Private disability benefits are basically insurance contracts. There are individual policies (which you secure on your own) and group policies (when you acquire your coverage as an employee benefit). Policies are written for short term benefits (usually 3-6 months) and long term benefits (usually after a waiting period and continuing to age 65).
If you have private disability insurance coverage through your employer, obtain a copy of the policy handbook and read through it.
If you think you may need to file a claim for benefits under one of these policies:
- Be sure you will have the active support of your doctor(s). Don't assume that you will. You will need the support of your doctor(s) far more than the advocacy of an attorney. These claims are primarily medically based, not law based. Before applying for these benefits make sure your doctor will support you and understands that he/she will need to comply with documentation requirements of the insurance company.
- Be sure that your treatment notes reflect the true nature of your symptoms and functional limitations. Be specific in describing your symptoms and functional limitations to your doctor(s).
- Get advice from a disability attorney before you apply
Qualifying for these benefits is always uncertain. In very few cases can a favorable decision be taken for granted. Much is riding on the result of the disability determination. Approach the application with care and attention.
If your claim is denied, you will have the right to appeal. Unfortunately, the appeal is almost always an internal review with the same insurance carrier that denied the claim initially.
If your claim is denied, contact a disability attorney immediately.
Appeals are difficult, but often successful if there is active support from your doctor(s)
If the appeal to the insurance carrier is denied, a further appeal to court is available.
If you have been approved for private disability benefits, do not assume you will continue to receive those benefits. Insurance companies are profit motivated. Your benefits can be cut off at any time if the carrier determines you no longer meet the definition of disability.
Many policies change the definition of disability after 24 months and therefore benefits often are terminated at that time. While receiving benefits you need to continually document your symptoms and functional limitations with your doctors in anticipation of an attempt by the insurance carrier to terminate your benefits.
Most private disability insurance policies require you to apply for Social Security benefits as a condition of receiving the policy benefits. This is legal and can have advantages for you.
Attorney fees for private disability cases
Most private disability cases are handled on a fee for service basis rather than a contingent fee (which often results in a windfall fee for the attorney). The current fee rate is $275.00 per hour. The normal initial retainer fee ranges from $1,500.00 to $4,000.00. All unused retainer fees are refunded to the client. An initial telephone consultation is provided as a courtesy. Office appointments and review of documents are normally billed at the hourly rate.
If you or someone you know has any questions about disability benefits, call the Disability Benefits Law Center for a free consultation at: 267-622-4475 or email us. The Disability Benefits Law Center maintains offices in Center City Philadelphia and Jenkintown. The Disability Benefits Law Center focuses its practice exclusively on Social Security and private disability matters.
