Lawsuit Claims Government Illegally Garnished Disability Benefits Over Student Debt

New evidence shows the student loan crisis affects many more Americans than younger college-age adults. According to a new study, more than 173,000 people in 2015 alone had their Social Security benefits reduced due to old student loans, including many younger adults on Social Security disability.

One borrower, army veteran Hector Rodriguez, has filed a lawsuit after losing part of his needed Social Security disability benefits due to a student loan that was already eligible for forgiveness. The lawsdisability lawyer Philadelphiauit claims the government is needlessly forcing disabled borrowers to lose their benefits over defaulted loans.

Rodriguez took out the loans in the 1970s to pay for college, but he was forced to drop out due to frequent hospitalizations. He later defaulted on the student debt. He was diagnosed with schizophrenia in 1973 and began receiving Social Security disability benefits shortly afterward and continuously since.

His disability was severe enough that he qualified to have his student loans forgiven through a total and permanent disability discharge (TPD), but he received a notice in 2013 that the government was going to garnish part of his disability benefits to pay off the loan. According to the lawsuit, the notice did not indicate that his student loans could qualify for a disability discharge and the information was never provided by the government-hired debt collector when he told them he was disabled.

After receiving the notice, the government began garnishing his disability payments and taking $177 out of his $1,184 monthly check. While the 67-year-old veteran eventually spoke to an attorney who told him he was eligible for the disability discharge, it took 11 months to prove and he lost $1,300 in garnishments.

This lawsuit highlights the government’s often extreme approach to collecting on defaulted student loans. A growing number of Americans are losing disability benefits to sometimes decades old student loans. Of the 114,000 borrowers over 50 who had government benefits garnished, over half were receiving Social Security disability benefits, not retirement benefits.

While the government has sometimes alleged that borrowers should know their debt is dischargeable, activists are trying to raise awareness of the government’s sometimes aggressive actions. In the case of Rodriguez, the government had information available to it to indicate the debt was dischargeale, yet still chose to hire debt collection companies anyway.

The Department of Education has taken some action to prevent this sort of problem. In 2016, the agency cross-referenced its records with the Social Security Administration to identify about 400,000 borrowers who qualify for a discharge, including 100,000 of which were at risk of losing Social Security benefits or tax refunds.

If your disability benefits have been garnished, it’s important to discuss your options with a disability attorney in Philadelphia.

The post Lawsuit Claims Government Illegally Garnished Disability Benefits Over Student Debt appeared first on Philadelphia Disability Insurance Lawyer.


Department of Labor Publishes New Rules Affecting ERISA Disability Claims

disability insuranceThe Department of Labor has published new regulations that will affect ERISA disability insurance claims as well as the appeals process. The new rules will apply to any claims for disability benefits filed on or after January 1, 2018.

These rules will apply to any ERISA-governed disability plan, includig short-term and long-term disability plans and other plans that offer benefits based on whether a participant is disabled, including pension plans and 401(k) plans.

The following are the most important changes coming to the ERISA claims process.

#1. All claims and appeals must be decided impartially and independently.
This means that the individuals who decide to approve or deny claims cannot have an incentive to deny claims. This rule will prohibit a plan from offering bonuses to claims adjusticators based on the number of claims they deny. It will also prevent plans from contracting with medical providers based on their reputation for giving outcomes that benefit the plan in contested cases. This is an important change as insurance companies routinely contract supposed independent medical providers who have an incentive to deny claims that would cost their employer too much money.

#2. Denial letters must include specific information.
The new regulations will require claim denial letters to include:
– A notice of the claimant’s right to access their claim file and other documents.
– An explanation about why the plan did or did not agree with the opinion of medical providers or with any disability determinations that were made by the Social Security Administration.
– Any internal guidelines the plan used while deciding whether to approve or deny the claim.
– Linguistically and culturally appropriate. As an example, a denial letter sent to an address in an area in which at least 10% of the population is literate only in the same non-English language must have a statement that the information provided is available in other languages. The notice must be provided in the claimant’s native language upon request.

#3. Claimants must receive notice and an opportunity to respond before an appeal is denied.
Before an appeal can be denied, the plan must give the claimant sufficient notice and a fair chance to respond if the denial is based on new or additional evidence or opinions. All appeal denial letters will need to describe any plan-imposed time limits on filing a lawsuit and the date of expiration for any limitations.

#3. Claimants cannot be barred from filing a lawsuit due to failure to exhaust the plan’s claims process in some cases.
When the new rules take effect, a claimant will be allowed to sue even if the plan’s claims procedure is not exhausted if the plan fails to comply with its own claims procedures.

These regulations will take several important steps to protect disabled workers from unfair denial of disability benefits.

The post Department of Labor Publishes New Rules Affecting ERISA Disability Claims appeared first on Philadelphia Disability Insurance Lawyer.

Is Your Disability Insurance Policy Subject to ERISA?

Most people who file a disability insurance claim are unfamiliar with Employee Retirement Income Security Act (ERISA) — but it can have a big impact on your claims process and taxes on your benefits. ERISA is a federal law that is designed to give affordable employee benefits that protect workers. Unfortunately, ERISA regulations have generally been interpreted by courts in a way that favors insurance companies. An important goal for any disability attorney is proving that a claim is not governed by ERISA to improve the odds of collecting benefits.

Group vs Individual Long-Term Disability Insurance

Is your disability insurance policy ERISA regulated? disability lawyers in philadelphiaThere are two main types of long-term disability insurance policies: group policies provided by an employer and individual policies which are purchased independently through an insurance agent. Group policies are usually subject to ERISA regulations whereas most individual policies are not. Over 80% of people with disability insurance have a group policy through their employer.

Is Your Policy Subject to ERISA?

There are five key requirements for a policy to fall under ERISA regulations:0

  • A “plan, fund, or program”
  • That is established or maintained
  • By an employee organization or employer
  • To provide surgical, medical, hospital care, accident, sickness, disability, death, vacation, or unemployment benefits
  • To plan participants or their beneficiaries.

ERISA-governed disability policies are usually part of an employee benefits package and it may require that some amount of the premium be paid by the employee.

Even if you have a group insurance policy, it may not be subject to ERISA if:

  • No contributions are paid by the employee organization or employer,
  • Participation is voluntary for members or employees,
  • The primary functions of the employer in terms of the program are to allow the insurer to publicize the program to employees, collect premiums through payroll deductions, and remit them to the insurer, and
  • The employer receives no financial benefit from the program other than reasonable compensation (not profit) for administrative services.

There are several differences between ERISA and individual disability policies, including premium costs, portability of coverage (whether it moves with you regardless of employer), benefits taxation, and the appeals process. Not sure if your disability policy is governed by ERISA? An experienced LTD attorney in Philadelphia can help you understand your policy and your rights. Contact Edelstein, Martin & Nelson today for a free consultation with a long-term disability lawyer to discuss your case.

The post Is Your Disability Insurance Policy Subject to ERISA? appeared first on Philadelphia Disability Insurance Lawyer.

What Happens When Your LTD Benefits Run Out?

If you are already receiving long-term disability (LTD) benefits or you are in the process of making a claim, one of long term disability appealyour biggest concerns may be what happens when your benefits period runs out.

If your insurance company terminates your LTD benefits while you are still considered disabled under your policy, you may have a lawsuit against the company. In most cases, LTD benefits run out because the policy’s definition of disability has changed, even though the recipient’s health has not improved.

Changing Definition of Disability

It’s important to understand that your policy’s definition of disability can change at pre-set time periods. For example, many policies define disability as an inability to perform the essential duties of your own occupation for the first 24 months. After this point, your policy may require that you be disabled from any occupation you are qualified to perform, even if it’s in a completely different industry with dramatically reduced pay.

Most LTD benefit policies contain this change in the definition of disabled which means your benefits can run out after two years, even if you have not improved, simply because you could potentially seek a job in an unfamiliar field for pay that is far less than you made in your previous occupation. This is the most common reason for long-term disability benefits to run out.

If this happens, you do have options available to you.

Apply for SSDI or SSI

You have the right to apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) while you are receiving LTD benefits or after your long-term disability benefits run out. Just keep in mind your LTD benefits can be reduced if you receive SSDI or SSI while your benefits are in effect.

SSDI pays benefits to people who have worked long enough and paid into the program through Social Security taxes if they meet medical criteria. SSI, on the other hand, pays benefits based on financial need.

To decide if you are disabled and eligible for benefits, the Social Security Administration uses a 5-step process that begins with learning about your past work to determine if you can still do your job. You are not considered disabled under the program unless you have a condition, illness, or injury that prevents you from doing your prior work or adjusting to other work. Whether or not you are considered able to adjust to other work depends on your age, education, and work experience.

Contact an LTD Attorney in Philadelphia

Whether or not you meet the definition of disabled according to the insurance company is at the center of many LTD disputes. If you believe you have a claim against an long-term disability insurer or you need assistance appealing a denied LTD claim, an LTD attorney can help. Contact Edelstein, Martin & Nelson – Philadelphia for a free consultation with a Philadelphia disability insurance lawyer to discuss your case.

The post What Happens When Your LTD Benefits Run Out? appeared first on Philadelphia Disability Insurance Lawyer.

Reasons Your LTD Benefits Can Be Terminated After 2 Years

Even though your long-term disability claim has been approved, your benefits can be terminated by the insurer for a wide variety of reasons. It’s important to understand the conditions under which your monthly benefits can be long term disability denialterminated so you can protect your right to your benefits for as long as you are disabled.

Disability Definition Transitions from “Own Occupation” to “Any Occupation”

There is a common clause in group LTD policies that changes the definition of disability from “own occupation” — or an inability to perform the duties of your regular occupation — to “any occupation,” which means an inability to become able to perform any occupation. Courts have upheld that this means you are not considered disabled and your benefits can be terminated if you are medically able to perform almost any job that exists, even if the pay is greatly reduced and it is not even related to your field.

Time Limit for Conditions with Subjective Complaints

Most group policies also have a two-year time limit for claims that involve any disability arising from a nervous, psychological, or mental impairment. This may include depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, or anxiety. Most insurance companies will only continue with benefits if you are confined to inpatient treatment or institutionalized after the limit expires.

There are sometimes exceptions to this limit, such as for organic mental disorders like dementia or mental illnesses like schizophrenia, but this is certainly not always the case.

There is also usually a two-year limit for benefits for chronic pain disorders like chronic back pain and arthritis as well as any condition that is primarily diagnosed due to a subjective complaint that can’t be objectified. This may include soft tissue disorders and fibromyaglia. In some cases, insurance companies make an exception when there is objective evidence showing traumatic spinal cord necrosis or spinal tumors, for example.

Failure to Apply for SSDI

Most policies require that you apply for Social Security Disability Insurance (SSDI) benefits. This is because the insurance company can reduce your LTD benefit payments by the amount you receive from SSDI.

Failure to Continue Treatment

You are also likely obligated to submit regular updates proving your disability through continued treatments. You may need to attend medical examinations or show evidence of re-certification.

Medical Improvement

Many people have their LTD benefits terminated because they have shown medical improvement and the insurance company no longer considers them disabled, even if they are still unable to work. The insurance company must show substantial evidence of medical improvement related to your ability to work.

Video Surveillance Evidence

LTD insurance companies often hire private investigators to produce video surveillance on claimants. If you are

erisa and individual long term disability denial and appeal

erisa and individual long term disability denial and appeal

videoed doing anything against doctor recommendations or even performing simple actions like basic yard work or taking groceries in from your car, the insurance company may try to use it as evidence that your condition has improved to discontinue benefits.

Maximum Age for Benefits

The majority of LTD policies end when the claimant reaches retirement age or upon their death. If you are over 60 when approved for benefits, your benefits may continue past 65-67, but not for long.

Return to Work

Your benefits can also be terminated if you work while receiving monthly LTD benefits. While some policies let you work and continue benefits as long as you can only earn a wage that is substantially less than your pre-disability wages, this is not common and the maximum amount you can earn will be set in the policy.

Contact an LTD Attorney in Philadelphia

If your LTD benefits have been terminated, it’s important to understand your rights. An experienced long term disability lawyer can help you review your policy and reason for termination to determine if you have a claim against your insurance company. Contact Edelstein, Martin & Nelson- Philadelphia for a free consultation with a Philadelphia disability lawyer to discuss your case.

The post Reasons Your LTD Benefits Can Be Terminated After 2 Years appeared first on Philadelphia Disability Insurance Lawyer.

How to Find the Best Disability Insurance Lawyer insurance Lawyer is a system that is designed to protect workers against an accident that can render them disabled. Everyone in the work force risks the possibility of suffering from a psychological or physical injury. This can create a compromising position for the employer and employee. With disability insurance, the employee or policyholder has a safeguard in which a fixed amount of money is available if deemed disabled in any form.

Unfortunately, claiming and using disability benefits is not that easy. The process, which should be simple, is often complex and confusing, which causes more pain than relief. Along with the pressure from the employer, the insurance company that set up the contract can find loopholes that keep the disabled from claiming their insurance disability money. More and more workers each year become disabled and never get their disability claims fulfilled. A lot of employees also end up losing their disability insurance throughout the claims process. This is why Quadrino Schwartz started helping disabled individuals in the first place. Quadrino Schwartz is the premier disability insurance law firm and has been committed to helping resolve disability claims professionally since 1996.

This firm can be found online at Schwartz was formed in 1996 to produce a standard of excellence in the field of disability insurance malpractice. Their ultimate goal is to help individuals deal with issues ranging from getting disability claims approved all the way to going through the litigation process if necessary. The company is made up of dedicated professionals, paralegals, and experienced attorneys that create a dynamic environment to help clients win multi million dollar cases.

Offering initial evaluations, the firm deals with all Long term Disability insurance Attorney  and has successfully defended CEO’s, doctors, cardiologists and even lawyers. They are capable of working with other law firms in all major cities and states, and have helped people select the right lawyer to defend their case. With a qualified attorney, the chances of success for any claim increases immensely, and Evan Schwartz, the founding partner, has establish Disability Insurance as the premiere firm to hire lawyers for every kind of disability claim there is.

Source: How to Find the Best Disability Insurance Lawyer