claim or appealing the denial of a claim for long term disability benefits under an ERISA or private disability policy, contact Taos disability lawyer Don Vigil.

 The Plan

The Plan is the long-term disability plan of which you are a member. Under ERISA, the plan is a separate entity that you can sue, or in turn, can sue you. The Plan may also refer to the documents that make up the Plan, including the Master Plan.

The Plan Administrator

The Plan Administrator is the individual named in the Plan’s documents. The Plan must include at least one named fiduciary to be in charge of operating the Plan. The Plan Administrator may be a single individual, or a group of individuals.

The Claims Administrator

The Claims Administrator is the point of contact regarding payment for claims and any pre-determination for disability benefits. The Claims Administrator is usually the entity responsible for determining whether your condition makes you eligible to receive benefits.

The Participant

The Participant is anyone eligible to receive benefits under the plan. For example, if you are an employee of a company offering ERISA benefits, you are a participant. It may be necessary for you to establish that you are a participant before you can receive disability benefits under the plan.

The Administrative Record

The Administrative Record includes the information you submit with your claim for disability benefits to the Claims Administrator. This may include medical records, or bills submitted by the Participant for reimbursement.

The Summary Plan Description

The Summary Plan Description, or SPD, is an explanation of the policy to convey the basics of the plan in clear terms that the Participant can understand. In addition, the SPD should also inform the Participant of the Participant’s rights and responsibilities according to the Plan. For example, the SPD will include information about how to file a claim for disability benefits and the contribution levels of the plan.

If your employer provides you with a package of insurance benefits, you may not know whether long-term disability benefits are included.  To find out, you or your Albuquerque disability attorney can send a certified letter to your employer requesting a copy of the Summary Plan Description for all of the benefit plans your employer provides.

If you need help making a claim or appealing the denial of a claim for long-term disability benefits under an ERISA or private disability policy, contact Albuquerque disability lawyer Don Vigil.

If you have a group long-term disability policy provided by your employer, it is probably an ERISA policy, unless your employer is a government entity or religious organization.  In that case, or if your purchased an individual policy on your own, your policy is not governed by ERISA.  There are some key differences between ERISA and private policies.

If you have an ERISA policy, you must file your disability claim with the insurance carrier’s Claims Administrator. Then, the Claims Administrator will make the initial decision whether your medical condition qualifies for disability benefits. If the Administrator denies your request for benefits, you can either accept the decision or appeal following the procedures required by the policy.  If your claim is again denied, you can file an appeal usually in federal court.  If successful, you may recover any benefits you are due.

In contrast, state contract law governs a private disability policy, and you must file a disability claim according to the policy’s terms. While a private policy may have definitions that are more lenient regarding what conditions qualify for disability, monthly premiums for a private policy may be costly. In a private disability policy, if the insurance company denies your disability claim, you can file a lawsuit in state court arguing a breach of contract.  However, your suit may end up in federal court if the insurer is from out of state.

You may be able to recover a broader range of damages for an improperly denied claim if you have a private policy than if you have an ERISA policy.  In addition, to damages for breach of contract, you may be able to recover damages for “bad faith” if the insurer’s conduct was particularly egregious.

If you have long term disability insurance, whether employer provided or privately purchased, and you need help making a claim or appealing a denial, contact Santa Fe disability lawyer Don Vigil.

Factors to look at include the following:

Nature of Disability. Some policies pay benefits only if you can’t do any occupation. With these policies, if you are capable of performing some job, even though you can no longer do the job you had been doing, you are not entitled to benefits. Other policies pay benefits if you can’t do your own occupation. These policies are often purchased by persons with high-skill or high-paying jobs, such as surgeons for example. Still other policies combine these elements, providing “own occupation” coverage for a certain period, and “any occupation” coverage after that.

Extent of Disability. Long-term disability policies typically pay a certain percentage of your income, often 50% to 70%, when you become disabled.  Some policies require you to be totally disabled to collect benefits, while other policies cover partial disability. A “partial disability” means that you can still work, but only in a job that pays substantially less than your former job. If your policy covers partial disability, it may pay you a partial benefit to make up for your lost income.  For example, if your policy would pay 50% of your income if you were totally disabled, and you suffered a partial disability and could work only at a job that paid half of your former salary, your policy might pay you 25% of your former salary.

Waiting Periods. Policies have different waiting periods, such as 90 days or six months, before you can receive benefits. Some have no waiting period at all.

Payment Period. Some policies pay benefits for a certain time period, such as two years, whereas other policies may pay benefits until age 65 or your retirement age.

If you have questions about whether your private disability policy covers your current condition, contact Santa Fe disability attorney Don Vigil for a policy review.

First, long term disability insurance companies are well-known for the shifty tactics they use to reject benefits for disabled workers who have become sick or injured. Their balance sheets look better if they don’t have to pay your claim. So, you need to let the insurance company know from the start that you have a knowledgeable and experienced Taos disability lawyer on your side ready to fight and win your case.

Second, long-term disability insurance policies are confusing and vary quite a bit. They use lots of “legalese,” rather than plain English. You want an experienced Taos disability lawyer to help explain your rights under the policy and help you navigate the internal processes the company uses to analyze a claim.

Third, if the insurance company acts in bad faith and unfairly denies your claim, you may be able to sue it. If you win the suit, the insurance company may have to pay your claim and your attorney’s fees. Having a Taos disability lawyer involved early in the process provides an incentive to the insurance company to give your claim fair and full consideration, or it may end up having to pay even more than if it had just paid your benefits from the start.

Finally, if you have to prove you’re entitled to benefits, it’s always better to be represented by a qualified Taos disability lawyer who knows how to effectively present and win a case. A good lawyer knows what evidence is most important and how to maximize your arguments. If you’re sick or injured, the last thing you need is to add to your pain by fighting with an insurance company.

Even before you file your claim, call Taos disability lawyer Don Vigil for advice.