TOP TWELVE TIPS FOR PURSUING YOUR CASE FOR DISABILITY BENEFITS: DOCUMENTING YOUR "DISABILITY"
By Debra S. Nelson, Esq.

When applying for disability benefits, you should know that the application process is very important. It is not as simple as filling out the application with "Yes" or "No" or one-word answers. The answers to your application should be well thought out and detailed. Keep in mind that the insurance company does not know you, your job, or how your disability affects you. You must draw them a picture with the answers in your application. You 
must "document your disability." No two people with the same disability have the same answers to their applications. The application phase is the most important stage of obtaining benefits. Remember, you are not automatically entitled to long-term disability benefits. You have to convince a long-term disability insurance carrier that you are disabled, and you were disabled at the time you left work or reduced your hours.
   Here are twelve tips to follow when you are considering applying for long-term disability benefits.

1. Review your short-term and long-term disability plans. If you do not have a copy, request one from your employer. Determine whether the plan is a "your own occupation" plan or "any occupation" plan. A "Your 
   Occupation" plan states that you must be disabled from one or more duties of your regular occupation, whereas, an "Any Occupation" plan states that you must be disabled from any occupation.
2. Consult your physician right away when you are finding it difficult to perform your job or even some of the duties of your job. Bring your physician a copy of your job description, so your doctor is aware of what your 
   job requires. If your job description does not completely describe your job, verbally describe your additional duties to your physician, including requirements for lifting, standing, keyboarding, etc. It is very important 
   that your physician is aware of what your job requires of you.
3. You should be very honest with your physician when he/she asks you to describe your symptoms or how you have been feeling. It is very important that your physician document these symptoms. For example: If you state you are "feeling better," your physician will put this in your medical records. You should ask yourself, "feeling better than what" and express this clearly to your physician. Insurance companies reviewing your records do not know what you are thinking or what you do not communicate to the physician; therefore, be open and honest and describe how you are feeling with specific examples. Describe to your doctor all of your ailments, such as extreme fatigue every day, which requires rest every two hours; pain in several areas of my body which keeps me from performing normal activities such as driving, cooking, reading, poor sleep, etc.
4. Discuss your concerns about your health and job with your physician. Work as a team to identify whether you are disabled from your job and when you should apply for disability benefits. Your physician should be your teammate not your opponent. Your doctor should be willing to assist you in obtaining benefits, i.e. filling out the necessary forms to apply for disability benefits.
5. Talk to your doctor(s) and ask them not to use the words "above baseline," "improving," "feeling better," or "no pain" in their notes or records without stating an explanation of what is meant by these terms in 
   relation to your condition.
6. When filling out a disability benefit application, do not use one or two word answers. The LTD insurance company does not know you or your situation. You need to describe why you believe you are disabled and document your disability. If the application asks what activities you do on a daily basis, describe your activities completely, such as, if you need someone to drive you, state so in the application. If you grocery shop, but need to lean on the cart or use a motorized scooter, then state this on your application. Do 
   not be shy in describing your inabilities. If there is not enough room on the application, attach additional sheets of paper. If you have medical records supporting your statements, attach them to your application. The more detailed information you provide in the application, the better your chances of receiving benefits. Sometimes, however, the wrong kind of detail or the wording of the detail can be harmful.
7. Once you prepare a draft of your application, have an attorney who is experienced in this field, review your application BEFORE you send it to the LTD insurance company. This is important, because an attorney may recognize mistakes or red flags of which you are not aware. They will also be able to help you determine your eligibility for disability benefits. This increases your chances of obtaining benefits.
8. Before you decide to switch jobs or reduce your hours or modify your workload because you are unable to perform the duties of your job, consult an attorney. By reducing your hours, you may be reducing the amount of benefits you would otherwise be eligible for.
9. REMEMBER, your Employer (including your benefit representative) is looking out for the Employer's best interests not yours. Even though they think they are doing you a favor or you think that they may be doing you a favor by assigning you to a lighter duty position with a resulting pay cut or letting you go "part-time" to "accommodate" your disabilities, this may not be in your best interest. It depends on the circumstances. YOU SHOULD CONSULT AN ATTORNEY.
10. If you have to terminate your position with your Employer because of your disability, TELL YOUR EMPLOYER THAT IS WHY YOU ARE TERMINATING YOUR POSITION. Do not make any other excuses for your termination. Those reasons may hurt your chances of receiving disability benefits.
11. Be sure to discuss with your employer in your review processes reasons for your decline in work ability if it relates to your disability. This may be difficult to do because you may think that your employer may view you less favorably. However, if your disability is affecting your work, then you should document this. Employers are prohibited by law to discriminate against you based upon your disability.
12. You are your best advocate. However, frequently, the best thing you can do for yourself is consult early on with an attorney familiar with ERISA and long-term disability benefits. Such consults can be priced very reasonably and a small price to pay when years of LTD benefits and possibly your main source of income is on the line.

Following these twelve tips will not guarantee that you will receive long-term disability benefits, but failure to heed them may prove fatal to your application and bring about the necessity of having to pursue costly and time consuming appeals or court litigation.

(Debra S. Nelson is an Attorney and Officer of Mansfield, Tanick & Cohen and a member of the law firm's ERISA/Disability Benefits Practice Group. Telephone: (612) 339-4295. Email Address: nelsod@mansfieldtanick.com).

©Mansfield, Tanick & Cohen, P.A. 2001