Wednesday, June 15, 2022

Which Of The Following Statements About Disability Insurance Is False

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Chapter 5: Short Term Disability Insurance Vs Family Medical Leave Act

Cigna Disability Appeal Tips Following Disability Benefit Denial

Both STD and Family Medical Leave are in place to help you if you become disabled and cannot work for a temporary time span. However, they are very different sources with different purposes. It is important not to confuse the two.

Family Medical Leave Protects Your Job

FMLA does not compensate for lost wages. If is a federal program that prevents employers from firing employees who miss weeks or months of work, because they are injured or very sick.

You may be eligible for up to 12 workweeks of leave per year under FMLA. The leave is unpaid: your employer is not required by law to pay you for missed time.

FMLA rules apply in all 50 states, and generally affect companies with 50 or more employees. FMLA also helps you be away from work due to a family members medical emergencies, and for maternity leave and adoption.

Short Term Disability Insurance Replaces Income

STD is a disability insurance plan that is totally financial in nature. It does not affect job security; i.e., your employer is not required to hold your job. The insurance carrier that provides the coverage promises to pay on a legitimate disability claim, per policy limits. STD generally starts after any paid sick days are used up, and other policy conditions are met.

Whether purchased privately or provided by an employer, STD coverage is optional. STD only covers the named insured on the policy, and no other family members.

Chapter 12: How To Obtain Medical Evidence To Support Your Claim

Before you undertake a VA compensation claim, it is critical to understand what is involved in obtaining the medical evidence to satisfy the nexus requirementor linkage evidence. The format is simple all you generally need is a letter or statement from a doctor/medical expert. This can be your private medical provider or one employed by the VA.

Occasionally the linkage evidence will be provided by way of military medical records or a physicians in-person testimony.

Just as important as the medical records is the careful wording and thoroughness of the doctors statement. The medical opinion connecting a veterans disability to a triggering service incident must be based on examination and reasoning, not just the veterans testimony, and must specify the rationale used by the physician to arrive at the opinion.

The terms and language of the doctors statements should be very clear and specific. Ambiguous or careless phrasing has been a frequent cause of claim denials in past cases.

The VA often rules medical experts opinions insufficient if analysis and reasoning are not clearly expressed in the opinion. Always review your medical records when you attend doctors appointments, to be sure your physician is very clear in his or her details on your records.

Some medical experts are better than others; choose carefully, and search out highly trained individuals who have a good reputation in your local community.

Other Strategies to Remember

Chapter 6: Establishing Service Connection Through A Medical Nexus

Making successful VA compensation claims is dependent on several factors. Perhaps the most important of these is establishing a service connection, or a nexus, between your current disability and a triggering incident during your period of military service.

The main cause of denied VA claims is a lack of medical evidence used to provide proof of this nexus.

Why Is Medical Evidence Needed to Prove a Nexus?

Veterans are often called to testify during hearings for VA compensation claims about their symptoms and the service-connected incidents that led to their symptoms. Some of your testimony may be deemed competent evidence if you appear capable of identifying the medical condition in question. However, most cases involve conditions in which a medical expert must provide specialized expertise for a diagnosis. In these instances, the fact that you may not be a medical expert makes your testimony invalid when it comes to proving the service connection.

Again, a veterans testimony or lay evidence can only be used to establish a diagnosis. It does not identify the connection between diagnosis and an inciting service-connected incident. Most VA compensation claims are lost due to lack of sufficient medical documentation of the nexus. An accredited VA attorney or agent will be aware of this requirement and can help you provide the proper medical evidence of the service connection.

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Chapter 4: Getting Legal Representation

Initially, claimants are not skeptical of the insurance industry or the disability insurance process. Once their claim is denied, they are at a loss about what to do to get their badly needed insurance coverage.

When it comes to filing a successful appeal, experienced legal counsel is in order. A disability insurance lawyer can take the burden of proof off your shoulders, develop your case properly and apply the law to your benefit, and provide all of the necessary evidence to effectively appeal a wrongly denied insurance claim.

Chapter 13: Disability Claim Denied File An Administrative Appeal

CHAPTER 10

After the claim is filed and evaluated, the insurance company will make a decision and either grant the claim or deny the claim. If the claim is granted, the insurance company will begin to pay monthly benefits. If the claim is denied, you should receive a denial letter.

The Letter of Denial

The insurance companys denial notice contains important information about your case, and how to appeal the decision. The letter will state:

  • what evidence the insurance company reviewed when making its decision
  • who reviewed the evidencewas it an in-house nurse case manager, a doctor hired as a consultant or only non-medical reviewers such as a Senior Claims Adjuster;
  • the reasons your claim was denied and what medical evidence the claimant needs to prove disability;
  • essential information regarding appeal procedures, including where to send the appeal and the time limits for filing the appeal.

Time Limits to File an Appeal

If the policy is a group benefit to employees the appeal deadline is 180 days. Most non-ERISA disability policies also give you 180 days to appeal.

In every case, it is very important to read the denial letter carefully, so no deadlines are missed. Under ERISA rules, you first have to exhaust or use up all available administrative appeals . Without that first step, you cannot file a lawsuit against the insurance company and your claim is over.

The Administrative Appeal Process

ERISA Administrative Appeals vs Non-ERISA Administrative Appeals

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Chapter 3: If Your Std Claim Is Denied: Do Not Give Up

As a whole, initial claims for short term disability benefits are more likely to be approved than those for long-term disability insurance. Still, STD claim denials are not uncommon.

STD claims that evolve into LTD claims become much more expensive for the insurer to pay out. Valid claims for short term disability benefits are sometimes deniedor benefits are discontinuedin order for insurance providers to avoid extensive long-term payments.

If your short term disability claim is denied, do not give up or think the process is over. Insurance policies must allow you the opportunity to appeal, or contest, an unfavorable decision.

File an Appeal

While the appeals process is more or less the same across insurance companies, each insurer and policy will have its own unique procedures and timelines. And because policy language rules, you need to review the wording in your policy plus the information sent in your denial letter to understand what your responsibilities are for filing an appeal properly and timely.

The time in which you have to file an appeal can be as short as 45 to 60 days, sometimes longer, depending on the policy.

An appeal is much more than filling out more paperwork. The letter of denial will include the reason the insurer denied the claim. Your appeal should be based largely upon the reason your claim was denied.

Examples Of Social Security Disability Fraud

Close to 13 million Americans received social security disability benefits in 2016. Although the precise numbers are unknown, the percentage of Americans who received benefits due to disability fraud is extremely low. But it does happen, and there are stiff penalties for those who are caught attempting to defraud the system.

What is Social Security Disability Fraud?

Social security disability fraud is any attempt to obtain benefits you would not be entitled to receive but for the fraudulent action. There are many ways to commit fraud, either alone or in conjunction with one or more people even with an SSA representative. Below are five examples of actions that the SSA considers fraudulent.

  • Lying on your SSD benefits application. In the income section of her SSD benefit application, Sharon listed her monthly income as double what she actually earns. This is fraudulent, because Sharons intent was to increase her monthly benefit amount. Purposely misstating any information on your benefits application.
  • Falsifying medical records. Sharons friend is a doctor. Together they created false medical records to make Sharons disability, and its effect on her ability to work, seem worse than it is. Both Sharon and her friend committed fraud, and each will be subject to penalties.
  • Penalties for Social Security Disability Fraud

    How to report suspected Social Security Disability Fraud

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    Which Do I Need: Need Short Term Disability Insurance Or Long Term Disability Insurance

    There are a few things to keep in mind when choosing disability insurance. First of all, do you have an emergency savings fund that could cover your expenses for a few months if you lost your job or were unable to work? If not, short term disability insurance is an essential financial protection, even if you are disabled for only a short period of time. If you have significant emergency savings on hand, though, you may focus on how a long term disability could impact your financial wellbeing and your retirement plans. If you were permanently disabled, could you cover your expenses until retirement? If not, look into long term disability protection.

    Chapter 10: Rfc Developing Your Residual Functional Capacity To Prove Your Claim

    Disability Attending Physician Statements Are Biased Toward Claim Denial

    Being disabled means you suffer from an impairment and symptoms which result in physical and/or mental limitations. Your RFC is the most you can do despite your limitations.

    RFC helps to assess the maximum remaining ability you have to do sustained work tasks in an ordinary job setting on a regular and continuing basis. A regular and continuing basis means work done for eight hours a day, for five days a week, or an equivalent schedule.

    Your RFC is expressed in terms of the exertional classifications of work. As mentioned above, these classifications are described as sedentary, light, medium, heavy, or very heavy work.

    Exertional Activities for LTD Claims

    Your RFC must be understood in terms of the seven primary strength, or exertional, activities of work. These consist of three work positions and four worker movements of objects, as follows:

    Three work positions:

    Definition of Residual Functional Capacity

    To determine what you can still do regardless of your impairment, the insurance companys claims analyst should consider all relevant medical and non-medical evidence.

    This includes medical records, opinions and assessments by treating doctors, evaluations of the medical evidence by non-examining physicians, as well as your testimony and the testimony of others who have observed you.

    The Five RFC Levels

    Remember the five exertional RFC levelssedentary, light, medium, heavy, and very heavy.

    SEDENTARY WORK

    LIGHT WORK

    MEDIUM WORK

    HEAVY WORK

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    Which One Of The Following Statements Regarding Disability

    QuestionWhich one of the following statements regarding disability insurance is false?

    Question 1 options:The longer the elimination period, the less expensive the policy.

    An own-occupation policy will provide disability benefits if the insured is unable to perform the duties of his or her own occupation.

    An any-occupation policy is less expensive than an own-occupation policy.

    A residual benefit clause provides the insured with benefits that extend beyond the disability period.

    Question 2

    Jack has a disability income policy that pays a monthly benefit of $2,400. Jack has been disabled for 60 days, but he only received $1,200 from his disability insurance. Which of the following is the probable reason that he only received $1,200?

    Question 2 options:The policy has a deductible of $1,200.

    The elimination period is 45 days.

    The policy has a 50% coinsurance clause.

    Jack is considered to be only 50% disabled.

    Question 3

    Jared is a university professor who teaches three classes. He developed throat cancer and can no longer lecture. His disability policy is not covering him due to his sickness. What type of policy does he likely have?

    Question 3 options:

    $4,000.

    Question 7

    Question 7 options:She will only receive a benefit of $2,400.

    The entire benefit will be taxable.

    The entire benefit will not be taxable.

    She will receive a benefit of $4,000, but $1,600 will be taxable.

    Question 8

    Question 8 options:

    Split definition.

    Question 11

    No more than 100 percent of his salary.

    Do I Need Both Short Term And Long Term Disability Insurance

    As you can probably tell, short term and long term disability insurance policies are designed to work together. Short term disability is intended to cover you immediately following a serious illness or injury, and long term disability insurance is intended to maintain income replacement if your condition keeps you out of work past the end of your short term disability benefit period, even to retirement, depending on your plan. If you have both short term and long term disability policies in place, short term disability will pay you benefits during the waiting period before your long term disability coverage begins, at which point youll transition from one policy to the next to receive benefits. For that reason, it makes sense to have both policies to help ensure an unexpected health problem wont derail your financial confidence for a few months or for several years.

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    Chapter 9: Veterans Pension

    Veterans pension is needs-based welfare. Pensions are paid when any total disability leads to the veteran requiring financial assistance. It does not matter whether the veterans disability is service-connected or not. VA pension payments are considerably lower than VA compensation payments.

    Pension is only available to certain veterans, such as individuals who served during a period of war or who are totally disabled from any type of work.

    Instead of a percentage amount, pensions are paid in a flat amount and are offset by other income dollar-for-dollar. The VA pension program allows for some favorable presumptions. For example, any veteran over the age of 65 is presumed to be totally disabled for the purpose of the pension program. Again, it is not necessary that the disability be service connected.

    Non-Service-Connected Disability Pension Veterans Benefits

    In certain cases, the VA provides pension benefits to disabled veterans who were made to give up their careers while serving in the military during war time. Now fully disabled, veterans have difficulty supporting themselves and their families.

    These payments are designed to compensate for income and resources that these veterans would have accumulated had they not been called to serve their country.

    Non-Service-Connected Disability Pension vs. Compensation

    Non-service-connected pension benefits are based on three important factors:

  • The veteran currently has permanent and total disability.
  • Chapter 15: Special Rules For Combat Veterans

    Solved: QUESTION 1 Which Of The Following Statements Is Fa ...

    Combat veterans are apt to have a less difficult time getting their condition service-connected than non-combat veterans. VA law makes it much easier for combat veterans to prove that their disability occurred or was aggravated during service. This reduces the chances that the combat vet is denied VA compensation benefits.

    This means a combat veteran does not need to show facts to prove that their disability stemmed from a service-related incident. They just have to make a claim that shows to be consistent with the circumstances and conditions in which they were deployed.

    In most cases, the combat veterans statement that the disability occurred from a combat incident will be considered as fact. This can only be disputed if someone provides clear and convincing evidence to the contrary.;;

    Why Do Combat Veterans Receive Special Treatment on VA Compensation Claims?

    This treatment is not due to favoritism or partiality. The reason combat veterans are treated differently is that during combat, military record-keeping can be very disorganized or faulty. Records are easily destroyed or are incomplete, and in some cases, no records exist at all. Because of this, the VA has chosen to err on the side of the combat veteran with regards to compensation claims.

    What Do Combat Veterans Need to Prove to Get VA Compensation Claims Approved?

    How Do You Know If an Incident Occurred While Engaged In Combat?

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    Chapter 2: Eligibility Requirements To Receive Veterans Benefits

    In addition to meeting the VAs definition of a veteran, you must meet the following criteria to confirm whether you will be classified as a veteran:

    • You have served in any branch of the military,
    • your military service was considered active, and
    • Under what circumstances you were discharged

    These three important points must be established if you are to begin the claims process. Dependents and survivors of veterans may also apply for benefits after establishing that their loved ones status met these three criteria.

    If a veteran fails to meet the three basic eligibility requirements, he or she may still qualify for some benefits in certain cases.

    Other factors might influence the types and amount of benefits that you, your spouse, or your dependents are eligible to receive. Examples include how long you actively served or if active service was during wartime.

    Meeting the Military Service Requirement

    The VA will evaluate your experience to establish that your experience qualifies as military service. Serving in one of the five branches of the US Armed Forces is the most common form of military service. By serving with the US Army, Navy, Marine Corps, Air Force, or Coast Guard, you would generally meet the military service requirement.

    Other Types of Military Service Can Make You Eligible for VA Compensation

    Some examples of other services that might qualify:

    Active Service Requirements for Veterans Status

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