Disability Benefits

What We Do

We are a firm that represents exclusively individuals to obtain and preserve their rights to disability benefits from private insurance policies and employer-sponsored disability plans. We never represent insurance companies or employers. Lebau & Neuworth has developed a stellar national practice. We work closely with medical professionals, vocational experts and consultants in fighting for our clients.

Disabled individuals who are receiving their monthly benefits are frequently harassed with unreasonable requests for additional information, surveillance, unannounced visits from insurance company representatives, or repeated demands for "independent" medical exams or tests. The goal of these insurance company tactics is to terminate benefits or "strong-arm" an unfair claim settlement.

We have successfully and swiftly helped disabled individuals who face these problems. A wealth of experience in this unique area enables us to quickly negotiate settlements or restorations of denied benefits, often without the expense and delay of litigation. Other times, we have to fight hard for our clients in court to obtain what they deserve. Many years of handling complex disability insurance issues have given us the unique litigation skills, knowledge and trial strategies necessary to identify and seek damages for income disability claim denials.

Disability Income policies are drafted with ambiguous and confusing contractual terms. This provides insurance companies with multiple reasons for delaying and denying disability income benefits. Given the complexity of the legal issues involved and the tendency of insurance companies to vigorously defend claim denials, evaluation of any potential legal claim on behalf of an insured should be handled by a disability attorney or law firm experienced in insurance claims and bad faith litigation.

How we can help you in connection with disability benefits:

Recent Cases

L&N has won benefits for many clients whom were previously denied by an insurance company. The following are just a few recent case summaries:

"Initial denial overturned within days of insurance company receiving court complaint" - Within three days of filing a court complaint, L&N recovered lifetime disability benefits for a severely disabled executive employee.

"Lump sum settlement for professional due to mental illness" - L&N, in a hard-fought lawsuit, won a lump-sum settlement for a professional whose mental illness prevented him for doing his job.

"Benefits obtained for 'soft brain injury'" - L&N was able to get a 20 year utility company employee disability benefits after he sustained a short fall which caused "soft brain injury."

"Side effects of medication must be considered by disability company." - L&N successfully challenged a denial of disability benefits when the insurance company did not consider the adverse side effect medication necessary for disease treatment.

About Disability Policies

There are two types of disability benefit policies

  1. private insurance purchased directly by the policyholder and,
  2. employer-sponsored disability benefit plans. Different laws govern.

Employer-sponsored disability plans are subject to and governed by federal law, the Employee Retirement Income Security Act of 1974, also known as ERISA, Under ERISA, the insurance company is supposed to undertake a full and impartial claims review at the time a person asks for benefits. Oftentimes this is not done. Once a claim has been denied, the claimant is required to file a timely internal appeal with the insurance company. A claimant can only file suit, if the appeal is denied. Moreover, to make it even more difficult for claimants to prevail, ERISA requires that a court give a certain amount of deference to the insurance company's determination, unless there is what is called a de novo review.

Private insurance policies are governed by State law and, generally, are not subject to mandatory internal appeals procedure, meaning the claimant can go straight to court once a claim is denied. Also, courts are not necessarily required to provide any deference to the determination of the insurance policy.

The claims process for employer sponsored plans covered by federal law. Many insurers frustrate claimants by using complicated forms or requiring multiple examinations by "independent" doctors who seemingly have little interest in doing a proper exam. Long delays in "review" are extremely common. During this process, it is likely that claimants are financially squeezed, only adding to their sense of frustration.

You should take the time to review your disability policy, you will see that it's a complex document filled with poorly defined terms. Some insurers will try to use various policy provisions to limit benefit payments or avoid payment altogether.

You should also obtain summaries of the disability plan through your employer, usually the human resource department. These summaries are called summary plan descriptions or plan documents. The plan administrator must furnish copies of the summary plan description within thirty days of obtaining a written request for the plan documents.

As a practical matter, it is important to seek the advice of an attorney whenever a disability insurer begins tactics which seem unfair. In fact, it is even prudent to seek counsel when completing the initial claims form, as that document will forever be controlling for the claimant.

Many times, there are administrative appeals available to claimants which, if skillfully used, can lead to getting the claim approved. If the appeals process is not used properly, this can lead to an irreversible claims denial. In some cases, litigation will be necessary, even in cases that seem open and shut.

It is critically important that objective supporting medical documentation be submitted during the claims process. Further, a claimant has the right to obtain documentation relied on by the insurance company in support of any denial and to submit refuting evidence. Specific requests for information need to be made by the claimant.

Beware - tricks of the trade (insurance)
Insurance companies have every incentive to deny claims. To do this, they routinely:

To avoid these traps:

Private Personal Policies Private policies for disability insurance benefits are subject to State law. Many of the same traps listed above are used to deny benefits under personal policies. There, however, are a few additional issues, including:

Social Security

We represent individuals in connection with claims for Social Security benefits. For general information, you should click here for the Social Security Administration's website - www.ssa.gov.

If you are disabled from performing substantial gainful activity, you may be eligible for Social Security Disability, SSDI or Supplemental Security Income (SSI). Unfortunately, the Social Security Administration often denies truly disabled claimants. All too often, it takes an experienced lawyer, with a thorough knowledge of the laws and medical listings to obtain disability benefits for the claimant.

The test for eligibility is not whether you can go back to a job that you've lost. Nor is it whether you've been able to find a job recently. The test is whether you are physically and emotionally capable of doing a job that is generally available in the every day work place.

Furthermore, to obtain Social Security Disability benefits, you must have a doctor state that you are disabled "by medically acceptable clinical and laboratory findings". Unfortunately, many genuinely disabling conditions are difficult to diagnose by objective testing. In cases like that, it's up to your representative or legal help to present your doctor's reports properly, and to convince the government that you deserve your benefits, to get disabled claimants benefits.

The general eligibility requirements for receiving Social Security Benefits can be satisfied in several different ways and is not necessarily limited to any specific test.

1. Are you working?
If you are working now and are not receiving Social Security disability benefits, you cannot apply and obtain Social Security disability benefits. You must stop working before you can receive such benefits. Under the federal Social Security Disability Act, "disability" means the "inability to engage in any substantial gainful activity by reason of any medically determinable physician or mental impairment which can be expected to result in death or has lasted or is expected to last for a continuous period of not less than 12 months."

2. Is your disability "severe"?
Your condition must interfere with basic work-related activities for your claim to be considered. If your condition does interfere with basic work-related activities, you should apply for benefits.

3. Is your disability found in the list of disabling conditions?
For each of the major body systems, Social Security Administration maintains a list of medical conditions that are so severe they automatically mean that you are disabled. If your condition is not on the list, Social Security. A disabling condition must of equal severity to any listing.

4. Can you do the work you did previously?
If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then Social Security Administration must determine if it interferes with your ability to do the work you did previously. If it does, you may receive benefits.

5. Can you do any other type of work?
If you cannot do the work you did in the past, there may be questions about if you can do any other work. In doing this, the Social Security Administration considers your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.

By law, anyone may file for his or her own Social Security Disability benefits. But statistics clearly show that claimants who have representation win their benefits much more often than those who apply on their own. The government makes the process very difficult. Waiting lines are long. Forms are complicated. Benefits are often denied to people who have legitimate claims. And not just once, but frequently twice- sometimes, people are denied even more often than that. As a result, many people who apply on their own become discouraged and intimidated.

We can assist throughout the process because we:

If you, a family member or friend needs a disability benefits lawyer or simply have a question to ask, you should call and speak to one of our lawyers, contact us.