ERISA Disability and Life Insurance Litigation
Oral arguments from various courts of appeal across the federal circuits involving long term disability or life insurance claims governed by ERISA.
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ERISA Disability and Life Insurance Litigation
For Health Care Providers - How to Buy Long-Term Disability Insurance
How to Buy Long-Term Disability Insurance
In today's podcast, listen in to a recording of a presentation long-term disability attorney Ben Glass recently gave to a national gathering of nurse anesthetists. During the session, Ben shared invaluable insights on how to navigate the complex world of long-term disability insurance. Here are the key takeaways from his talk:
Understanding the Importance of Individual Policies
Ben emphasized that individual long-term disability insurance policies generally provide superior benefits compared to group policies offered by employers or associations. One of the primary advantages of an individual policy is its portability; your coverage goes with you if you switch jobs or move to a different practice. Additionally, benefits from individual policies are typically non-taxable, provided you pay the premiums yourself. This can offer a significant financial advantage if you ever need to make a claim.
Evaluating Group Policies
Group policies are often included as part of an employment benefits package. These policies are generally cheaper and do not require health underwriting, making them accessible to all employees regardless of their health status at the time of enrollment. However, group policies come with several limitations. They may include pre-existing condition exclusions, meaning any medical conditions you had before the policy started may not be covered. Additionally, these policies often offer shorter own-occupation coverage periods—usually only for the first two years. After that, benefits are only paid if you cannot perform any occupation, not just your own specialty. Furthermore, benefits from group policies are taxable if the employer pays the premiums.
The Pitfalls of Association Policies
Ben warned that association policies, like those offered by the American Medical Association, tend to provide the least favorable terms. These policies are often inexpensive and do not require medical underwriting, but they offer minimal benefits. Given the choice, it's better to prioritize individual and group policies over association policies unless health issues prevent you from obtaining better coverage.
Navigating Elimination Periods
An elimination period in a disability policy is similar to a deductible in health insurance. It represents the amount of time you must wait before you start receiving benefits after a disability occurs. The length of the elimination period can significantly affect your premiums. Longer elimination periods result in lower premiums but may not be practical if you don't have substantial savings to cover the gap. When choosing an elimination period, consider how long you can sustain yourself financially without an income.
Dealing with Pre-existing Conditions
Ben stressed the importance of being completely honest about your medical history when applying for an individual disability insurance policy. Insurers will uncover past health issues, and failing to disclose them can lead to denied claims. Depending on your health history, insurers might exclude certain conditions from coverage or impose waiting periods before coverage kicks in for those conditions. A good broker can help you fin
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Hey everyone, this is Ben Glass and welcome back to the ERISA Litigation, Life Insurance and Long-Term Disability podcast. We're going to take a break from our usual episode where we are giving you a recording of an actual oral argument in a court, typically about a long-term disability or life insurance case, and today I'm going to give you a webinar, a seminar I recently did for a national group of certified registered nurse anesthetists, and what we're talking about on this session is how to buy long-term disability insurance. Since we're the biggest long-term disability insurance claimants law firm in our region, we have a ton of experience dealing with claims and claims oftentimes go back to rely on what did the policy say? So most professionals are insured under some group long-term disability insurance policy. Today, most of what we're talking about is how to go out and buy individual policy, and then we talk a little bit about how that affects certain claims, and I give some examples of cases either won or lost because of the language of the insurance policy.
Speaker 1:So I hope you enjoy this program. If you're listening and you ever have a question about claims, you can reach out to us. If you have been denied long-term disability insurance claim, you can go to freedenialletterreviewcom and you can get the advice of experts. That's us about your long-term disability claim. All right, please enjoy the program and welcome everyone to this afternoon's call, and I just want to acknowledge you are a group of nurse anesthetists and I just want to say just take a moment to thank you, all right, for the work that you do. It's a really cool profession. I've met a number of you over the years. Of course, I have been served by some of you, and the ability to help take patients and both relieve pain but also put them to sleep and wake them up safely is awesome. So just always remember that the work you do is really cool and very important in the world. So today we're going to talk about how to buy long-term disability insurance, and I'm speaking to you from this perspective is that I'm not a broker.
Speaker 1:I don't sell this stuff, but for over 25 years I have been representing claimants, including a lot of many people in the healthcare profession, against long-term disability insurance companies when their claims are denied, and so I see that entire process. When someone has an injury or an illness going on that prevents them from doing their own occupation, they make a claim for benefits and they get denied. That's when they come to me. I also do a lot of consulting around the country via Zoom with healthcare providers who are thinking about going out on claim, and that really is the best time to talk to somebody like me If you have something going on is speaking to an experienced claims attorney who can look at your policy or policies, look at your medical records, talk to you about what's going on medically, figure out what your goals are and help walk you through the process. And oftentimes when we do those consult calls, our goal is to have really one call so that you won't need to be involved in the claims denial process, you won't need to hire a lawyer, you won't be involved in litigation and oftentimes you're able to do that. We're either able to look at medical records and go look, I don't think your claim is a winnable claim, but maybe here's some additional testing you may need. Or here's some questions you need to have your physicians ask or answer. Or we tell them here's you know you are ready to go and here's how you should fill out forms and here's how you should approach the insurance company. And I will say, with all respect to the brokers and they're very smart brokers out there but I've never met a broker who truly understood the claims process and in fact, when I have conversations with my friends who are brokers or agents, they tell me that they are oftentimes actively dissuaded from learning about the claims process. They're dissuaded from counseling their own customers and clients when the claimant the potential future claimant contacts them to say, hey, I think I might need to go out and claim.
Speaker 1:So we are located in Fairfax, virginia. We do have the largest long-term disability practice in the region. We handle more cases and we know this because every lawsuit that we're involved in is filed in federal court, and so you can go on some of the databases and see who's filing cases. So we are we're the largest in the region and because of the nature of the law, we are able to do consultations and then represent folks all over the country. When we go into litigation we get local, what we call local counsel, and then most of my work is again is representing someone who's coming to us with a denial letter. So they have started the process. They've been denied by one of the major long-term disability insurance companies and we work to get them back on claim, and when we do that, we then work to keep them on claim for the duration. Each policy is different, but oftentimes folks will come to us and they may be entitled to benefits to age 65 or 66, and that could be 20 years of benefits for them. So today we have about $33 million of future claims that we call under management. Those are claimants that we are actively working. We have won theirants that we are actively working. We have won their claim. We're actively working with them and their doctors, if appropriate, to keep them on claim.
Speaker 1:A lot of our folks are able to go back to work. They may change professions, they'll find a different way of earning money and that also is a crucial time to talk to somebody like us as folks develop transferable skills. And again, we can help people transition back to work, because I will tell you, it is always better to be making money by working than it is to be reliant on a disability insurance company for your monthly paycheck. And there are ways to get back to work and being careful about it and not like screwing up your not screwing up your claim. And the last thing we do is we consult not only with healthcare providers but we consult with groups, so practice groups who are considering buying or changing group long-term disability policies for their insured physicians or nurses or other healthcare providers. We consult with them as well to help make sure working with the broker really to help make sure that what they are buying is what they will protect. They and the type of practice the best.
Speaker 1:I've authored a number of books that we use in our practice. These are both available for download at benglasslawcom. However, if anyone who is on this webinar or who sees it later would like to get a hard copy of this, you can always reach out to me through LinkedIn and we will give us your mailing address and we will make sure that you get a hard copy of this. Again. Every case is different, every policy is different, but these two books are good guides to the long-term disability claim process really, because that's again that's where most of my work is, and we only do two things. So we do personal injury automobile accident cases in Virginia and son Brian leads that. He's the young one in this picture and I'm the older one on the right and I lead up the long-term disability section and we do work all over the country.
Speaker 1:So let's just talk a little bit about what we are insuring and why. Every nurse, anesthetist indeed, every young professional that I talk to really needs to consider buying long-term disability insurance. Again, I don't sell any of this. I get nothing from advising about this, but seeing people who come to us with claims or claims issues, there are definitely different flavors of policies and we grade them from really good down to some crappy group policies and the better protection you can afford to buy early when you're healthy, the better off you're going to be if you happen to make a claim.
Speaker 1:So you all have a, as I understand the role you have a physically demanding role. You can make good money doing this so that if you're not able to do the occupation, the duties of your occupation, it can have a substantial impact on you individually and on you and on your family. And again, you do hard work. It requires both manual dexterity, it requires vision, it requires hearing, being on your feet, being able to respond in instances to emergencies. So there's all of that sort of physical realm of your work. There also is the cognitive realm and one of the things that I say and tell my health provider, friends and clients is that in your world, you and your patient cannot afford for you to be anything less than your 100% Okay.
Speaker 1:Healthcare providers will often come to me I get I'll represent surgeons and cosmetic dentists and they'll come and say I've got a tremor or something, and the first thing I always have to talk to them about is are your patients safe? Because not only are we concerned with you and your ability to go out to make a living, but we all are going to put patient safety at the very top of the list. And so there's this balance between working to make money, dealing with a disability insurance company, dealing with potential malpractice risk and dealing with potential ethical and licensure issues once there's some sort of impairment. And so these policies will protect you if there's either some physical reason Again, I've represented surgeons who had knee issues, whose surgeries required four and five and six hours of being on their feet at a time, but because of their knee issues or hip issues, they weren't able to do that. There's vision issues, there's hearing issues. Vision issues, there's hearing issues and there's cognitive, because you have to be able to make decisions obviously make correct decisions under pressure often, and it really for purposes of these policies. If there's any diminution in this, I think that you have valid, probably have a valid claim to talk to somebody like me about.
Speaker 1:I once represented a surgeon who had cardiac issues and he had a defibrillator implanted and it was their doctor's his doctor's prediction that hopefully this thing would never, ever go off. And the insurance company was giving him, this client, a hard time because they were looking at the records and saying, look, your doctors are saying hopefully this thing will never, ever go off. And my response to them was what if it goes off when he has his hands down your child's throat doing his surgery? And so just that small chance that some patient would be injured because in this case there was an internal defibrillator implanted entitled and made this physician, this surgeon, eligible for benefits under the policy because there was no way ethically, really morally, that he could continue to do surgery knowing that there was a tiny chance that his defibrillator could go off. I want to talk for a moment and don't be intimidated by this chart because I want to talk generally about the different types of policies that are out there, that many of your followers do not become actual employees of groups, but many will, at some point in their career, be an employee of a group.
Speaker 1:Almost every group medical group is going to offer as a benefit a group short-term and long-term disability plan. These policies are generally decent but not great. They are generally pretty low-priced. They generally will insure the physician or the healthcare provider, members of the group, without doing any underwriting, without doing any testing of current health. They all have pre-existing condition provisions in the policy. We'll talk about that in a little bit. But they're good.
Speaker 1:But my message to you all and to every again young professional that's talking about, is that if you can, buying your own individual long-term disability insurance policy, disability income policy from a broker is the best protection you could ever provide for you and your family. Why is that? Look, they are more expensive. They are typically underwritten, so they're not going to sell you a policy unless you are a good risk for them. But then generally the benefits are going to be better. Number one the policy is going to be easily portable if you move from practice to practice. Number two, you're going to be able to get benefits under both policies if something does happen and you can't do your work.
Speaker 1:We'll talk in a little bit about group policies.
Speaker 1:If you're on claim and you become eligible for social security disability benefits, the social security disability benefit will offset or reduce what the group policy is paying you.
Speaker 1:You generally do not see this in the individual policies Individual policies, because they're paid for out of your pocket.
Speaker 1:The benefits are typically not taxed.
Speaker 1:By the way a little tip here for anyone who hears this and is insured under group policy these policies are generally pretty inexpensive you should talk to your employer about.
Speaker 1:The employer will typically give you a choice hey look, either we, the employer, is going to pay the premium for you, or you can pay the premium In the law firm. We recommend to our employees, and particularly the young people, to go ahead and, if they can, to pay the premium themselves. Why? Because if something happens and they do become entitled to benefits later, those benefits will be tax-free Again. If you pay the premium, either through your own individual policy or because the employer allows you, as part of the plan, to pay the premium instead of the employer paying the premium, allows you, as part of the plan, to pay the premium instead of the employer paying the premium, then if you become eligible for benefits, those benefits will be tax-free and that can make a huge difference depending on how much benefit you're getting and how old you are if you become unable to work, and how long it is that you remain on claim.
Speaker 3:This podcast is brought to you by Ben Glass Law, a national leader in long-term disability insurance claims. We help doctors, lawyers, entrepreneurs, ceos and other C-suite executives get paid for their long-term disability benefits. Visit us at benglasslawcom or give us a call at 703-591-9829.
Speaker 1:Case so it is something to think about. The other thing that you'll see most often in group policies is that a group my dog knows that it's five o'clock and it's time for dinner, or he thinks it's five o'clock. Group policies will typically protect you from your if you are unable to do your own occupation duties for about two years. Again, most policies are different, but most policies will protect you for the first two years, the first 24 months, if you can't do your own occupational duties, and then it will only pay you benefits if you can't do quote any occupation. After that we can talk and answer questions about that. Virtually every individual policy I've ever looked at will protect you in your own occupation, and we'll talk in a minute about what own occupation means. But it's another benefit. Come on, give me a chance here. It's another benefit of having a good individual policy. Again, these policies are more expensive, but the healthier you are and the younger you are when you get into one, the better the pricing is actually going to be over a long period of time. The third type of policy that many of my healthcare professional friends will see is the association policy. The American Medical Association may offer a giant group disability policy? Certainly the American Bar Association, which I'm not a member of, but if I was, they offer group long-term disability insurance. These policies tend to be the worst in terms of benefits. Why is that? Again, it's because they're really inexpensive to buy. They insure a large number of people but they don't do any medical underwriting. And, given your druthers, you would always want to go find an individual policy through a broker first. Number one, number two if you're working for a group, a medical group, you're likely going to be covered or have the option to buy into coverage for your long-term disability benefits from the group. And having done those two things, you probably do not need to ever go to the whatever Association of Nurse Anesthetists, for example. Those policies, again, will tend to be the worst of the group. But some people aren't, because of their own health issues, aren't able to get private insurance, individual policies. So in that case then, yes, you would look at the group policy and I would always say look every time when you go and you buy a policy. They will deliver the policy to you and you will have typically 30 days or so to reject the policy or to examine it and make sure it is right for you. Again, we do a lot of consulting on that as well. Let's just make sure before we need to go and make a claim, that this policy that we are buying or is offered to our employer is what we think it is. So I'm not going to go.
Speaker 1:This next slide is about sort of key features of a policy. We've talked a little bit about some of it. I'm not necessarily going to go through all of them. Thanks, anne. But these are the big sections of a typical long-term disability insurance policy. We've talked a little bit about own occupation definition. I'm going to show you a slide here in a minute that will show you that even the own occupation definitions in different policies can differ and some are much stronger than others.
Speaker 1:Most policies that you'll see either buying group policy or buying individual policy are going to provide you coverage up until Social Security retirement normal Social Security retirement age, which is 65, 66, 67 years old, depending on the day you were born. We'll talk here in a minute about pre-existing conditions. We already have talked about Social Security disability benefits. That is, under most group policies. If you become eligible for Social Security benefits, that will reduce the amount of benefits the insurance company is paying you. Again, that helps the employer keep premiums down. There are all sorts of riders to get, mostly in the individual disability policy world because the employer is buying a group policy world, because the employer is buying a group policy and being an employer, I've been on that end where you go and you negotiate with Hartford or New York Life. You negotiate for the terms of the policy you're selling to your employees and then typically the individual employees are not buying or not entitled even to buy individual riders on a group policy. Riders is something we talk about in individual policies.
Speaker 1:I think that a big, important provision is this what we call this mental and nervous limitations. So in most group policies that we see, if the nature of the disability is a so-called quote, mental and nervous limitation or mental and nervous condition, which can be anything from anxiety to depression to substance abuse, often coverage would be limited to 24 months. So again, you rarely see this limitation in an individual policy. It's in almost every group policy because the employer didn't negotiate it out and the employer didn't negotiate it out in order to keep the employer's premiums down. That's neither good nor bad. You should just know about it, which means that if your claim involves things like depression, anxiety or other defined mental illness terms or mental illness conditions. You will be typically limited to 24 months.
Speaker 1:Now what my job is in that situation, just so you know, is to help you if appropriate right, we never lie but if appropriate, to show the insurance company that there is some physical component as well to your disability and that the physical component is really the predominant reason why you can't work. So again, if you are thinking about going out on claim, talking to somebody like me, an experienced disability claims attorney, before you start to fill out forms, can be really helpful to you, because I'm jaded right. But I do think these insurance companies are in business to make money and to deny claims. So that's just kind of an overview of different features that are involved in a policy. Let's see. Here I do want to talk about a case that I handled which it's important to understand. That's why it's important, if you have a policy and it's through the group that you work for, I think it's really important to know, before you make a claim, to have a copy of that group policy and to understand it.
Speaker 1:This case was a case in Virginia and Dr Evans is an interventional radiologist and over time, and he was one of the early pioneers in interventional radiology. He had spent 20, 25 years in the interventional radiology suite being exposed to radiation and of course, the protections that healthcare providers have today, in 2024, are a lot better than they did when they started. And over time he developed some wonky blood results which his hematologists were concerned about, and of course their concern was that it could turn to some sort of lymphoma or other type of blood cancer related to exposure to radiation. And so they said to him look, we believe that you need to stop doing interventional radiology, you need to end the exposure to radiation. The doctor was employed by a group here in Virginia and the group had a long-term disability insurance policy issued by the Standard Insurance Company and it had an own occupation definition in it.
Speaker 1:However, in this particular policy again, I can't say this enough every policy is different. Own occupation was defined as what you were board certified in, and because Dr Evans was an early pioneer in the space of interventional radiology, his board certification was in general radiology. At the time his doctors recommended that he not continue as an interventional radiologist. He was teaching to residents, he was leading the program at a major health institution here in Virginia and over time the board or the Association of Interventional Radiologists had developed a subspecialty certification in interventional radiology. He had never applied for that subspecialty certification, even though he was teaching fellows and residents so that they could have that certification. And this policy said look, if your specialty has a subspecialty, actual certification, then that will be your occupation, your own occupation Interventional radiology. How to subspecialty certification? He did not have that piece of paper because he just didn't need it in his life and his claim was denied and we lost the case. The court actually upheld the standards view of the world. His claim was denied because he was certified in general radiology and they said you can go back to read films, even though he really hadn't read regular x-rays in 25 years. Now I think that this was the fault really of the group, of the employer who didn't ask enough questions. When they bought the policy were promised this is an own occupation policy, but nobody was smart enough. Again, because they don't deal in claims, nobody was smart enough or curious enough to ask what about guys like Dr Evans who don't have that subspecialty certification but have been around a long time? And so again, the rule in lawyering is read the policy.
Speaker 1:Let me talk about pre-existing conditions for a moment, because whether you go out and buy an individual policy or whether you are moving to a new company and being insured under a new group policy, if you have something, an illness or disease that is festering or beginning at the time you start work and now you, at some point later, you have to go out on disability and it's caused by this so-called pre-existing condition, then you're not going to be paid benefits, and so what is, I think, important to understand here is that if you are, typically, if you are making a claim within the first year of being on a new group policy and your claim is for a condition that manifested itself or you were getting treated for before you became a new employee of the group, the insurance company is going to take a look to see whether your claim disability is caused by something that was going on before you became an insured under that policy. Now I just grossly oversimplified that, again, every policy is different. Every policy will have a different look-back period. Typically, once you have worked for six months or 12 months, then the pre-existing condition exclusion or the limitation won't apply. But it's one of those things that, again, talking to me, or somebody like me who can understand your medical records, understand your policy and may say to you hey, dr Brown, it's May of 2024, and you're thinking about making a claim. But when I do the dates, like if we can just get you to July before you make your claim for disability, then you're not going to have to deal with this pre-existing condition limitation. Now, there's all sorts of issues under there, but too many people don't fully understand the pre-existing condition exclusion or limitation in a group policy.
Speaker 1:Now, in an individual policy, what I cannot impress upon you enough is that when you're filling out an application for an individual long-term disability policy, a new one, you have to be honest. You can't hide anything. They will find it. They will find the one time you went to the ER with a little bit of chest pain but you forget about it, or you don't think it's important enough, or you're trying to hide it. They will find it, trust me. And so never if any broker or agent who's helping you fill out an application for a policy tells you otherwise, they're wrong.
Speaker 1:You just have to be brutally honest about your condition, because you can still buy an individual policy. So let's say, for example, a nurse anesthetist has a history of back pain or maybe he had back treatment. You'll still be able to buy a policy usually, but they may exclude completely any future claims related to back. Or they may say look for the first two years or three years that you're on this policy. If you make a claim related to the back we're not going to pay it, but you get to year four or five it'll be fine. So you can't do that if you're hiding the past medical condition, and a good broker will also if you do, if you're not like in perfect health. A good broker can also look around at various policies, different policies issued by different companies. Help you study the various pre-existing condition exclusion on those policies and at least help you find the one that minimizes the risk that if you have a claim, that your claim is not going to be honored because of the pre-existing condition part of the policy.
Speaker 1:I think the other thing that's important to understand is what we call, what the policy is called, residual disability. A better name is partial disability, and the best way to explain this is there may be times where a sickness or an injury happens to you and maybe you can no longer work 40 hours a week so you cannot do your occupational duties on a full-time basis for some period of time, but maybe you can do it for 10 hours or 20 hours a week and you want to keep working. Assuming that your medical records support that claim, you may still have a claim under your policy. It'll be for residual disability or partial disability and you'll still be entitled to some benefit.
Speaker 1:Let me give you an example of a physician who didn't figure this out, didn't understand his policy. So this gentleman several years ago came to me and he was an OBGYN, so he obviously had a surgical and maternity baby delivering practice, but he also had a robust clinical practice. He developed either I don't remember whether it was a tremor or revision issue which took him out of the OR and took him out of the maternity part of his practice. And he made the mistake of talking to some friends who were not lawyers, they were doctors and who didn't understand obviously they're not specialists in this world who told him that because he could still do his clinical practice, he was not entitled to any benefits. He wasn't totally disabled and as a result of his condition, his practice, he was making a lot of money and let's just say his practice income went in half.
Speaker 1:And he came to me for a different issue later, but I asked him about it. I looked at the history and asked him about this and he told me about the advice his friends had given him. And his friend's advice was totally wrong. He was partially disabled, or he was residually disabled, because he was able to continue a clinical practice but lost substantial income because he couldn't go into the OR, into the delivery room anymore. He was at that time entitled to benefit. Now the problem was, by the time he came to me, too much time had passed, because all of these policies have provisions in them for prompt notice, for giving the insurance company information that supports the claim in a timely manner, and too many years had passed for him to go back and as a result, he really lost hundreds of thousands of dollars because he took the advice of non-lawyer friends about his disability policy.
Speaker 1:So I would say this, and I'll be happy to take some questions here is that in the search, particularly if you're a locum tenens, so let's just say you're not attached to a group for any substantial amount of time maybe you move around the country, maybe you do a lot of part-time work. Whatever it is yes, you should have an individual long-term disability policy and you should find a broker, in my view, who is familiar with an experience in the medical world. I don't know how you all found me, but White Coat Investor is a very popular podcast and website. We actually are sponsors and we run ads there on the claim side. But there's a number of brokers who advertise there and who have articles there and have been interviewed there, who are specialists in the healthcare side of long-term disability insurance claims, and that's where I would probably start, because most of them will be able to help you, no matter where you are in the country. And absent that or in addition to that, I would be looking locally for experienced brokers of long-term disability insurance and I would make real sure that they understood exactly what my duties are. So, if I'm a surgeon, exactly what I do day to day in my world, crna exactly what that job is and what it is that I'm trying to protect against. Now again, as always, these policies are more expensive than group policies, but I've helped a lot of people who were really happy that they were able to find a good policy, early pay for that policy and at some point you just never know when something's going to happen to you injury or illness that requires that you make a claim.
Speaker 1:We have got a ton of information at our website, benglosslawcom. We even have a special section just for. It says doctors, but it is really all healthcare providers. We've got a ton of articles there. I'm easy to find on LinkedIn. We've got a good YouTube channel that talks a lot about these policies, and so I'd be happy, eric anybody who's on this call to take questions. What I'm going to do is I'm going to stop sharing the screen and remember this is being recorded and this will be rebroadcast in some way, shape or form, and just know that don't ask about personal medical questions if you don't want the rest of the whole world to know about. If anyone has a question there's a couple of us here you can unmute yourself. I'm happy to answer them.
Speaker 2:Great, mr Glass, I'll start with the question. Thank you for your presentation. Thank you for your time today. I recently started doing locum tenens, although I've been a nurse anesthetist for almost 20 years now and I've always been under the umbrella of a group policy. So now I need to find my own individual policy to protect myself and my family, as your presentation stated. Policy to protect myself and my family, as your presentation stated. One thing I did not hear you say was anything about the policies where your rate and your health are locked in. So I'm assuming that your annual or your monthly price does not elevate over the years of the policy.
Speaker 1:Yes, yes, you can get those policies, Certainly. So. I started when I was like 23 and buying my first individual policies and I use Northwestern and I think, from a claims perspective, we see very few claims from Northwestern. Why? Because they work really hard to not insure you if you're not a perfect candidate Okay. To not insure you if you're not a perfect candidate Okay. But, yes, absolutely, Pricing and keeping rates are absolutely in the market.
Speaker 1:Because I'm not a broker and because I've limited experience in actually buying policies and negotiating the price of individual policy. I'm not really an expert on that, but you can definitely find that. And what you are going to be looking at, I think, is generally how much money do I make in a year? What's my I don't know what my family financial responsibilities are? What would happen if you couldn't work? How far away from you from social security? How many if you have kiddos that you need to support, send to college? These are all sorts of things that I would be talking to a good broker and maybe even more than one broker about to find the policy that I can afford and that would protect me if I can't do my work. Does that make sense?
Speaker 2:It does. It does, and I know just briefly, looking over some policies and just trying to become familiar with this before I decide which company I'm going to go with. I know that they have a waiting period before you can start collecting Any word of advice on policy. You should pick as far as the yeah, exactly, it's a great question.
Speaker 1:In disability insurance it's called the elimination period. It's just like the deductible in your healthcare. When you are choosing a health insurance policy and you're going down the different columns, that says I can pay this premium and get this deductible. Same thing for your auto policy, right? What you're thinking about is how much in terms of family finances, how much could I absorb? So someone that has got maybe a lot of cash built up would be able to reduce their premium by having a six-month elimination period.
Speaker 1:Six months is a pretty long period if you can't work to not be paid, and so most group policies have that. But why do they have that? Because typically the company is also offering a short-term disability program. So the short-term disability program is six months and the elimination period for the long-term is six months. So every single provision in a long-term disability policy is negotiable. It really is, and so I think the answer to that question is how much would it hurt me or my family financially if I couldn't work and I got zero paycheck for a month or two months or seven days, whatever it is? But what you're talking about is what we call the elimination period. It is the deductible. I don't know again, because I have not been on the buying side of individual policies really other than my own, whether there are others where you can even buy a short-term sort of a gap policy. I don't know, but that's the way I would think about it and it's a great question for a licensed broker.
Speaker 2:Okay, thank you.
Speaker 1:Yes, let's see. I think someone put up a chat message. I'm trying to find if I can see it. Yes, so, crystal, is disability insurance something to look around for different rates? What do you do if rates increase on an already in place insurance plan?
Speaker 1:This really goes back so to a question that Talitha had absolutely different rates and there are so many policies out there and when you're buying an individual policy, part of your rate is going to be based on how healthy are you, how old are you? You may be healthy today, but maybe you've got some chronic conditions that have festered and poked their heads up over the last five years or 10 years. Those are all going to affect rates. And then, absolutely, you can talk to a broker about what they call level premiums. So how many years can I keep premiums five, 10 years level? And one of the things to think about there is how much longer do I plan to work? So you may, let's just say you're planning to work for 10 more years and you're going to retire or do something else in 10 years, and you can find a policy that has level premiums for 10 years and then it quadruples on year 11. If your plan is to only work 10,. You're never going to be responsible for the quadrupling in year 11, but then you'd have to be a pretty good predictor of what you want to do with your life.
Speaker 1:The other thing so I just turned 66. I have no plans to retire. I run a good practice, but my individual policies I dropped because the older you get, I can't buy 10 years of benefits anymore. So the most number of years of benefits I could buy with Northwestern was like two. I'm good If I can't work for two years. I've made money, I've got good resources and I would just be retired and I would get Social Security benefits anyway. So those are things you start to think about as you get older.
Speaker 1:It's like life insurance. We're always asking ourselves what am I trying to protect? What would happen? Who's relying on me? Really, that's a big question. Who's relying on me and the income I produce? Maybe it's only you, but maybe it's you and your kiddos and spouse. Who knows? Those are all questions that, again, a good broker and even a good wealth person could help you figure out. All right, what's the best way to go spend my money on insurance? America really is a good place for insurance because I think, by and large, insurance is relatively inexpensive, even though I know everything goes up every year. But we're pretty fortunate, I think.
Speaker 1:With so many companies competing for your business, how long does it take for a claim to pay out? Once a claim is made? It's a great question. So you get hit by a bus and you're in the hospital and you're not coming out for a month. They're going to pay that claim just as soon as they see the picture of you sitting in the bed right. Very short time You've got.
Speaker 1:I represent a lot of people who I call. They have the one in three million disease process, the one where it takes them five levels of specialists to figure out, like why is this person losing consciousness in the middle of the day? I had a lady, a client. She had stiff person syndrome. I had never heard of that and most neurologists never see it in their entire career. Right, those claims are going to take longer because I have to convince the insurance company that the condition is real, that my client actually has this condition and that this particular healthcare team that's taking care of my client knows what they're doing. You know the other hand, the people that get hit by a bus. I tell them like you don't need me. Me, that's really obvious. Insurance claims adjuster is going to pay that claim. Let's just call it for our conversation the weirder the claim or the rarer the claim or the more murky the diagnosis, the longer it's going to take to get it paid.
Speaker 1:Under many group short-term disability policies they'll start paying you quickly, but then, once you get to the long-term disability side of the equation now you're dealing with, you're moving up the food chain of an insurance company and they are more skeptical. Your job when you are making a claim, your job is to make the claims adjuster's job easy. Like you want the file that is well-documented, you give them the medical records You've got before you make the claim that you've got physician support. Again, this is a reason why doing, if you're thinking about going in on claim, doing a consult with me or somebody like me can help you go. Here's what these records are going to need to see. Here's how they could be cleaned up. And again, we never tell doctors what to say, but we tell doctors how to speak in the language of the insurance company. We're always making truthful claims. But doctors are good at doctoring. You all are good at nurse anesthetist work and then you have lawyers like me who are good at this work, and the doctors meaning aren't experts in disability, because the word disability even can mean so many different things.
Speaker 1:We're talking about social security. We're talking about not being able to get out of your bed. Are we talking about a particular insurance policy that protects you from your board certification of radiology, but not because you can't be in the interventional radiology lab anymore? So hopefully that's helpful. It's a case Lawyers always say it depends. It's a case-by-case basis there. Yeah, hopefully you never need me, but we're here and I love talking. I meet interesting people every single week in the healthcare field and again, my goal when I have one of those conversations is you're going to work with my team, we're going to have one conversation, I'm going to set you straight and next time you call me it's because you got unclaimed and you made the job easy for the insurance company. I make enough money dealing with people whose claims have been denied and then we go get it, try to get it from the insurance companies.
Speaker 3:Thank you, ben. I appreciate you talking to us today, Very informative.
Speaker 1:Yeah, thank you very much Again. You can reach out on LinkedIn If you want a hard copy of the book. Any of your members do. Just reach out on LinkedIn and message me and we'll set that up for them, or they can download. Okay, all right, all right, all right, thank you. It's a great Saturday afternoon here. It's been nice weather on the East Coast. Thanks for inviting me on All right.
Speaker 3:Thanks, take care, ben Case. The proceeding has been a production of Ben Glass Law, a Fairfax, virginia-based personal injury and long-term disability law firm. For a free evaluation of your claim, visit us at benglasslawcom or call us at 703-590-7000.