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Is This the Wrong Time to be Disabled in America

  • Published: 2010-11-11 (Revised/Updated 2013-06-13) : Author: Allan Checkoway Author, Getting Paid
  • Synopsis: The increasing incidence of disability in recent years has increased the need for quality Disability Income protection even more.

Main Document

"If you're just in the process of filing your disability claim the first time around, we urge you to do all your homework."

Isn't it time to stop tens of millions of dollars of disability benefits from being denied, unnecessarily.

Tens of millions of dollars in disability benefits go unpaid by private insurers. Over 40 states jointly investigated how one insurer handles their disability claims. Another state set up a system to scrutinize the handling of every rejected claim. What led to the dramatic change in the handling of disability claims? Or has anything changed at all and there's just more adverse publicity

22,500 Veteran's PTDS disability claims denied as personality disorders, as reported in USA Today... How is it possible that a personality disorder (assuming it existed prior to military service) is diagnosed when psychological evaluations aren't done prior to induction? Each year tens of millions of dollars in Insurer, Social Security and Veterans Administration disability claims continue to be denied.

The increasing incidence of disability in recent years has increased the need for quality Disability Income protection even more. Over a two decade period, due to improvements in modern medicine, the four leading killers of people between ages 45 and 65... heart disease, hypertension, diabetes and cerebrovascular... resulted in a 32% reduction in mortality. However, there was a 55% increase in chronic long term disability from these very same causes! And this study was completed before the onset of some relatively new causes of long term disability... Chronic fatigue and carpal tunnel syndrome and Fibromyalgia.

Be aware that some insurers have begun to offer disability coverage with restrictions for these conditions, that they refer to as "self reported" disabilities.

Self-reported symptoms means the manifestations of your condition, which you tell your doctor, that are not verifiable using tests, procedures and clinical examinations standardly accepted in the practice of medicine. The symptoms of self reported disability usually include body aches, fatigue, difficulty concentrating, digestive disturbances, insomnia and poor memory. These symptoms can be debilitating but are usually too generalized to attach to a specific diagnosis.

The "self reported" disabilities (fibromyalgia, carpel tunnel and chronic fatigue syndrome) frequently have depression as a symptom. One insurer reported that M/N claims represented 10 percent of their claims in numbers but costing over 30 percent in claim dollars.

To continue, in recent years, mental & nervous disorder claims have increased the risk of disability to even more alarming levels. The majority of Group Long Term Disability (LTD) programs in existence have a standard two year limitation on mental and nervous disorder claims. Full benefits are available for the first two years of disability. Thereafter, benefits can be continued if the claimant is "institutionalized", confined to an institution that specializes in the treatment of such disorders. Therefore, there is already a significant restriction in most group LTD programs that accounts for the added risk of mental/nervous disorder claims.

Let's look at why the disability insurers automatically provide this exclusion period... one major insurer saw an 85% increase in psychiatric disabilities over a five year period. Plus, a minimum of 10 percent of their claims result from some form of psychiatric disorder. Moreover, in another study, approximately half of the total claims reviewed have a psychiatric disorder as a contributing cause of disability.

Does the Disability Safety Net have holes in it? If more than 60 percent of Social Security disability claims are denied initially, then why are 63 percent approved at the hearing stage? What causes the turn around? Unfortunately 39 percent of claimants give up before determining if they would be successful going through the appeal process!! Using the 60+ percent frequency of Social Security claim denials, let's examine the some issues.

First and foremost, there's three hurdles to overcome. The waiting period before benefits begin is after six months of Total Disability. And, the disability must be expected to last 12 months or longer. Most applicants consider themselves "disabled" but they won't be in the eyes of the Social Security claims examiner. They're not disabled "enough".

As we've already mentioned, the 60 percent Social Security initial disability claims denial rate reverses to 63 percent approved at the hearing stage. Regrettably, we can assume that knowing that 39 percent of claimants gave up the appeals process; a significant percentage of this group might successfully gain approval had they hung in there longer.

We can't know for sure, we can only assume, that this "reversal of fortune" meant they did their homework better the second time around. They had to have provided better "evidence" to support their disability. "Evidence" could come from a new medical specialist who irrefutably supported their degree of disability. They might have asked their doctor to see what he/she reported to Social Security. They discover their physician attested that they're disabled from their former job but they're still capable of working at some job.

The Social Security disability claim denial rate increasing from 39 percent to 62 percent is well documented. We've been unable to develop similar statistics for commercial disability insurers and the Veterans Administration. Having worked for one major disability insurer for two decades, I can assure you the claims examiners have "toughened up".

Relative to VA disability claims, we have a never ending stream of Veterans returning home suffering from PTSD. With the war debt now approaching the TRILLIONS, it doesn't surprise me when I read the headlines. USA Today reported on '22,500 Veteran's PTSD disability claims denied as personality disorders'. Plus, there are the unconscionable delays. The Associated Press told us that 'Soldiers risk ruin while awaiting benefit checks.' And the Washington Times called our attention to the 'Federal Disability Traffic Jam'.

Plus, it's well known that heart conditions and cancer frequently have depression as a component. Too often the heart or cancer patient recovers from their primary disability but have trouble alleviating Mental/Nervous disorder complications.

Passing McDonald's yesterday reminded me of one other disturbing fact. One mom recently sued her local McDonald's on behalf of her obese son. Her claim was that McDonald's food made her son over weight. Point being, we're living in a HIGHLY litigious society. It's been said that there's an attorney for everyone.

In summary, our purpose was to stress that there are literally TRILLIONS of dollars of disability benefits being turned down annually. There are at least 10 or more common reasons why this occurs which we can't cover within the confines of a single article.

If you're just in the process of filing your disability claim the first time around, we urge you to do all your homework. When you don't and your claim is denied, the appeals process can best be described as onerous the "second time around". Again, do your homework and "do it right the first time" - www.eldercaresurvival.com

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