Better Insurance Options from Employers a Major Draw for Millennials

According to a new study, Millennials are more realistic and financially savvy than many give them credit for. The survey conducted by Anthem found that a full 35% of Millennials between 18 and 34 have turned down a job offer at least partially due to dissatisfaction with the insurance options from the employer. This compares to just 27% of respondents of all ages in the workforce.

Millennials are also far more likely than the previous generation to engage in long-term financial planning at 29% among Millennials compared to 19% of 35- to 54-year-olds.

While employers are all increasing their financial wellness offerings, Anthem says that they’re missing an opportunity by failing to improve their insurance offerings as well. A particular form of insurance that Anthem suggests for employers is disability insurance as these policies can benefit employers as well as employees. By integrating disability and medical benefits, Anthem says it can reduce benefits administration costs while helping employees return to work sooner.

Disability insurance offers the greatest benefit to employees, especially those who aren’t paid well and live paycheck to paycheck.

Among survey respondents who didn’t have disability insurance, more than half said it was because it wasn’t offered by their employer and 32% said it was just too expensive.

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Study: Only 20% of Americans Have Disability Insurance

According to a new study commissioned by the Million Dollar Round Table (MDRT), even families who appear financially stable are not always protected against risk. Nearly half of Americans say they could only maintain their existing lifestyle for 3 months or less if they were to lose their primary source of income and even fewer have insurance products like life insurance and long-term disability insurance to protect against risks.

The study found 61% of families would need to assume debt if they lost the primary wage earner in their family while 38% would have at least $10,000 in debt. Just half of Americans have life insurance. Among adults with dependents, 47% say their families would run out of money without their income in less than two years if they were to die.

One key area of financial planning that is overwhelmingly overlooked is the risk of disability or illness. 1 out of every 20 Americans are unable to work due to an illness or disability, but just 20% of Americans have short-term or long-term disability insurance. Only 39% of those who do have coverage think it would be enough to cover their care and medical expenses if they are seriously hurt, disabled, or sick.

Many Americans with long-term disability (LTD) insurance receive it through their employer, although LTD insurance can also be purchased as a private policy. An individual policy may have looser definitions of “disabled,” greater coverage, and flexibility, although these policies are usually more expensive than group coverage.

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Long Term Disability & Mental Health Issues

mental illness ltdIt can be very challenging to get long term disability benefits for mental disorders, even though you may still be eligible. The reason is mental illness typically doesn’t show up on diagnostic tests and the severity of the condition can be difficult to measure objectively.

LTD claims processors are not licensed psychologists and often fail to understand the true limitations of a mental illness. They are typically quick to deny disability claims for mental illness because the disease does not show up on a blood test. Many disability insurance adjusters also fail to understand that many mental illnesses have a cyclical nature, including schizophrenia and bipolar disorder. An insurance agent may assume someone is “cured” because they are not displaying symptoms when this really just means that symptoms have abated temporarily and are almost sure to return.

There is also a strong bias against mental illness in popular culture. This bias extends to some disability insurance agents who do not consider mental disease a real illness.

Mental Illnesses Eligible for Long Term Disability (LTD) Benefits
Many forms of mental illness and impairments can qualify for LTD benefits if the condition prevents you from working and a residual functional capacity test shows functional, social, or intellectual limitations. Qualifying conditions include:
— Bipolar disorder
— Schizophrenia and other psychotic disorders
— Affective disorders like schizoaffective disorder
— Anxiety
— Personality disorders
— Substance abuse disorders
— Organic mental disorders

LTD Limitations on Mental Illness
It’s becoming more common for LTD insurance companies to limit payments for nervous and mental conditions to just two years. This provision is found in almost all employer-provided ERISA LTD plans and many individual LTD policies. With individual policies, it may be possible to buy a rider to remove this limitation in exchange for a higher premium.

Most policies have a limitation that states that disabilities based primarily on self-reported symptoms and disabilities caused by mental illness, drug abuse, and alcohol abuse are limited to 24 months of benefits. This provision defines self-reported symptoms as manifestations you report to your doctor, such as fatigue or pain, that can’t be verified by objective tests and clinical exams. Depression is almost always included in the list of conditions for which benefits are limited to 24 months.

Some mental illnesses are exempt from this limitation in many cases. Commonly exempted disorders include dementia, schizophrenia, Alzheimer’s disease, organic brain disease, and sometimes bipolar disorder. If your policy exempts these disorders from the limitation, you can collect LTD benefits indefinitely as long as you remain disabled.

Documenting Your LTD Claim
To improve the chances of having your claim approved, it’s vital that you properly document your claim and receive consistent treatment from a mental health professional. Your treating doctor should write an explanation about your condition and limitations rather than using the form provided by the insurance company which is designed to elicit responses that allow the insurer to deny your claim. Be sure your doctor explains any limitations you have with:
— Stay on-task all day
— Maintaining concentration and focus
— Avoiding excessive absences
— Responding appropriately to criticism
— Interacting appropriately with the public and co-workers
— Remembering, understanding, and performing simple actions

If you are attempting to file an LTD claim for a mental disorder or your claim has been denied, it’s important to work with an experienced Philadelphia LTD attorney to help document your condition and avoid common mistakes that can get your claim denied. Contact Edelstein Martin & Nelson for a free consultation with a disability lawyer in Philadelphia to get help with your claim.

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Trump’s Budget Director Attacks Social Security Disability As “Very Wasteful Program”

On a recent appearance on Face the Nation, Trump’s budget director, Mick Mulvaney, finished his interview with an attack on Social Security and Social Security disability in particular.

“Do you really think that Social Security disability insurance is part of what people think of when they think of Social Security? I don’t think so,” Mulvaney said. “It’s the fastest-growing program. It grew tremendously under President Obama. It’s a very wasteful program, and we want to try and fix that.”

The truth is that while Social Security retirement enrollment has continued to increase at a steady pace since 2008, disability is far from the fastest-growing Social Security program. It’s not even growing with enrollment that barely expanded between 2012 and 2014 before steadily declining. At a peak in 2014, disability enrollment reached 8.95 million disabled Americans but it had fallen to 8.81 million by last year, dropping about 3% in two years.

Social Security trustees predict disability enrollment will pick up again in the coming years but at an average pace of around 0.5% a year. On the other hand, retirement enrollment is expected to increase from 41.5 million last year to nearly 69 million in 2036, or 66% compared to 11.7% with disability over the same time period.

Calling the program wasteful is also a stretch. The average disabled worker receives just $1,165 per month under Social Security disability for an annual income of just $13,985. That’s hardly more than the federal poverty level of $12,060.

The myth that Social Security disability is a waste and huge amounts of government money go to people who are gaming the system is damaging and potentially complicating the claims process for workers who find themselves disabled. Despite anecdotal evidence, the disability error rate in the program is less than 1%, which includes underpayments and overpayments.

Disability benefits are not easy to obtain, contrary to popular belief, but may involve a long certification process that may take many months. Only around 40% of disability applicants even end up receiving benefits.

Government officials perpetrating these harmful misconceptions can have a very real effect on the 11 million workers and their family members who depend on disability benefits to get by.

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Trump’s Budget Director Attacks Social Security Disability As “Very Wasteful Program”

On a recent appearance on Face the Nation, Trump’s budget director, Mick Mulvaney, finished his interview with an attack on Social Security and Social Security disability in particular.

long term disability appeal“Do you really think that Social Security disability insurance is part of what people think of when they think of Social Security? I don’t think so,” Mulvaney said. “It’s the fastest-growing program. It grew tremendously under President Obama. It’s a very wasteful program, and we want to try and fix that.”

The truth is that while Social Security retirement enrollment has continued to increase at a steady pace since 2008, disability is far from the fastest-growing Social Security program. It’s not even growing with enrollment that barely expanded between 2012 and 2014 before steadily declining. At a peak in 2014, disability enrollment reached 8.95 million disabled Americans but it had fallen to 8.81 million by last year, dropping about 3% in two years.

Social Security trustees predict disability enrollment will pick up again in the coming years but at an average pace of around 0.5% a year. On the other hand, retirement enrollment is expected to increase from 41.5 million last year to nearly 69 million in 2036, or 66% compared to 11.7% with disability over the same time period.

Calling the program wasteful is also a stretch. The average disabled worker receives just $1,165 per month under Social Security disability for an annual income of just $13,985. That’s hardly more than the federal poverty level of $12,060.

The myth that Social Security disability is a waste and huge amounts of government money go to people who are gaming the system is damaging and potentially complicating the claims process for workers who find themselves disabled. Despite anecdotal evidence, the disability error rate in the program is less than 1%, which includes underpayments and over payments.

Disability benefits are not easy to obtain, contrary to popular belief, but may involve a long certification process that may take many months. Only around 40% of disability applicants even end up receiving benefits.

Government officials perpetrating these harmful misconceptions can have a very real effect on the 11 million workers and their family members who depend on disability benefits to get by.

If you are in need of assistence for Social Security disability insurance, then contact the best disability insurance attorneys in Philadelphia, which is Edelstien Martin & Nelson. Contact them today to discuss your case.

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Own Occupation vs Any Occupation Disability: What You Should Know

back painWhen it comes to long-term disability insurance, few areas are as confusing and difficult to overcome as how the insurance policy defines a disability. Disability insurance falls into two primary categories: own occupation policies and any occupation policies. The type of policy you have will have a dramatic impact on whether the insurance company even considers you disabled. Here’s what you should know about the difference between these two types of disability claims.

What is Own Occupation vs Any Occupation?
When the policy covers “own occupation” disability, it means your policy requires that you be unable to perform the duties of your particular occupation to be classified as totally disabled. More commonly, disability insurance uses the “any occupation” standard. This means disability is defined much more broadly to the inability to perform any occupation for which you are reasonably suited based on your work experience and education.

With most long-term disability group insurance policies, the policy offers benefits under the “own occupation” disability definition for the first two years. To continue receiving disability benefits, you must be considered disabled under the “any occupation” standard.

Without the “own occupation” coverage, you face the risk that the insurance company may decide you could work in some other capacity. This is especially important if you have a high level of skills or training that could lead the insurance company to determine you are able to work in another occupation, even if you would be unable to perform your current job.

What is Your Own Occupation?
While the “own occupation” clause is fairly specific in terms of defining your disability, it does leave room for question. An experienced LTD attorney will argue that your policy’s “own occupation” definition should be limited to the exact work you were doing at your job when you were hurt, not an occupation performed in a similar setting in the general industry in which you worked.

There are also two types of “own occupation” clauses: one states that you are disabled when you can no longer perform the duties of your own job but you are not gainfully employed in another area, while a “true own occupation” definition just means you can’t perform your own occupation. In the latter case, you can still find employment in another industry without sacrificing your disability benefits. This type of “own occupation” clause is most favorable but it’s rarely found in group insurance plans.

The “own occupation” clause is an important form of protection as it can also give you the ability to work in another field if you can. If you find work in another industry, you can still receive long-term disability benefits under this clause without negative consequences. As an example, a surgeon who is determined to be totally disabled and unable to perform his or her own occupation could work as a general practitioner and still receive disability benefits.

Understanding how your insurance company defines disability is crucial and every insurance company is different. It’s important to work with a long-term disability attorney who has extensive experience handling LTD claims to help you build a strong case. Contact Edelstein Martin & Nelson today for a free consultation with a Philadelphia long-term disability lawyer to discuss your case.

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The Case of Del Gallego versus the Plan on the Offset of Disability Benefits

John Del Gallego, an employee, was injured at work and granted permanent partial disability (PPD) workers’ compensation benefits. The Plan, Wells Fargo and Company Long Term Disability Plan and insurer Metropolitan Life Insurance Company (MetLife), offset such award by the amount of John’s long-term disability benefits. The employee filed suit under Employee Retirement Income Security Act (ERISA), 29 USC  § 18, against the Plan and MetLife, saying that the offset was improper. Judge Vince Chhabria of the Northern District of California granted summary judgment to the plan and MetLife, but Del Gallego appealed.

“Other Income Benefits”

The Plan incorporates group certificate of insurance, which was issued by MetLife. It provides long-term disability benefits reduced by other income benefits, which it defines as including workers’ compensation or similar law. It also states that periodic benefits, substitutes and exchanges for periodic benefits will all be accounted.

The court interprets ERISA terms in the popular and ordinary sense, as would a person of average experience and intelligence. The Plan’s plain language provides that a covered worker’s long-term disability benefits will be reduced by periodic compensation benefits and the district court did not err in interpreting the Plan.

Russell versus Bankers Life Case

workers comp benefits and justice for allHowever, Del Gallego argues that other income benefits are only the ones paid for lost wages and includes only temporary disability payments. He relies on the case of Russell versus Bankers Life Company, but this involved a contract defining income from other sources as any payment under Workmen’s Compensation Act providing benefits for loss of time from employment. Since the Plan does not limit other income benefits to loss of time from employment, the case is inapposite.

Del Gallego’s Arguments

Del Gallego also cites the workers’ compensation phrase as ambiguous since a reasonable person would not anticipate that payments for the worker’s future would be offset from the disability insurance benefits. However, Plan’s language unambiguously covers all compensation benefits. The employee also asserts that because the Plan asks for proof of the amount attributable to lost income when a worker receives other income benefits in lump sum and not in monthly payments, reduction should be limited to the portion of the lump sum attributable to the income lost. He cites the provision only applies to lump sum and not to periodic benefits, so the Plan did not offset the lump sum compensation settlement that he received against his Plan benefits.

Del Gallego also asserts that even if his weekly permanent partial disability benefits were for loss of future earning, these are not income. Additionally, the term periodic benefits are ambiguous. Since the Plan has particular language exempting lump sum payments from the setoff, it is impossible to interpret periodic payments as lump sum payment.

The Panel’s Decision

The Ninth Circuit US Court of Appeals panel rejected the arguments of John Del Gallego that partial permanents disability benefits were not income and that periodic benefits is facially ambiguous. Del Gallego was represented by Laurence F. Padway while Rebecca Ann Hull represented the Plan and MetLife.

If you are in need of a personal injury attorney in Philadelphia, Pa, then you should call Edelstein, Martin & Nelson at http://www.philadelphiadisabilityinsurancelawyer.com/ or you can call them at the following number (215) 731-9900 and schedule an appointment to sit down and discuss your case.

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Long-Term Disability Risk Increases After Seniors Visit ER

working seniorAccording to a new study, older adults who are treated in an ER for an injury or illness are more likely to become less agile and more disabled over the next six months. The study, published in the Annals of Emergency Medicine, was a follow up on research that found seniors suffer from reduced physical agility and disability after hospitalization.

During the study, researchers tracked more than 750 patients aged 65 and older over 14 years, including some adults who were treated in an ER and some who were not.

Researchers discovered that seniors who were discharged from an emergency room were more likely to be living in a nursing facility, become disabled, or die over the next six months compared to seniors who were not treated in an ER.

The extra cost for medical care and long-term care for newly disabled older adults is estimated at $26 billion per year. One strategy to potentially address the issue may include employing geriatric advanced practice nurses to assess older patients’ risk for decline.

Last year, a separate study found that more seniors are working now than any time since the turn of the century and today’s senior workers spend more time on their jobs than their peers. Almost 9 million people, or 19% of seniors in America, were employed part- or full-time. The number of older men and women who are in the job market has grown over time, although working during what many consider the retirement years still largely affects men.

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Nurses At High Risk of Workplace Injuries

nurse disability claimsWhile nursing may not be at the top of the list of most dangerous occupations, nurses still face higher-than-average risk of health complications due to their career and they are more likely to suffer overexertion injuries than most professionals in Pennsylvania.

Nurses working in Philadelphia hospitals, care facilities, and nursing homes play an important role, but many at some point face health problems due to their job that prevent them from working.

Nursing Is a Physically Demanding Job
Nursing is a very physical career that often requires strenuous tasks such as moving patients. According to the New York Times, the average nurse works a 12-hour shift that can feel even longer due to the physical strain. The same article reported that 75% of nurses suffer a strain or sprain in the workplace and about 50% of all nurses experience lower back pain or injuries within any given year.

Nurses are at a higher risk for a variety of potentially disabling injuries, especially overexertion injuries caused by sudden or repeated trauma or exertion. Nurses who work in a hospital are twice as likely as other workers to suffer these injuries while nursing home workers are three times as likely to suffer an overexertion injury.

In addition to the physical demands of the job, nurses and other healthcare shift workers are at a higher risk of sleep disorders, heart disease, diabetes, and stress than the general public.

Sometimes injuries sustained by nurses can be shown to be a work-related accident and qualify for workers’ compensation, but this can be very challenging in some cases, especially with heart disease and back injuries. Nurses who have become disabled and unable to work may qualify for workers’ compensation and/or a long-term disability claim. If you are unable to work and need help filing an LTD claim or appealing a decision, an experienced LTD attorney in Philadelphia can help.

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Canadian Study Finds Link Between GDP And Long-Term Disability Claims

philadelphia LTD claimsIn a pioneering study conducted by Canada’s RBC Insurance, a link has been found between long-term disability (LTD) claims and GDP. The link is counter-intuitive, showing that long-term disability claims actually rise with economic growth. When GDP falls, LTD claims do as well.

It may seem odd to find claims increasing when economic times are good, but RBC Insurance believes it’s a similar phenomenon to adrenaline rush stressing the body.

“During challenging or uncertain economic times, workers are worried about job security and performance, creating significant mental and/or physiological stress,” RBC Insurance said in a statement. “As GDP rises and the economic outlook brightens, workers begin to feel more secure and that pent up stress and anxiety takes its toll, which results in them succumbing to illness and taking a leave from work to recoup.”

As with the United States, most LTD claims are related to stress, including mental and nervous system disorders like depression and circulatory disease like heart attacks and stroke, not workplace accidents and physical impairments as many believe.

The correlation was found after studying six years’ worth of data from more than 300,000 group benefit clients. RBC Insurance says it’s created an algorithm for companies to predict disability rates up to two years ahead.

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