Does Short-Term Disability Transition Into Long-Term Disability?

Have you been injured and now you want to see what benefits you qualify for in regards to short-term or long-term disability? You have options. The problem is, many people don’t understand how the transition works when you are moving from short-term disability to long-term disability. The truth is, some people will not make it past short-term disability, as they may not have an injury severe enough to keep them out of work for several months or years. But what happens if your injury is extremely severe and you are wondering how to make the transition?

From Short-Term to Long-Term Disability

long term disability appealShort-term disability is supposed to support you financially, of course, for a short amount of time. This type of disability will usually provide benefits to you for the first 3-12 months of your disability. But what happens if you have to move past that? This happens in cases where you have sustained a severe injury. Sometimes a doctor is unsure of how a treatment plan will work over a year’s time and can’t give you a statement right off the bat on how long you should expect to be out of work. But if your short-term disability is running out of time and you are still suffering from your injury, there is a good chance you will receive long-term.

After your short-term benefits have concluded, therefore, you will transition into the approval for long-term benefits. Usually, the insurer will administer both short and long-term benefits in the same way. If you are eligible for one, you will probably be eligible for the other if you need more time to recover. The only difference is that sometimes the transition can be difficult because of this element: When short-term disability ends, you might end up having to go through the whole process of applying for long-term all over again. Going through a new claim can be time-consuming as you work to prove your disability and gather documents that support what you have experienced.

Luckily, at Edelstein Martin & Nelson, we can get you proven results when you are suffering from a disability and need urgent help with your case. No matter your disability, uncommon or common, we have worked a variety of cases and want to see you gain results and make your transition as easy as possible.

Why It’s Important to Act

All too often, employees say things like, “It won’t happen to me” and sadly, it does. Getting injured on the job can happen to anyone in the blink of an eye. Many people wait until it’s too late and an injury occurs, and then find out the hard way that long-term disability insurance has a waiting period of 3-6 months before you’re able to secure benefits. As such, you should always act, because short-term disability can pick up and leave you in a better position while you wait. This is why it helps to talk to your employer and stay prepared for any event.

Are you looking for more information on how long-term disability insurance can benefit you? If you live in or around the Philadelphia area and you have been injured, you have rights to compensation for your injuries, and one of these benefits could be a long-term disability if your injuries were especially severe. Call us today at Edelstein Martin & Nelson for more information, at 800-300-0909.






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Moving to Health Improvement: Will I Lose My Benefits?

If you qualify for long-term disability benefits because of a serious injury, you may feel a sense of accomplishment and peace knowing that your benefits will protect your best interests and keep you from going into debt over medical bills and more. But what happens if your benefits are cut suddenly due to a variety of reasons? Are there reasons for your benefits to end? Today we will discuss some of these scenarios to prepare you in case any of these circumstances happen to you.

Reasons for Losing Benefits

denied disability claimHealth Improvement: It is obvious that, if your health improves, you will no longer qualify for long-term disability benefits. These programs are available to those who are suffering from severe impairments due to injury on the job. Long-term disability, for instance, is for those who are expected to be disabled for quite some time, usually longer than a year. If your health improves and your doctor believes that you are able to return to work, you may be able to re-enter the workforce without issue, which could lead to a decrease or cut-off of your benefits.

Most often, your eligibility will all depend upon the health status and a review of your status over time. If your health improves, then you could be disqualified from benefits.

Earning Too Much Income: If your health has not improved but you are earning enough money, you could lose your benefits. You may even go through a trial period where you must return to work for a period of time so that you can be monitored to ensure that you are actually able to return to work.

The same can occur if your household income changes as a whole. If you are married and your spouse starts making more income, then you could lose your benefits. You could also be disqualified if you start to receive benefits from another person’s earnings in other ways.

Retirement Benefits: If you have reached retirement age and you start receiving retirement benefits at your qualifying age, you may no longer qualify for long-term disability.

Moving Outside of the Country: If you move outside of the United States, you could lose your benefits as well. In many cases, other countries prohibit you receiving these benefits, though this is subject to the country’s discretion, which is why you should always make phone calls.

Long-term disability is important to you and your lifestyle, which is why you should always follow all the rules that coincide with your benefits and understand them at-length so that you do not risk losing them in your time of need. Understanding these regulations can sometimes be a difficult procedure and you may need help in every aspect. Call the disability lawyers who can help you in your time of need at Edelstein Martin & Nelson. We are waiting to hear from you at 800-300-0909.




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Is it Difficult to Obtain Long-Term Disability for Fibromyalgia?

If you are dealing with complications from fibromyalgia, you know that you may be eligible for long-term disability. But what is fibromyalgia? This disorder causes aches and pain in many areas of the body, from the neck, shoulders, back, and hips, to the arms and legs that ache badly when pressure is applied to them. Some of the other symptoms that become present in cases of fibromyalgia are cognitive and memory problems, trouble sleeping, morning stiffness, headaches, IBS, painful periods, restless leg syndrome, sensitivity to temperature, and more.

The truth is, there are many, many cases of fibromyalgia, making it a pretty common disorder. It affects as many as 5 million Americans who are over 18. Most are women who have been diagnosed during middle age and it usually occurs with other types of autoimmune diseases, like Rheumatoid Arthritis and Lupus. In most cases, other diagnoses are believed to afflict a patient before a doctor lands on a diagnosis of fibromyalgia.

Fibromyalgia: Subjective Claims?

fibromyalgia lawyerMany people believe that the symptoms of fibromyalgia are subjective. One of the reasons for this is because the disorder can only be recognized by a doctor, but not through diagnostic testing. The only way that it can be found is when doctors have ruled out every other condition and came to no conclusion. To be diagnosed, you must have pain and symptoms that last over three months, usually lasting in the same spot on both sides of the body. You may even have up to 18 tender points on your body, which a doctor will look at to make their diagnosis. The issue is, many people don’t tend to see fibromyalgia as a “real” condition, and say that their doctors do not consider their pain or disability examiners deny that it is legitimate.

What the Insurance Company Might Say

In some cases, an insurance company may claim one of the following things: They may say that you do not have fibromyalgia, your fibromyalgia does not make you functionally impaired, you are not getting proper treatment, it has been identified that there are jobs you could still work at, or a physician determined that your restrictions and limitations are no longer there, making you able to work. The fact is, it is your job to prove that the insurance company is wrong for thinking that way and you actually have limited abilities at work, making you a candidate for long-term disability. You must be able to support these conclusions with evidence, such as documentation from seeing another physician. This is why it is a good idea to always seek a physician who has experience with these cases and can take a closer look at the effects it has on your life.

If you are attempting to gain long-term disability for fibromyalgia, your best bet is to seek medical attention and talk to them about the limitations you have with work due to your condition. Moving forward may be a difficult journey at first, but it doesn’t have to stay that way. At Edelstein Martin & Nelson, we want to help you get the benefits you need. Call us today at 800-300-0909 to get started.




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Can Any Aspects Affect How Much Long-Term Disability I Receive?

The first thing many people wonder when they have been afflicted with a disability is: How much will my long-term disability benefit be? The truth is, every policy is very different from the next, so it is sometimes difficult to place a specific dollar amount. Most LTD plans will allow you to collect anywhere from 50-80% of what you were making with your salary. However, not every LTD plan will take your monthly salary into account – sometimes they will provide you with a fixed amount. There are also factors that can slightly influence how much LTD you will receive every month.

Factors That Affect Your LTD

disability insurance lawyerPartial Disability: Perhaps, even though you have sustained a long-term disability, you are still able to work – just not as much as last time. You may be making a huge amount less than what you made before you sustained your injury. You may have the opportunity to file for something known as partial disability benefits. Partial disability benefits cover things like compensation for lost wages due to the injury because of having to basically downgrade your job and work less, for less money. If you have qualified for partial disability, your LTD payments will be reduced in proportion to the amount of work you are still able to complete at your job. You could still, in turn, be receiving a decent amount in LTD. at

COLA: Long-term disability takes something known as the cost of living adjustment (COLA) into consideration. This is Social Security’s way of taking a look at the increases in the cost of living. If you have a LTD policy that contains COLA, your benefit amount each month will be measured with inflation in mind. This could leave you with an increase in amount, such as anywhere from 1-3% a year.

Offset: In most cases, if you qualify for LTD, you must apply for other benefits as well – like Social Security Disability. If Social Security finds that you are indeed disabled, they will begin to cover you and your LTD benefits could be reduced. In fact, LTD could take some of your Social Security benefits to balance things out. Either way, you are getting what is owed to you.

Policy Premiums: You will usually not have to keep paying premiums if you receive LTD.

Taxes: You may wonder if your LTD benefits are taxable. This can become a complicated matter. In most cases, your plan will be paid for by your employer, so LTD benefits are treated as taxable income. If you bought the plan yourself, you have a higher chance of not owing taxes.

Sometimes gaining LTD is a difficult concept. You may end up receiving short-term disability insurance for some time before your LTD benefits begin. In other cases, your employer may require that you have worked for them for a certain amount of time before your benefits take place. Because there are so many questions concerning your benefits that you may have, the best thing you can do is turn to an attorney who can help you. Call us at Edelstein Martin & Nelson at 800-300-0909 or 215-731-9900 for more info.






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Can Mental Illnesses Like Depression Really Lead to Long-Term Disability?

As many of us already know, there are huge consequences for negative stress, eventually leading to depression and so much more. Depression is a very real illness, even though people who do not experience it may deny this fact and argue this is not true. When you have depression, you know that you have more than just sadness that wears off after some time, such as when the event corrects itself. Doctors tend to diagnose it as “depressive disorder” or “clinical depression.” Some of the symptoms include a persistent sad or anxious mood, feelings of hopelessness, feelings of guilt or worthlessness, loss of interest in hobbies, decreased energy, fatigue, irritability, thoughts of suicide, and more.

depression long term disabilityThere are actually many different types of depression, too. For instance, you may experience major depression, which could interfere with your ability to work, sleep, enjoy life, and more. A persistent depressive disorder is a depressed mood that lasts for at least two years, with severe episodes coming and going. Psychotic depression occurs when depression meets psychosis, which leads to hallucinations and delusions. Postpartum depression takes place after you have a baby, which up to 15% of women experience. A seasonal affective disorder is a depression that takes place over the winter months when there is not enough natural sunlight. And, lastly, bipolar disorder is a mental illness all on its own, but it causes depression and extreme high moods as well.

Biased Opinions

Sometimes, it may be difficult to achieve long-term disability when you are struggling with depression and many other mental illnesses, because disability examiners that work for Social Security may not have experience with mental illnesses like a psychiatrist would. Even if you are not currently displaying symptoms, it does not mean that you are not suffering, and this is something that an examiner might miss. Some examiners are also biased against mental illness claims because they believe that they are lazy or faking their mental illness for benefits. We understand that claims are denied far too often for this very reason.

In fact, you could be delaying your long-term disability for one of these five reasons:

  • You are not getting regular care from a family doctor, even though the key to achieving disability is to show that you and your doctor are working together
  • You are not being seen by a psychiatrist, which is used as a way for the insurance company to say that your anxiety must not be all that bad
  • You haven’t attended recommended psychological treatment to see if it would help with your illness
  • You are receiving a poor standard of care and just haven’t received the best treatments
  • Your treatment is not being documented properly

If you want to improve your chances of obtaining long-term disability when depression or another mental illness has taken hold in your life, you should always be under the care of experienced healthcare professionals, as it will help your case in the long run. Your long-term disability carrier will typically speak with these professionals to get a better idea of what you are struggling with. Because we want to help you protect your rights, we want to talk to you as soon as possible about your case. At Edelstein Martin & Nelson, we want to get you the best results when you believe you are entitled to long-term disability. Call us today at 800-300-0909 or 215-731-9900.




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When Long-Term Disability (and Not Short-Term) Becomes Necessary

Why do many people turn to long-term disability? Perhaps a workplace injury has impacted more than your health, making your everyday life a difficult battle. Not only could you miss time at work, which could result in lost income, but you may also have a variety of medical treatments to attend. Nobody plans on becoming disabled, but unfortunately, it could happen to us without notice. Long-term disability insurance is intended to make many of these matters easier on you by covering a portion of your income when you are disabled. If you have become disabled due to an injury you may ask: Why should I consider long-term disability instead of short-term?

Seeing the Differences

disability insurance lawyerPerhaps you have been injured and now you’re facing the possibility of short-term or long-term disability insurance. You may wonder what the differences are between the two. Disabilities are more common than you think due to workplace accidents. For instance, the Council for Disability Awareness has compiled statistics regarding disabilities and how frequently they occur. The average worker has a 30% chance of becoming disabled in the workplace, and about 12% of the population (and growing) already receives disability benefits today. Workplace injuries are causing more and more workers to become disabled every year.

Short-term disability insurance provides coverage for only a limited amount of time, after a short waiting period. Most of the time, this insurance coverage gives you enough time to recover, spanning from a few weeks, to a few months, to a year at times. You will be given a maximum coverage amount for a limited amount of time. Long-term disability, on the other hand, gives you a lot more freedom if you have sustained the most serious of injuries.

With a long-term disability claim, you will prove that you are disabled due to being unable to perform the duties of your job because of the injury you’ve sustained. Your treating doctor will give an opinion about the state of your injury or illness and the claims administrator will take a look at your disability to make their final decision. Some of the notes and documents they will look at are notes left by a doctor, lab results, x-ray results, surgical reports, and more. Perhaps you can also show that your disability is ongoing and that you are still receiving treatment and, if this is the case, you are more likely to get the long-term disability benefits you deserve.

Some of the main injuries and illnesses that call for long-term disability insurance every year include musculoskeletal disorders, cancer, poisoning illnesses, cardiovascular disorders, and mental disorders. You may find that waiting for long-term disability benefits can take a longer time to process, but in the end, you will be able to receive benefits for years.

So, in the end, which is right for you depending on your injury? There may be no doubt that your injury is going to cause you turmoil and hardship for years to come, and so long-term disability may be your main consideration. It doesn’t hurt to ask for assistance in making this decision by calling an insurance lawyer with a focus on long-term disability. Call us today at Edelstein Martin & Nelson at 800-300-0909 or 215-731-9900.






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A few helpful facts about long-term disability claims

The benefit of long-term disability insurance is often offered by an insurance company or employer.  It includes monthly payments to covered workers who cannot perform their work duties due to medical reasons.   

Most often, a long-term insurance care policy will require the policyholder to apply for Social Security benefits.  Benefits will usually be reduced depending upon other sources of income such as Social Security disability, worker’s compensation, or accumulated retirement or sick leave.  Our attorneys can help you with the process of filing a claim for Social Security disability benefits or Worker’s Comp.  

Even though your disability might have begun as a short-term disability, it has now turned into an extended, long-term disability that has led you to be impaired to the point of being unable to work.  We will guide you through the process of recovering long-term disability benefits by documenting your disability.

long-term disability claims lawyerIn the event that you are denied benefits, it’s always a good idea to file an appeal.  We assist clients with the appeals process as well as clients who were approved at first and then later had their benefits stripped of them.  If you have lost benefits or are currently seeking an appeal to a decision, our attorneys can help.  We have years of experience in disability benefits applications and appeals.  

Get a copy of your policy

You should obtain the policy itself before even thinking about filing a claim.  Your employer’s human resource department will send you a plan and its descriptions.  If your policy is an individual one, contact your insurer.  Request all relevant documents and go over them carefully.

Disability policies involve stringent deadlines relating to filing the initial application and any subsequent appeals.  Missing a single deadline allows an insurer to deny your claim regardless of all other factors, so be sure to submit everything on a timely basis.

Defining a disability

While no single definition of disability exists, it’s generally defined by insurers as being unable to perform the duties of one’s own occupation due to injury or illness.  This often means that you only need to prove that you cannot do your particular job, although certain policies do define disability as in inability to work at all.

Obtain medical evidence to support your claim

Opinions of your doctor coupled with documented medical records will be two of the most important pieces of evidence for your case.  After filing a claim, your insurance company will do these things themselves.  Ask to see your claim file for yourself so you can ensure all necessary information is present.

Ask your doctor to write a note that contains details about your medical history and current limitations.  Do not sit back and rely on the insurance company to do anything for you.  Be sure your doctor gives specific medical details as to why you have been disabled.

If you have a long-term disability claim to file, or have been denied benefits and need to appeal, contact our skilled and dedicated attorneys today.





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How does the Social Security Administration evaluate mental illness with regard to disability cases?

Many applications for Social Security disability cite mental illness as the primary cause of disability.  In addition, physical ailments can come with unseen psychological consequences.  Painful chronic conditions can take a toll on an individual both emotionally and psychologically.  Many of these cases get denied and wind up going to a hearing.  

There are three basic things needed by the Social Security Administration in order to proceed with evaluating your mental disorder.  First, they require documentation of a severe and lasting mental illness.  Then they must be able to consider whether or not your mental illness impairs your capacity to work, and to what extent.  Finally, they must also consider whether or not that limitation has lasted for at least twelve months.

Mental conditions considered by the SSA

SSI mental conditions What kinds of mental illnesses does the Social Security Administration consider in disability cases?

There are nine general diagnostic categories set forth by the Social Security Administration.  They include:

  • 12.02 Organic mental disorders.  This category includes a disabling mental state that can be directly linked to a specific biological (organic) abnormality in the brain that leads to impaired functioning.  For example, a severe head injury that caused permanent brain damage.
  • 12.03 Psychotic disorders.  The most well known psychotic disorder is schizophrenia.  Psychotic disorders involve a decrease in functioning from previous levels.  
  • 12.04 Mood disorders.  Mood disorders are just as they sound – disturbances of mood.  The most common mood disorders include severe depression and bipolar disorder.  A mood, in this case, is considered to be a long-lasting emotion that overshadows the entire psychic life of an individual.
  • 12.05 Retardation.  Retardation involves less than average intellectual capacity.  Deficits in adapting to normal functioning that usually first occur during early development.  Specifically, evidence must exist to support the fact that the impairment began before twenty-two years of age.
  • 12.06 Anxiety disorders. Anxiety disorders can involve either generalized anxiety or a manifestation of anxiety when an individual tries to mask other symptoms.  Confronting the object of a phobia or attempting to resist compulsions related to obsessive-compulsive disorders are two examples.
  • 12.07 Somatoform disorders.  Somatoform disorders are those in which physical symptoms arise from no known or perceivable biological mechanism.
  • 12.08 Personality disorders. When maladaptive personality traits become inflexible and result in decreased occupational or social functioning, the individual is said to have a personality disorder.  Maladaptive personality features must be sustained over a long period and not be limited to isolated instances.
  • 12.09 Substance abuse disorders. Physical or behavioral changes the arise as a result of consistent use of substances that impact the nervous system.
  • 12.10 Autism Spectrum Disorder and other developmental disorders. These disorders involve deficits in social interaction, delayed development of communication skills and imaginative activity.  Limited activities and interests, often of a repetitive nature, are also common hallmarks of these disorders.

There are several other conditions that must be met in addition to having one of these disorders.  If you need disability benefits stemming from mental illness or any other condition, contact us today.




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Applying for SSDI Benefits

Coping with disabilities presents many challenges.  If you have been disabled to the point of not being able to work or function on a daily basis, then of course you must find a way to get by.  The Social Security Administration (SSA) allows those who have been disabled to seek benefits through the Social Security Disability (SSD) benefits system.

The most common type of benefits awarded by the SSA is Social Security Disability Insurance (SSDI) benefits.  Such benefits disburse a pre-determined amount to qualified claimants on a monthly basis.  Unfortunately, even those who are qualified can have their applications rejected and not receive the SSDI benefits they are entitled to because of mistakes made during the long and complex Social Security claims process.  Even the minutest mistakes can result in benefits being denied.

Therefore, it’s best to consult with a disability lawyer from the beginning in order to maximize your odds of success.  In the event your application has been denied in the past, an attorney can appeal for you.  

Practice Areas in SSDI

social Security Disability laywerIf you cannot work due to a debilitating mental or physical disability, you may be eligible for social security disability benefits.  No matter if you are applying for benefits for the first time or have had an application denied in the past and need to file an appeal, our lawyers can help you.  Our Pennsylvania disability lawyers are experienced in helping clients with claims such as:

  • Social Security Disability Insurance (SSDI)
  • Supplemental Security Income (SSI)
  • Long-term Disability Benefits

Do not be denied your right to benefits due to the fact that your initial application has been rejected.  Most social security disability applications are denied the first time around and require an appeal before a person receives their benefits.  Our well-versed Pennsylvania disability lawyers comprehend the importance of these benefits to disabled individuals and families.  We’re ready to assist you with filing your claim or appeal.  We will make sure that all information needed for a successful claim or appeal will be included in your claim.  We can address every issue pertaining to your filing with diligence to make sure that your case is supported with the most compelling evidence possible.

The SSD process in Philadelphia

The application process for Social Security disability is, for the most part, identical in Philadelphia as anywhere else in America.  Most individuals go through two parts of this process.  They include the paper application along with the administrative hearing.

Physical application

  • The first part of the process involves completing the application.  Almost two-thirds of people get denied the first time they apply.
  • Your odds of approval are improved by making sure your application has been completed in the proper way.  This involves having adequate evidence and physician testimony explaining your disability.
  • After the initial application, you can expect a response in about three to six months.
  • Our Philadelphia disability lawyers will ensure that your application has been completed properly.

If you are disabled and need benefits, don’t delay.  For more information on the Social Security Disability application process in Philadelphia, contact our office today.




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How we hold insurance companies accountable

The law stipulates that insurance companies must deal with their policyholders in good faith and act in a fair manner, not depriving the insured of the benefits that the policy brings.  Unfortunately, many insurance companies do not live up to this standard.  They have been known to deny claims before even conducting a thorough investigation in addition to fighting medical diagnoses and challenging each and every loss claimed.  They do all this as they attempt to negotiate a settlement that lets them off easy, leaving you with less than you deserve or were entitled to.  Our firm holds insurance companies accountable and makes them abide by relevant laws and statues.

Our firm will fight for you

Disability Cases Lawyer PAWe bring claims against all major insurers and review major disabling medical conditions.  Sometimes this involves the insurer admitting an injury while disputing its severity.  Other times it may involve a disease the insurance company would rather deny their policyholder has, such as Crohn’s Disease or Multiple Sclerosis.

First, we will gather all the necessary evidence for your claim.  This can include W-2s, medical records and bills, and other important documents that can show the totality of your economic losses.  This way the insurance company cannot claim they were unaware of your injuries and associated losses.  Then we will consult with the appropriate medical professionals to make sure you get the care that you need.  And finally, we will interpret insurance policies in your favor.  We won’t let the insurance company do the interpreting in a way the benefits only their own interests.

“Bad faith” in disability cases

Most lawsuits filed by individuals against insurance companies involve the legal claims known as breach of contract and bad faith.

Breach of contract refers to an insurance company not paying a claim they should have paid.  This constitutes a breach of the agreements that were established when the policyholder purchased a policy from the insurer and means the insurance company still has a responsibility to pay the claim in full.

Bad faith is defined as a breach of duty towards an individual for one’s own personal gain.  In this context, that would take the form of an insurance company denying a claim without a good reason for the simple fact that they would benefit by not having to pay a settlement.

Pennsylvania law allows for a claimant to recover additional damages on top of what they are owed, such as punitive damages and attorney’s fees, in the event they are able to prove “bad faith” by the insurance company.  There are many different means by which one may show unreasonable claims handling.  It can be done by closely examining every part of the insurance claims file, by deposing the insurance claims adjusters or those who manage them, or even by serving a subpoena for the internal policies of the company.  Using this information, it can then be shown how the insurance company violated basic requirements for its policies.

If you have a disability case and need quality representation, contact our law office today.



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