Video instructions and help with filling out and completing Will 8850 Form Disability

Instructions and Help about Will 8850 Form Disability

Hi I'm attorney Greg Dell here with attorney Stephen Jessup and Steve I want to talk to you about something that's probably one of the top five reasons that we see claim denials and that has to do with the change in definition that comes about in a long term disability policy and that obviously has to do with a change from a known occupation definition usually to in any occupation definition or used to be that you're able to do your own occupation then you can't do a job that pays you more than sixty percent what used to make but for the most part they're usually from your own occupation to any gainful occupation which is very similar to the Social Security disability standard very common in almost every group long term disability policy because you know all of these group disability carriers governed by ERISA make you apply for Social Security disability so they kind of tie that in to say look after 12 months or 24 months of getting paid benefits your definition is going to change so we know that you know a big chunk of the calls we get every week are either I've been denied because they changed my definition or they've notified me they're doing an evaluation of my claim and they're saying that I'm gonna have this change the definition and four or five months what can I do so let's talk about first some things that possibly people could do to prepare for the change in definition to help avoid a denial I think really it's it starts from the beginning of the claim the vast majority of people are going to have jobs that fall in a cementary light-duty capacity so when an insurance company is reviewing you know your ability to do your own occupation during the initial 24 months at the end of the day as much as they're supposed to look at the actual material and substantial duties they usually try to just dumb it down to what those physical demands are of the job so in setting up say you do have a desk level job we do sedentary work from the get-go you're not only trying to necessarily establish it you can't do your particular job but you can't do anything else that would require the same physical abilities a lot of people just kind of take it for granted when the claims approved and think oh two years down the road that's so far away but the reviews that insurance companies are doing start very soon on and then you know within six to eight months before the change full-blown is when they're really going to start looking at it so some of the things you really need to be cognizant what the medical records are saying we've seen a lot where the doctors don't necessarily document all the complaints that are happening or you know there's a standardized software where you click the boxes and there's maybe a little blurb about what's going on so if there's any you know if there if there's contradictory evidence in those records because of a data entry problem compared to what's written insurance companies will look at that or if the if the records aren't documenting much of anything South's silence by you know acquiescence by sounds if it's not there it's not happening kind of things so first and foremost the biggest for any claim and then long term longevity of it is going to be what is in those medical records and so like you said when I look at any claim and we help people apply for benefits all the time then we help them manage their claim I really look at the change of definition as almost starting over again like and often they send it to a new claims adjuster because that's like the way the claims people are trained is okay they got approved for this first thing and then we're gonna look at their medical records every couple months and see if they're still eligible oh and my training as a claim rep now I got this changed definition I'm going to re-evaluate the whole damn thing and see if I can come up with a reason to not pay the claim and you were right the first place is in the medical records well so what we do is obviously we're regularly getting the medical records and we're reviewing them we're also consulting and advising our clients as to how they should be communicating from a medical legal perspective with their doctor to make sure things are documented appropriately in the records because like you said everything is automated I think it's required now by law to have the digital files and a lot of these things have software that go through range of motion you know levels of pain and then the the dermatomes you know do you have loss of sensation on a 1 through 5 scale and often it starts off it not often it does start off that everything's normal so if you have a doctor who's not very detailed and leaves a person who say I got no my fingers you know numbness running down my arm and I have weakness in my hands but the doctor has five out of five for all the symptoms saying there's nothing wrong with you and then where it says musculoskeletal areas do you have any discomfort in the neck the back the shoulders and it says none but yet you do the insurance companies eat that up and the doctor will get it back later after the fact and then oh I know you told me about this isn't that sorry it was my program that defaults to normal so that that's a big thing you know it's very important to review the records and often without representation the doctors are hesitant to