Disability Insurance and Planning
Social Security Disability
Our government provides benefits to individuals who are disabled through a variety of programs offered by the Social Security Administration. Each of these benefits programs can bring challenges that our highly experienced attorneys can help you handle.
Some of the most common programs that provide disability benefits are:
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Social Security Disability Insurance Benefits (SSD), which is based on your work record and taxes paid
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Supplemental Security Income (SSI), for individuals without a strong work history and who have minimal assets and resources
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Child’s Disability Benefits
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Disabled Adult Child Benefits, for children who were disabled before age 22 and have an opportunity to obtain benefits off of a deceased, disabled, or retired parent’s work record
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Widow’s Benefits, for widows and widowers who were married at least ten years and who are 50 years old with a disability or 60 years old without a disability
The Process Can Be Exhausting
After filing an application at the initial level, you may have to go to an examination or two scheduled by Social Security, and you will likely be required to fill out and return several questionnaires.
If denied, an appeal must be filed within sixty (60) days, and your claim will be sent to the reconsideration level. This level is also a paper-driven level where you will not have an in-person hearing.
If denied at the reconsideration level, you have the right to request a hearing in front of an Administrative Law Judge. Again, the appeal must be filed within sixty (60) days of your reconsideration denial. These hearings can be extremely difficult for an individual to attend without the representation of an experienced attorney because of the many statutes, regulations, and other sources of law that govern how these cases are decided.
If denied at the hearing level, you have one more right to an appeal at the Appeals Council. The Appeals Council, however, does not look at your case and decide whether you are disabled, but focuses its attention on whether the Judge made a legal error in following the process to decide your claim. Therefore, if you are unfamiliar with the regulations, this can be another very difficult and frustrating level of appeal.
Finally, if you are denied through all of these levels, you may file a lawsuit against the Social Security Administration in Federal Court. These lawsuits should be filed by attorneys with extensive knowledge of Social Security law, and who have experience with Federal Court Judges in the Court where the lawsuit is filed.
How We Can Help
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Our office assists individuals at all levels of the Social Security process including filing lawsuits in Federal Court. Although an individual will not typically need an attorney at the first level, in certain circumstances it may be wise to consult with an attorney before filing your application.
All of our attorneys have experience at all levels of the Social Security Administrative appeal process, as well as Federal District Court, and the Federal Court of Appeals for the Sixth Circuit (which hears appeals from Courts located in Ohio, Kentucky, Tennessee, and Michigan).
If you would like a consultation about your Social Security application, appeal, or preparation for a hearing, please contact the Law Office of Malyuk McDaniel Kasper LLC and ask to speak with one of our attorneys.
Short Term / Long Term Disability
If a person becomes disabled and is unable to continue working, he or she may have a claim for disability benefits from a company plan. Our office has many years of experience with ERISA law and will be more than happy to talk with you about your claim.
Employers often offer employee benefits to their employees, such as short-term disability benefits, long-term disability benefits, health insurance, dental insurance, and life insurance.
Because short-term and long-term disability benefits are offered as employee benefits at work, these are regulated under a federal law called the Employee Retirement Income Security Act of 1974. These claims are commonly referred to as “ERISA Welfare Benefit Claims.” They are very different from other types of litigation and can have many pitfalls and traps for unrepresented claimants and even for lawyers who are unfamiliar with the ERISA procedural rules.
Generally, the ERISA short-term and long-term disability process involves two parts:
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(1) The Administrative Process
The application and appeal of any denial of a claim for benefits is handled by submitting medical documentation, and the employer or employer’s insurance company decides the claim. After appeals end with what is called a “final” letter ending the Administrative Process, the next step is to proceed to Federal Court.
(2) Federal Court
A federal court judge is only permitted to look at the administrative record (what the employer or insurance company had at the time it denied the claim) to decide whether the employer/insurance company completely lost its way in coming to the decision to deny benefits.
The Administrative Process described above demands that all pertinent documentation concerning disability be furnished either to the employer or the insurance company, whomever decides whether the disability should be paid. Once that Administrative Process is closed with the “final” letter, no more documents can be added to the file, and the paperwork that has been submitted is called the “record.”
If a case then proceeds to Federal Court, the Federal Court only reviews the “record” and does not allow for any additional evidence in the Federal Court proceeding. Any federal action for employee benefits can only result in the payment of those benefits and no other compensation for inconvenience or other normal type damages that are included in civil lawsuits. The Court simply enforces the contract for the disability or health benefits, whichever is the case.
Anyone seeking short or long term benefits should consult an attorney to determine if representation is necessary.
Contact us today for a free consultation.
Ohio State Disability Plans
Many employees in the State of Ohio are covered by disability plans through the Ohio Public Employees Retirement System (OPERS), State Teachers Retirement System (STRS), School Employees Retirement System (SERS), and the Ohio Police & Fire Pension Fund. These programs are separate from Social Security Disability and provide benefits for such employees as teachers, policeman, and those who work for educational institutions and/or governmental offices in Ohio
Generally, an application for disability must be filed within two years of an employee’s last pay in order to meet a deadline for filing. Typically, an employee must have at least five years of service credit in order to qualify for benefits.
The main feature of the State Disability plans is that medical examination is conducted by a physician selected by the State Board to determine whether an applicant for disability is mentally or physically incapacitated from performing the duties of his or her last job. A disability must last or be expected to last for a continuous period of not less than twelve months.
Anyone applying for disability benefits through any of these State Disability plans would be well advised to consult with an attorney familiar with these plans and with the Ohio law regarding the decision making process. The reason for this is to ensure that all deadlines are met and that all evidence appropriate for decision making is submitted to the State Board for any of these programs.
One cannot assume that the State Board has received all of the medical evidence necessary for a decision and every employee must be prepared to provide information in order to be sure the application is properly considered.
The Law Office of Malyuk McDaniel Kasper LLC would be happy to review your application and help you secure your coverage.
Contact us today for a free consultation.
Private Insurance
Coverage Denials
Insurance, whether it be automobile, homeowners, medical, life or health, is a necessity of life and most people have one or more of these type policies. When a loss occurs under any such policy, or if there is a death or a medical problem, and the insurance company refuses to pay for one reason or another, legal advice may be necessary to provide the appropriate guidance in dealing with the insurance company.
The Law Office of Malyuk McDaniel Kasper LLC is prepared to assist you with any type of insurance policy including issues such as denied coverage for injuries, death, health conditions, loss of property or property damage. Be sure to understand the terms and conditions of any policy you buy, as they contain exclusions and other clauses that may impact one’s ability to collect benefits.
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Disability
A person may purchase a private disability insurance policy which is not connected with his or her work and has nothing to do with Social Security Disability. A private disability policy is typically sold by insurance agents who work for or with insurance companies. These policies are contracts between the person purchasing the policy and the insurance company.
When a person with a private disability insurance policy becomes disabled, a claim can be made for benefits and the insurance company is obligated to evaluate the claim according to the terms and conditions of the policy. If the claim is denied, then the person with the disability may pursue legal action immediately for enforcement of the terms and conditions and for payment of the benefits.
A private disability insurance policy is to be distinguished from the employee benefit policies from one’s work place (ERISA) or any government entitlement for disability purposes such as the Social Security system.
Private disability policies should be reviewed very carefully to be sure that the terms and conditions are not so difficult that it would be impossible to obtain benefits if a disability occurs. These policies are written by insurance companies and vary in their terms and conditions. For example, a policy may be written indicating that if a person cannot do his or her own occupation, and the limitations are supported by medical evidence, that person may be considered disabled. Another policy may indicate that a person is disabled only if he or she is unable to perform any occupation, not just his or her former work.
Our attorneys can advise you with regard to the terms and conditions of a policy, whether it be before purchasing one or when you are trying to obtain benefits from a policy you already have.
Contact us today for a free consultation.