FAQs

Frequently Asked Questions -Disability Insurance Denials and General Insurance Questions

At DarrasLaw, we protect policyholders from insurance company abuse.

Getting timely payment on any insurance claim is crucial in today's economy, if you are like most people, you can't afford the insurance runaround.

The questions answered in this Frequently Asked Questions section, although not intended to be legal advice, should give you fact specific information that may be relevant to your case.

Please review the questions and see if any of our material will help you. If not, please Email Site Administrator and send us your questions.The DarrasLaw team of experts will answer as quickly as possible.

Feel free to call our office toll free, at any time for free insurance help, policy information, or claim advice at 1- 877-670-0128 or Email Site Administrator.

Disability FAQs

Q: Do I have to appeal the denial of my disability benefits before I can file a lawsuit?
Q: Why is it so important that I appeal?

Insurance FAQs

Q: What is bad faith insurance denial?
Q: I am 75 years old and cannot live on social security and am running out of savings. I am thinking about selling my life insurance. How do I do this and get what is fair?
Q: My individual disability insurance claim has been denied, what do I do?
Q: How do I file a disability claim?
Q: My parents each have a long term care policy with Conseco. Last year, their policies were put into a trust. My father recently just went on claim and we have been told my mother no longer has to pay her premium. Is this true?
Q: My wife was diagnosed with breast cancer and now the insurance company is refusing to give her the treatment her doctor says she needs. What do we do?
Q: I bought an own occupation disability insurance policy twenty years ago. Should I keep paying on it if I plan to retire?
Q: I am 42 years old and have my own business, do I need to buy disability insurance in addition to my healthcare?
Q: I have my own business and pay for my family's health care. My insurance card says ERISA: What does that mean?

Frequently Asked Questions -Disability
Insurance Denials and General Insurance Questions

Q: Do I need an attorney to appeal the denial of my disability benefits?
Q: Does your firm work on a contingency basis?
Q: How do I appeal my own denial of disability benefits? ["Tips for Preparing Your Own ERISA Disability Appeal"]
Q: Is there a deadline to appeal the denial of my disability benefits?
Q: I have missed the 180-day appeal deadline. Does this mean I can't sue the insurance company?
Q: What is ERISA and how does it affect my LTD benefits?
Q: I have lost everything because of the denial of my insurance claim. What can I recover from the insurance company?
Q: My doctors' reports state I am disabled. Why has my Long Term Disability ("LTD") claim been denied?
Q: What's the difference between "own occupation" and "any occupation" when defining disability?
Q: What are "offsets"?
Q: How does my disability policy differ from Social Security Disability Insurance ("SSDI"), Supplemental Security Income ("SSI") or State Disability Insurance ("SDI")?
Q: I have heard horror stories about denials to seniors of long term care insurance, should I buy it? My wife and I are both 64 years old.
Q: My mother was put in a home and then her LTC carrier denied her care because she self-neglected, can they do that?
Q: What steps do I need to follow to protect my home in case of a disaster?
Q: I hear if I have a company sponsored insurance plan and I am denied disability coverage, ERISA will do me in-what does that mean?
Q: Tell me how to prevent a disaster if I am wrongfully denied my coverage under ERISA.
Q: What is an IME? Who are they and does what they think, matter when it comes to my case? Do they have any power over my case?
Q: My insurance company continues to delay processing my paperwork. They have requested the same information from me 3 times in 10 weeks and continue to
say they do not have what they need. What are they doing?

Q: Whenever I call my credit card company, they try to get me to sign up for income protection – should I become disabled or die. Is this worth it?


Q. Do I have to appeal the denial of my disability benefits before I can file a lawsuit?


A. The answer depends on the type of policy you have:

Generally, you do not need to appeal if you have an individual policy purchased through an agent or broker, or if your policy was provided to you by a government or church employer directly (that is, not through a union or employee organization). You may file a lawsuit after your first denial.

If your policy is through a private employer, an employee organization, or a union, the Employee Retirement Income Security Act of 1974 ("ERISA") requires you to exhaust your administrative remedies before you can file a lawsuit. This means you must follow the insurance company's internal appeals process. For example, most plan documents only call for one mandatory appeal, but if the plan documents call for two mandatory appeals, you will have to complete two levels of internal appeals before you can sue.

If you are uncertain whether you are required to appeal your denial, you should immediately consult an attorney experienced in handling ERISA disability cases. We may be able to help you. Please Email Site Administrator or call at 1- 877-670-0128 . BACK TO TOP


Q: Why is it so important that I appeal?

A: The Employee Retirement Income Security Act of 1974 ("ERISA") requires you to exhaust your administrative remedies before you can file a lawsuit. The internal appeal process allows the insurance company an opportunity to correct its mistakes and avoid a lawsuit. If you do not give the insurance company the chance to right its own wrongs first, most courts will not allow your lawsuit to proceed.

The internal appeals process is also a very important opportunity for you, the disabled claimant. It gives you a chance to load your claim file with information supporting your disability claim and to correct any misconceptions. It is imperative that you submit everything that may possibly help prove your disability and your credibility. (See "How do I appeal my own denial of disability benefits?" below.) BACK TO TOP


Insurance FAQs


Q: What is bad faith insurance denial?

A: Bad faith insurance denials are common in America as carriers try to unreasonably delay or wrongfully deny your legitimate right to your insurance benefits. Delaying, not paying the full amount owed, not promptly, fairly, equitably investigating and evaluating the claim with an eye towards payment are all examples of carrier bad faith. Policyholders often hurt their chances to establish bad faith by giving their insurance company two bites at the claim apple when offered an appeal. In some cases the appeal is mandatory and in others it is not necessary and builds in more time for the carrier to hold onto your benefits. To appeal or not appeal really requires expert top insurance attorney help.

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Q: I am 75 years old and cannot live on social security and am running out of savings. I am thinking about selling my life insurance. How do I do this and get what is fair?

A: Senior life settlements are quickly dominating the senior landscape. If you are older and have health problems and could use cash now to assist with your medical care or you are in jeopardy of losing your life insurance due to lapse because you can't afford the premium or you have enough and just want to enhance your loved ones now or charitably donate the life insurance policy. Make sure you engage an agent with a national company and make sure you get their commission schedule and all bids to buy your policy in writing. The transaction could have tax implications so it's always a good idea to get top insurance attorney help.

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Q: My individual disability insurance claim has been denied, what do I do?

A: Many policyholders make the mistake of trying to appeal on their own when it may not be necessary. Some policies require appeal and policyholders misread, misunderstand or just don't have enough familiarity with the legal language to know what to do. Contact a top insurance attorney before you make a fatal claim or appeal mistake so you and yours are protected.

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Q: How do I file for a disability claim?

A: If you bought the policy from an agent or broker contact them so they can alert the carrier to send you claim forms or contact the carrier directly to get the package of forms. Beware, these forms are tricky, confusing and ask questions that could derail your claim so get some free help from a top disability attorney before sending in any of your forms or filling out crucial paperwork.

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Q: My parents each have a long term care policy with Conseco. A few years ago, their policies were put into a trust. My father recently went on claim and we have been told my mother no longer has to pay her premium. Is this true?

A: Some of the older LTC policies did contain a waiver of premium feature for the other living spouse if they purchased LTC together. Check with a long-term care attorney for the best advice.

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Q: My wife was diagnosed with breast cancer and now the insurance company is refusing to give her the treatment her doctor says she needs. What do we do?

A: First get some free help from a medical insurance attorney familiar with both individual and group medical policies. Timeframes and appeal requirements vary by policy and by state but timely top advice is key so you can bullet proof your appeal and get the benefits you richly deserve.

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Q: I bought an own occupation disability insurance policy twenty years ago. Should I keep paying on it if I plan to retire?

A: Your individual disability policy should protect you even if you retire as long as it is before age 65. The definition will switch to the substantial and material duties of a retired person so if you can't get dressed, feed yourself, toilet, transfer and do the things retired people do your carrier may still be on the hook for the benefits.

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Q: I am 42 years old and have my own business, do I need to buy disability insurance in addition to my healthcare?

A: Individual disability coverage pays you a monthly benefit of 60-70% of your monthly earnings and should protect you if you can't do the important duties of your own occupation for 2 years, 5 years, or until your 65th birthday. The benefits are tax free if you pay the premiums yourself and not through your corporation, plus individual policies are backed by the strongest consumer protections under the law. Running your own business is tough, so what would you do if you were laid up for 6 months or a year? How would you pay the bills to stay afloat? Contact an agent or broker and get as much individual disability insurance you can afford to protect you, your business and those you love.
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Q. I have my own business and pay for my family's health care. My insurance card says ERISA: What does that mean?

A: If you own a business with just you and your family covered you probably aren't subject to ERISA. If you add a secretary or receptionist or any other person as an employee then you are ERISA preempted. Unfortunately, ERISA has very time sensitive and fairly confusing rules and regulations with which most attorneys are completely unfamiliar. ERISA also means you gave up your right to a trial by jury, there will be no punishment, emotional distress damages and you must administratively appeal your group insurers wrongful denial before you can proceed to Federal Court to have your ERISA case heard. Finally, in order to win under ERISA, it is the insured's burden to administratively appeal the denial in a timely manner and supply all of the evidence on appeal for the court to look at and beat the reasonable doubt standard of review. Make sure if you get your benefits at work you contact an ERISA appeal attorney before filing your claim and certainly before you file your appeal.

If your policy is an individual policy purchased from an agent, contact a top insurance attorney and get free advice before you file a claim or consider appealing.

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Frequently Asked Questions -Disability
Insurance Denials and General Insurance Questions


Q: Do I need an attorney to appeal the denial of my disability benefits?

A: You do not need an attorney to appeal your denial of benefits, but it is recommended because the insurance company will certainly have lawyers on their side. In fact, the insurance company will have an army of claims personnel, in-house medical reviewers, on-site physicians, designated medical officers, vocational consultants, and an entire legal department at their disposal. They are hoping you won't have anyone on your side, especially not an attorney experienced in handling ERISA disability cases.

There are no special considerations made for claimants who are not represented by counsel. The rules are the same, regardless of whether you have a cognitive impairment, you are on high doses of medication, or you are otherwise unable to put together a thorough appeal. Unfortunately, most claimants are too overwhelmed by the realities of living with disability to handle their own appeals. Furthermore, if the denial letter from the insurance company attacks your character, directly or indirectly, it may be difficult to stay focused on the specifics of your appeal. As in many legal matters, you can represent yourself, but it is not advisable. But if you must proceed without a lawyer on your side, request their assistance of a capable family member or friend. Start by sending that family member or friend a link to this website, www.darraslaw.com . We have tips for preparing your own appeal below. (See "How do I appeal my own denial of disability benefits?") If you need additional help, Email Site Administrator or call at 1- 877-670-0128 as soon as possible.

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Q: Does your firm work on a contingency basis?

A: Yes. The majority of our clients are disabled or have recently suffered a major catastrophe. Often, they have lost their main source of income. They cannot afford to pay the hourly fees associated with undertaking an expensive legal action, especially against large insurance companies. A contingency fee agreement does not require payment of attorneys' fees up front. Attorneys' fees are paid only at the end of the case, and only if the outcome is successful. Without contingency fee arrangements, most people would be deprived of the opportunity for justice.

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Q: How do I appeal my own denial of disability benefits? ["Tips for Preparing Your Own ERISA Disability Appeal"]

A: Follow the steps below:

  • Start by reading the denial letter carefully from start to finish. The insurance company is required to advise you of the specific reason(s) for the denial; reference the specific policy provision on which the denial is based; describe what additional material or information, if any, is necessary to support your claim; and explain what steps need to be taken to appeal.
  • Next, request a free copy of your claim file (often referred to as the "administrative record" in ERISA cases) from the insurance company. You must submit your request in writing as soon as possible after the denial, so that you will have enough time to review its contents, including your disability policy, before you write your appeal letter.
  • You must submit your appeal before the deadline, in writing, and preferably by certified mail with delivery confirmation. [See "Is there a deadline to appeal the denial of my disability benefits?" below.] It is very important that you do not miss your deadline. The clock starts ticking the day the insurance company denies your claim.
  • Your appeal letter should state clearly that you are appealing the denial of your disability benefits and the basis for your appeal, and list the additional information you are submitting in support of your claim.
  • Your appeal letter should be polite, respectful, and loaded with specifics. There is no particular wording required, and no need to cite the applicable law when you are appealing on your own behalf.
  • Did you have help with your appeal? If a family member or friend helped you with the appeal, be sure to mention this fact because insurance companies have been known to point to a well-written appeal letter by the claimant as support for upholding their previous denial. If preparing the appeal letter and enclosures took you several days or weeks due to your disability, mention that fact as well.
  • Lastly, do not assume that the insurance company already has your medical records or any of the other information pertinent to your case. Submit or resubmit anything that may help prove your disability.
    Remember, in most cases, you cannot submit any further evidence during the lawsuit, no matter how pertinent to your case. The only thing the court will look at is the information in the claim file. The appeals process is your opportunity to include as much information as possible in the claim file, to support your subsequent lawsuit. For this reason, we generally do not recommend handling your own appeal. There is far too much at stake. Competent, experienced ERISA appeal attorneys know the tricky landmines and defenses the carrier will use to snuff out your claim. ERISA laws are unfair and difficult to comprehend, and innocent policyholder mistakes are incurable. Hire an expert ERISA appeals attorney to marshal the correct evidence to overturn a wrongful denial.
    If you need help with your appeal, Email Site Administrator or call at 1- 877-670-0128 as soon as possible.

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Q: Is there a deadline to appeal the denial of my disability benefits?

A: Under ERISA, you have 180 days from the date your disability claim was denied to file an appeal. It is very important that you do not miss this deadline.
The easiest way to calculate your deadline is to look for the date of the insurance company's denial letter and add 180 days using a free on-line calendar service. For example, see: http://www.timeanddate.com/date/dateadd.html

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Q: I have missed the 180-day appeal deadline. Does this mean I can't sue the insurance company?

A: Not necessarily. You should immediately consult an attorney experienced in handling ERISA disability cases to determine whether the deadlines apply to you. We may be able to help you. Please Email Site Administrator or call at 1- 877-670-0128 .

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Q: What is ERISA and how does it affect my LTD benefits?

A: If you obtained your insurance coverage from your employer, union, or employee organization, a claim against your insurance company is most likely subject to a federal law called the Employee Retirement Income Security Act of 1974, more commonly known by the acronym of "ERISA."

If you did not obtain your disability policy through your employer or employee group, but rather purchased it as an individual policy from an agent or broker, then chances are your claim will not be governed by ERISA and you will have greater consumer remedies.

Congress originally enacted ERISA to protect workers' pension benefits, and to standardize the administration of "employee benefits plans." Most employer-sponsored life, health and disability insurance plans are considered "employee benefit plans" under ERISA. Unfortunately, certain aspects of ERISA have been used by insurers and the federal courts to severely limit the rights of people just like you. ERISA operates to preempt or supersede state laws that "relate to" employee benefit plans.

If your disability claim is governed by ERISA, you must timely appeal the denial of your benefits. ERISA requires that you exhaust all administrative remedies (or appeals) before you can file a lawsuit. The deadline for filing your appeal is 180 days from the date of denial, but please check the last page of your denial letter from the insurance company: often the exact deadline and the address to which you should send your letter of appeal will be stated there. You do not need an attorney to appeal your initial denial of benefits, but you may benefit from the assistance of one in dealing with the insurance company.

If you have an individual disability policy purchased from an agent or broker then, generally, you do not have to appeal the denial before filing a lawsuit. You should consult an attorney immediately. We may be able to help you. Please BACK TO TOP


Q: I have lost everything because of the denial of my insurance claim. What can I recover from the insurance company?

A: This depends on the type of policy you have. If your policy falls under ERISA you are only entitled to the past due benefits minus any offsets. Under certain circumstances, the court may award interest on past-due benefits and attorneys fees. No matter how badly you were treated or how much you lost as a result of your denial of benefits, ERISA prevents claimants from suing for any extra-contractual damages, including emotional distress damages and punitive damages. There is no penalty when an insurance company wrongfully denies or delays your benefits in an ERISA case. For this reason, ERISA is widely regarded as harmful to America's workers.

If your policy is not subject to ERISA, you may be entitled to "bad faith" damages, including emotional distress damages, extra-contractual damages, and punitive damages, depending on the facts of your case and your state law. Insurance companies are generally far more careful about denying benefits payable under policies not governed by ERISA.

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Q: My doctors' reports state I am disabled. Why has my Long Term Disability ("LTD") claim been denied?

A: The insurance company evaluates your eligibility for benefits based on the definition of "disabled" under your policy. In most LTD policies, "disabled" is defined as having an illness or an injury that prevents you from performing the material and substantial duties of your regular occupation on a full-time basis with reasonable continuity. If your policy defines disability in this way, your doctor should review your job requirements and report that you cannot perform your regular occupation because of your disabling condition.

Many policies have a change in the definition of "disabled" after a certain amount of time (usually 24 months), such that "disabled" is defined as having an illness or an injury that prevents you from performing the material and substantial duties of any occupation for which you are reasonably qualified by your training, education and experience. On the other hand, some policies state that if you can perform any work on a part-time basis, you are no longer considered "disabled" under the policy. Still other policies state you will only be entitled to disability benefits if you have been declared disabled by the Social Security Administration. Thus, depending on how restrictively your LTD policy defines disability, your doctor's report alone may not suffice.

Furthermore, under ERISA, your insurance company does not have to accept your doctor's conclusion that you are unable to work. Sometimes insurance companies demand "objective medical evidence" of your condition or other information to support your doctor's conclusion that you are disabled. You should obtain a copy of your LTD policy or certificate and review the definition of disability, preferably with the assistance of an experienced ERISA attorney.

Benefits may also be denied due to coverage issues, including problems that may arise during enrollment or an insurer's claim that you had a pre-existing condition which you failed to disclose prior to enrollment. In these situations, you definitely should consult an attorney with experience in ERISA.

At DarrasLaw, we would be happy to review your LTD policy and answer any questions you may have about obtaining benefits. Please Email Site Administrator or call at 1- 877-670-0128 .

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Q: What's the difference between "own occupation" and "any occupation" when defining disability?

A: An "own occupation" provision means that your policy will provide benefits in the event that you are no longer able to perform the material and substantial duties of your occupation at the onset of your claim. Some policies use the term "your regular occupation" instead of "own occupation" in the definition of disability. Many policies also define your regular occupation as it is performed in the "national economy" and not as it is performed for your specific employer.
Most employee-benefit related policies will only provide "own occupation" or "your regular occupation" coverage for a limited period of time (usually 24 months). After that period expires, you must be disabled from performing the material and substantial duties of "any occupation" for which you are reasonably qualified by your training, education and experience, in order to continue to be entitled to benefits.
We would be happy to review your disability policy and answer any questions you may have about obtaining benefits. Please Email Site Administrator or call at 1- 877-670-0128 .

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Q: What are "offsets"?

A: Generally, disability policies will pay either: (a) a set amount of benefits per month, or (b) a percentage of your pre-disability earnings on a monthly basis—often between 50% to 70% of your earnings.

Most policies that pay a percentage of your pre-disability earnings will subtract or "offset" from your benefits any amount you receive from other sources of disability income, such as State Disability Insurance (available in California and several other states), Social Security Disability Insurance, Public Employee Retirement System Benefits, Workers' Compensation, awards from third-party related lawsuits, and other employer-sponsored disability benefits. This is because, in theory, the policy is only insuring that you will receive the specified percentage of your pre-disability income combined from all sources. Nevertheless, most policies also include a minimum benefit amount payable to you each month, no matter how much you are receiving from all your other sources of disability income – typically 10% of the monthly benefit or 100 dollars, whichever is larger.

Insurance companies aggressively follow-up on your other possible sources of disability income so that they can reduce their monthly payments to you.

If your insurance company is reducing your benefits because of "offsets," you should check the policy to see if this is allowed and confirm the amount being subtracted is accurate. We would be happy to review your LTD policy and answer any questions you may have about offsets. Please Email Site Administrator or call at 1- 877-670-0128 .

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Q: How does my disability policy differ from Social Security Disability Insurance ("SSDI"), Supplemental Security Income ("SSI") or State Disability Insurance ("SDI")?

A: The primary difference is in who administers the benefits. SSDI, SSI, and SDI programs are all benefits administered and provided by the government. There are no insurance policies involved, no sales, and no profits. In contrast, your disability policy – whether obtained through a broker or insurance agent, or through your employer, union, or employee group – was sold by and is administered by a corporation.

Social Security Disability ("SSDI") is a Federal disability insurance program provides benefits if you worked long enough and paid Social Security taxes. For more information about eligibility for SSDI, click here.

Supplemental Security Income ("SSI") is a Federal income supplement program designed to help the aged, children, blind, and disabled adults, who have little or no income. It provides cash to meet basic needs for food, clothing, and shelter. One does not have to be disabled to be eligible for SSI. For more information about eligibility for SSI, click here.

Lastly, State Disability Insurance ("SDI" or "TDI" in some states) is a state-government program designed to provide temporary disability income for workers who become disabled due to an injury or illness not caused by their job. There are only five states that provide state disability programs: California, Hawaii, New Jersey, New York, and Rhode Island, as well as the Commonwealth of Puerto Rico. Each State or Commonwealth governs how its program is structured. The following links will provide additional information regarding each state's SDI or TDI program:

The information provided in our FAQ section is not intended to be legal advice. Consult the team at DarrasLaw for fact-specific information relevant to your particular case.

We would be happy to review your disability policy and answer any questions you may have about obtaining benefits. Please Email Site Administrator or at 1- 877-670-0128 .

Q. I keep getting mailers about mortgage disability insurance-what is it and should I buy it?

A: Mortgage disability insurance is a specialized form of disability insurance. Mortgage disability insurance promises to make your mortgage payments in the event that you are disabled and cannot.

Usually, it is an unnecessary expense and the dollar amount of the benefit versus the dollar amount of the premium makes it one of the most expensive insurances you can buy. A better choice would be to purchase an individual disability insurance policy.

Individual disability insurance provides a monthly benefit you can use for all of your financial needs and usually gives you longer own occupation protection. Mortgage disability policies usually protect the policyholder for 1 year if they can't do the important duties of their occupation whereas individual disability policies can protect your own occupation for 2 years, 5 years or to your 65th birthday.

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Q. I have heard horror stories about denials to seniors of long term care insurance, should I buy it? My wife and I are both 64 years old.

A. The right time to buy long-term care is around age 55 to 60. You can buy it when you are younger, but new systems for care may emerge before you need your LTC and they may not be covered in your policy. For instance, assisted-living facilities were not covered in policies written just 15 years ago.

Find an insurance company with excellent claims paying history that has been in business for a long time. Research their prices and safety ratings and check online ratings such as www.ambest.com ; www.moodys.com ; www.standardandpoors.com ; and www.weissratings.com.

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Q. My mother was put in a home and then her LTC carrier denied her care because she self-neglected, can they do that?

A. This sure sounds suspicious as most LTC policies pay when you get care if you can't do 2 of 5 activities of daily living or are cognitively impaired. Read your policy thoroughly and contact your state Department of Insurance for guidance on this, the laws vary according to state. Because of the tricky language in insurance policies, you may also want to contact us and we will refer you to a lawyer in your state that can give you a free evaluation.

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Q. What steps do I need to follow to protect my home in case of a disaster?

A. Every year, videotape your interior and possessions and also your landscaping and the outside of your home. Make sure you have copies of important documents stored in another physical location outside the home, like a family member's home or a safe deposit box. Always have your insurance company name, your policy number and your agent's contact information in an easy to find spot.

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Q. I hear if I have a company sponsored insurance plan and I am denied disability coverage, ERISA will do me in-what does that mean?

A. ERISA, the Employee Retirement Income Security Act, applies to company-sponsored health insurance, disability coverage as well as any life insurance; regardless of who pays or contributes to the premium.

ERISA disability denial can be horrific for the average worker. For instance, if a disabled employee is denied a legitimate claim by the group insurance carrier and her home is foreclosed on, her equity extinguished and her credit destroyed; those damages are not collectible under ERISA. In addition, when disabled employees are wrongfully denied their disability benefits, ERISA eliminates their Seventh Amendment right—the right to a trial by jury. So if the group insurance company wrongfully denies a client's righteous disability claim and he suffers severe emotional distress, there is no right to collect on those damages.

Even if the group insurer denies the insured's' claim with evil, vile or loathsome intent, under ERISA, the employee has no right to receive punitive or punishment damages.

There is no discovery under ERISA. This means you won't be deposed, your doctor won't testify, and your friends and loved ones who would like to tell the judge how impaired you are won't be allowed to testify, either.

Under ERISA, there are no interrogatories, no document requests, no subpoenas and no real trial on the claim's merits.

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Q. Tell me how to prevent a disaster if I am wrongfully denied my coverage under ERISA.

A. You only have one chance to get it right. Be sure to get expert ERISA appeal counsel before submitting anything to the insurance company. View the video here for full details.

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Q. What is an IME? Who are they and does what they think, matter when it comes to my case? Do they have any power over my case?

A. An IME is an independent medical examiner, generally contracted or hired by the insurance company to review your medical records (paper review) or hands on physical exam with medical history and a clinical exam to determine whether you are disabled. In nearly all cases, the independent medical examiner is not independent and often, you never meet him nor does he evaluate you or your disability in person. Most IME's make determinations in favor of the insurance company and can derail your case for a long time, if not forever. A top insurance attorney usually has the goods on these over-used examiners and can help level the playing field.

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Q. My insurance company continues to delay processing my paperwork. They have requested the same information from me 3 times in 10 weeks and continue to
Say they do not have what they need. What are they doing?

A. This is a delay and deny tactic. When the economy is slow, this tactic keeps money in the coffers of the insurance company and makes their bottom line look stronger. This strategy is effective too, because most insurance companies are banking on the fact that sick people don't fight hard and old people don't live long. View our videos here for more information on how to protect yourself if this happens to you.

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Q. Whenever I call my credit card company, they try to get me to sign up for income protection – should I become disabled or die. Is this worth it?

A. If you already have substantial life and disability insurance policies, you most likely have enough coverage in those policies to cover your credit accounts due to your death or disability. But, if you don't have any type of life and disability policies that does not necessarily mean credit insurance is the best choice. Shop around and get an individual life and/or disability policy that suit your needs.


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