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Disability Insurance is not a Slam Dunk says Lawyer

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Minneapolis, MNDisabled workers sometimes get a rude awakening when the workplace disability insurance policy they thought would help them maintain their standard of living in the event of injury or illness abruptly ends.

“Many people think once the disability company finds them disabled and starts paying benefits these benefits will continue until age 65 or 67,” says Kristen Gyolai from Fields Law Firm in Minneapolis, Minnesota, “So when their benefits are cut off they think 'what the heck happened there?’ ”

What many workers don’t realize is that the insurance policy covers you for loss of income for your “own occupation” for the first two years. At the end of that period, the policy clicks over from “own occupation” to “any occupation”.

It’s a standard clause in most disability insurance packages and attorney Gyolai has seen insurance companies use that rule to force people back to work time and time again.

“The insurance company pays them for that ‘own occupation period’ which is generally 24 months,” says Gyolai. “Then after that 24 month period the definition of disability changes.

“Usually any occupation is defined in the policy is any job where you are making 60 to 80 percent of what you were making before and it’s a job you have the education, the training, the experience to perform based on your prior work history and your prior education.

“That’s confusing for people because they thought once I am declared disabled by the insurance company they are going to pay me these benefits through the policy duration,” says Gyolai. “People usually don’t know that there’s a change in definition of disability in their policy.”

The insurance companies then have the power to review the disability claim. That review usually starts with vocational analysis.

“The insurance company gets a vocational skills expert to say with your restrictions and based on your past skills analysis you should be able to do this job, and this job and this job,” says Gyolai. “They might be jobs that person has never heard of or they know they can’t do – or just various things. The insurance conducts a transferable skills analysis.”

People who have been cut off after the 24 month period have the right to appeal. That’s where Fields Law Firm steps in. Attorneys get another vocational analysis, start looking at the claimant’s work restrictions and try to get the benefits re-instated.

Even if that appeal is successful the insurance company can do another review of the claimant’s ability to work later down the road – 5 or 10 years later.

“People think they already adjudicated me as unable to perform any occupation and they think how in the world are my benefits being cut off now?” says Gyolai. “We have to tell people that the insurance company is constantly reassessing for disability. They have the power to look at your claim whenever they want. They can look at updated information whenever they want and say we have decided you can do any occupation now or you can do this particular occupation.”

Gyolai’s firm fights back for those individuals by bringing evidence to the insurance company that the original injury or illness has not changed significantly and the problems that prevented them from working still remain.

Disability claimants often find themselves in a David and Goliath style battle with insurance companies.

“It frustrates people to pay an attorney to get their benefits re-instated when they feel they are already owed these benefits,” says Gyolai. “They wonder why do I have to pay a lawyer when it is the insurance company that came to the wrong conclusion? Why do I have to fight to make the insurance company realize they made a mistake? So it is very, very frustrating for these individuals.”

Attorneys who work in the area of disability law work on a contingency fee basis. In other words, they charge only a portion of the value of the claim re-instated. However, the reality is, many people weigh the legal costs against the value of the claim and then give up and go away.

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READER COMMENTS

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Good article! What I did not know is that Congress protects these sleazy insurance companies under "ERISA" laws. You get no jury; it's all hidden. The general citizen never knows until it's too late. Insurance can just shut down your benefits on a flimsy excuse. You must hire an attorney (again) but they pay none of your attorney fees for their "mistakes". They have no penalties so of course they operate this way.

The key is 80% of your previous salary. You also need to be very proactive. Send an updated copy of your doctor's certification of disability each year and before they ask -never stop. (Use same/ original form) Harass them about failure to respond to "recertification" (sent certified mail and faxes)... If they make big demands, make your demands bigger (make them work). "Before I send (XYZ) I must first know what you have for my medical records- get me a full copy of the file before your response date (usually unreasonable) and I need time to review." The file is normally huge or should be. If it's not send them a mountain of reports that they "should have and should have reviewed before sending me this notice- they need to Review and respond- next time I would expect this to be a part of your records". Keep very good records and be prepared to send them (lots of them) number & date each page. Include what was sent before if they ask again complaining that they are neglecting the record keeping process. PLUS. be aware that their record (not yours) is all the ERISA judge will consider. I know my reaction sounds nasty and it is but I believe that it's all they understand.

I kept Aetna off me for 12 years.

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