Long Term Disability FAQ

Do I need an attorney to appeal the decision by the insurance company?

You are not required to have legal representation. However, your chances of having a successful claim for your disability benefits increase when you have an experienced attorney on your side.

How do I appeal?

In most instances it requires a written letter or a form provided by your insurance company.

What documentation is required for a successful claim?

Depending on the facts of your case, you will likely need medical and employment evidence. A letter from your doctor is only one important piece of the evidence necessary to establish your total disability; by itself it will not result in a successful claim.

The insurance company wants me to be examined by another doctor of their choice, what are my options?

In this instance you should immediately contact your attorney. Independent examiners are paid by the insurance companies, therefore they may not give a fair opinion regarding your case. You also want to ensure that their opinion is within their particular area of expertise.

Can my employer fire me?

Employers are only required to hold your position for 12 weeks of unpaid leave spanning any 12 month period in accordance with the Family Medical Leave Act. Depending on your employers' particular leave policy, they may fire employees who are on disability longer than 12 weeks. Your attorney can help assure you are not fired based on your disability alone.

Should I sue for disability benefits?

You may be required to exhaust all of your options with your carrier before going to litigation. However, those with an individual policy can file an action immediately.

Disclaimer: Prior Results Cannot and Do Not Guarantee or a Similar Outcome with Respect to Any Future matter, Including Yours, In Which a Lawyer or Law Firm May Be Retained.　
In The Absence of a Recovery No Fee Will Be Charged and You Are Not Responsible To Repay Silverman Law for the Expenses and Disbursements Incurred.　
Contingent Fee Rate is Computed After Deduction of Costs, Disbursements and Other Expenses of Litigation.

Bold labels are required.

• What do I need to show to obtain Workers Compensation benefits?

  
  In order to obtain compensation benefits you need to document that you were an employee, that an accident occurred during the course of your employment (or you developed an "occupational disease" during the course of your employment), that you gave notice to your employer within 30 days of the accident and that you filed your claim for benefits within two years of the date of the accident. There are some exceptions to these requirements which should be discussed with your attorney in detail.

• If the administrative law judge directs the carrier to pay my medical bills and to pay me compensation benefits, and the carriers still objects, what happens?

  
  If a carrier believes that there are grounds for an appeal they may file such an appeal within 30 days to the Workers Compensation board. Pending the resolution of that appeal in most instances the carrier is not required to pay medical bills or make biweekly payments to the Claimant as directed by the administrative law judge.

• Am I required by law to have an attorney?

  
  No. But bear in mind that the insurance carrier is mandated by law to have an attorney or a licensed representative appear at every hearing. These attorneys and licensed representatives often have years of experience, have handled thousands of hearings and are well versed in representing the carrier's point of view. While there is no similar statute requiring the Claimant to be represented, we would highly recommend that they retain counsel. Silverman Law has decades of experience in representing Claimants.

• The carrier argues that my condition was pre-existing. I don't think that it was but even so I never had these symptoms. What should I do?

  
  This question of a pre-existing asymptomatic (unnoticed) condition which is made symptomatic by a work-related accident has been decided by both the Appellate Division of the Supreme Court of New York State and the New York State Court of Appeals.

• Can I collect both Workers Compensation and the Social Security Disability benefits at the same time?

  
  Yes. If you qualify you may indeed collect both Workers Compensation and Social Security Disability benefits. While Workers Compensation is not reduced because of Social Security Disability payments, your Social Security Disability payments may indeed be reduced because of your Workers Compensation benefits.

Silverman, Silverman & Seligman, P.C.
527 State St.
Schenectady NY 12305
Phone: 518-631-4521
Toll Free: 877-851-4319
Fax: 518-374-4338