Get Answers to Your Benefits Questions in Our Disability FAQ

Dealing with the process of applying for and receiving disability benefits, whether it’s through the Social Security Administration (SSA), your employer, or a private insurer, can be a challenge, and many people are left with questions about what they can do to get the help they need. At the law offices of Loyd J. Bourgeois, we understand how hard it can be to get the answers you need. That’s why we’ve put together the following list of Frequently Asked Questions (FAQs) and answers dealing with personal injury, disability benefits, claims, and appeals and the related law in Louisiana.

The following are some FAQs that I receive as a Louisiana attorney. They may answer some of the questions you have regarding your Social Security Disability appeal, your long-term disability insurance denial, or your personal injury claim. If you have a question that is not answered here, please call the legal team of Louisiana Disability Law, Loyd J Bourgeois at 985-240-9773.

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  • When do you need a personal injury attorney?

    Have you been seriously injured in a crash or maritime/industrial incident? Are you now dealing with a disabling injury? Did your crash/incident occur in Louisiana’s River Parishes (St. Charles Parish, St. John the Baptist Parish, St. James Parish)?

    5 signs that it's time to hire a personal injury attorneyYou need to decide if you need a local injury attorney to help protect you and your family from the insurance industry.  The simple truth is this – You need to hold the insurance company accountable. You decide – what is the best way for getting it done?!

    If you experienced a severe or disabling injury, you may or may not need to speak with a Louisiana personal injury attorney. Some signs that it is time to contact an injury attorney include:

    1. Someone else caused the injury;
    2. Insurance companies are denying your claims, or refusing to tell you how much coverage is available for your damages;
    3. The responsible party or their insurance company refuses to acknowledge their responsibility;
    4. Your injuries required surgery, extensive medical treatment, and are not getting better;
    5. You have high medical bills or significant property damage directly related to the accident.

    Use your common sense and decide for yourself.  Do you need an attorney? 

    Peace of mind is important.  Louisiana disabling injury attorney Loyd Bourgeois at Louisiana Disability Law can look at the specifics of your case to determine the grounds for your Louisiana personal injury lawsuit and help you file your claim. Contact us for a FREE NO OBLIGATION consultation – (985) 240-9773.

  • How do I get to the Social Security office in New Orleans, LA for my hearing?

    The New Orleans Social Security hearing office is located at 1515 Poydras Street in New Orleans, Louisiana. 

    • Coming from the Westbank, cross the Greater New Orleans bridge, exit at O'Keefe Avenue.
    • Stay on O'Keefe until you get to Poydras Street.  It will be 4 red lights.
    • Take a left onto Poydras Street.
    • The building is at 1515 Poydras Street, just past Lasalle Street.  To get to the parking garage, pass up the building and proceed to Freret Street.
    • Take a right on Freret.
    • The parking garage will be on your right.
    • Proceed up the ramp and press the button to get a parking ticket. Bring this ticket with you into the building.  Do not leave it in your car.
    • Once you have found a parking space, follow the signs to the elevators.
    • Take the elevator to floor 1.
    • Exit the elevator and cross the lobby to the second bank of elevators which go to floors 16-27.
    • Take the elevator to floor 16.
    • When you exit the elevator, you will see the Social Security Hearing Office.
    • Have your picture ID and hearing notice with you.
    • Remember that you cannot bring weapons such as guns, pocket knives, fingernail files or chemicals such as pepper spray or mace into the hearing office.
    • After your hearing, by the parking garage elevators, there will be a pay kiosk to pay for your parking.  It accepts cash and credit cards.
    • Taking your ticket and receipt with you.  You will need them to exit the garage.

    If you have more questions about your upcoming hearing and what to expect, check out our blog post What to Expect at an SSDI Hearing.

    If you need legal help or have specific questions about your case, give us a call at 985-240-9773 or fill out the contact form to the left.

  • Can I apply for Social Security if I was hurt in a car accident?

    As a Louisiana Social Security Disability attorney and a disabling injury attorney, I am often asked: “I was hurt in a car wreck; can I apply for Social Security Disability Benefits?”

    Can I apply for SSDI if I was hurt in a car accident?The answer to this simple question is – it depends.

    It depends on your injuries.  It depends on your symptoms.  It depends on your treatment. 

    If your disabling injuries keep you from being able to work for 12 or more months, you may be eligible for Social Security Disability benefits. 

    If your injuries heal in less than 12 months, you are not eligible for Social Security Disability benefits in all likelihood. 

    If you or someone you love suffered an injury in a car crash and have questions about Social Security Disability benefits, give us a call at Louisiana Disability Law.  We have the experience to guide you through this difficult process of figuring out whether or not you may eligible for Social Security or other injury-related benefits.

    9 Mistakes That Can Disable Your Social Security Disability Claim Book Offer If you're preparing to apply for Social Security disability or appeal a claim denial, I've written a book 9 Mistakes that Can Disable Your Social Security Disability Claim.   This is a helpful and informative guide that will guide you through some of the common mistakes and errors that lead to unfavorable Social Security Disability decisions.  Don't make a costly mistake that could cause you to lose the benefits that you need to survive! I'd love to send you a copy.  Just click here to receive your free copy of my book 9 Mistakes That Can Disable Your Social Security Disability Claim.

     

  • Can I get punitive damages for a denied Long-Term Disability claim?

     

    Recently, while working on a claim for a disabled heavy equipment mechanic, he asked if it was possible to recover punitive damages because of his improper disability denial.  My answer to him and now you follows: 

    I know that having your disability claim denied is very frustrating. The long-term disability insurance industry has a history of bending and twisting laws just to avoid paying benefits to people who need and deserve it.  Unfortunately, the law governing Louisiana ERISA long-term disability claims simply does not have any way to hold these insurers accountable.  The ERISA law does not provide for punitive damages or bad faith damages.

    While my client was disappointed in the news, he knew there was nothing we could do. 

    However, if your plan is not an ERISA plan, you may be able to win other damages for the insurance company’s bad faith actions.  This includes those with private disability insurance policies, those employed by federal, state and local governments, and those employed by churches or other religious organizations.  Because these plans are not covered by ERISA, often they rely on state insurance laws that provide certain penalties for bad faith actions. 

    To discuss a plan of action for your denial, call disability attorney Loyd Bourgeois at 985-240-9773 for a free consultation. 

  • What types of expert witnesses testify during disabling injury cases?

    Most serious disabling injury cases come down to the witnesses. In any case, witnesses can be either fact witnesses or expert witnesses.

    Types of Legal Witnesses for personal injury casesA fact witness is someone who has personal knowledge of the specifics facts at issue. This may be someone who actually saw the accident – an eyewitness to the accident for example. It may be a medical doctor who treated you and testifies to the facts of your treatment.

    The other type of witness important to disabling personal injury cases is an expert witness.

    An expert witness is typically an individual who has specialized knowledge, training, or skill in a particular field, and who can provide some information relevant to your case. Expert witnesses are often hired by both sides in a case, and many times play a critical role in the outcome.

    There are many types of expert witnesses used in personal injury cases, - a few are discussed here.

    Experts on How The Accident Happened

    Car Accident Reconstructionist – This expert is usually a consultant for a collision analysis, reconstruction of the accident, injury reconstruction, and crashworthiness. An accident reconstructionist may also provide reports that focus on collision speed and vehicle safety. This type of expert witness may also testify about acceleration, right-of-way, braking, steering angles, and other issues related to vehicle crashes.

    Maintenance Specialist – This expert can be helpfu1 in 18-wheeler involved crashes. Maintenance specialists can show whether a trucking company did or did not perform required maintenance as claimed and whether the failure caused or contributed to the crash.

    DOT Regulations Specialist - Department of Transportation regulations are extensive. An expert can help your attorney determine if certain safety type products (helmets, tires, airbags, etc.) were properly tested prior to being put on the market. This expert can also help establish whether a trucking company’s drivers followed the safety rules and DOT regulations, and if not how that may have led to the accident.

    Cell Phone Records Specialist – In the information age and age of distracted driving, cell phone records are frequently used as evidence in crash cases. This expert can provide information used to demonstrate whether or not the other driver was likely using their mobile phone at the time of the crash.

    Vehicle Information Specialist - Data from the vehicle’s ECM (electronic control module) and EDR (event data recorder) or “black box” is important in some cases and it takes an expert who knows how to read and recover it.  The information from this witness can be used to show various information regarding the vehicle’s actions immediately prior to an accident. This witness can help determine whether or not the driver’s actions or inactions may have contributed to the crash. They may also be able to show if the driver had exceeded the federal hours-of-service rules (too much time on the road) mandated by the FMCSA.

    Forensic Toxicologist - A forensic toxicologist provides clarification in disabling injury cases that involve an investigation into drug interactions, drunk driving, drugged driving, poisoning, and other cases that involve chemical ingestion or inhalation.

    Experts On Injury Type

    Medical Doctors in General – Medical doctors can review the facts of the case in order to understand all the issues and objectively clarify any relevant medical questions. They may also assess the condition of the patient in order to determine the appropriate ongoing medical care and to assess the need for more specialized care in the future.

    Neurologist/Neurosurgeon - Neurology experts may provide testimony on a variety of topics relating to the brain, spinal cord, and nerves. Oftentimes, a neurologist may be needed to testify to the degree of your injury, your level of disability, and your treatment plan moving forward. The neurologist/neurosurgeon can also provide assistance with connecting the incident to your injury.

    Neuro-Psychologist – this is a medical doctor trained in both neurology and psychology, and this expert can be very important in cases with traumatic brain injuries (TBI) and mild traumatic brain injury cases. These cases often require years of rehabilitation or assistive care, and you need to take this into consideration before accepting any settlement with the insurance company or at fault party.

    Orthopedist/Orthopedic Surgeon – This is a doctor who specializes in bones and muscle/tendon/ligaments.  An orthopedic surgeon can provide testimony regarding all aspects of your orthopedic injuries, including your level of disability and future outlook. They may provide reports related to surgery, arthroplasty, hip replacement, spinal injuries, and other issues related to the musculoskeletal system.

    Medical Examiner/Pathologist – A medical examiner, or coroner, is typically a pathologist and are responsible for evaluating the cause(s) of death. Testimony from this expert can be vital to a wrongful death case and help with determining responsibility.  A pathologist conducts examinations and autopsies and can provide qualified and objective opinions on a victim’s medical condition and cause of death.

    Pain Management Specialist - Since some types of injuries can leave a victim with chronic pain and discomfort, the injured party can often help his/her case by using the testimony of a pain management specialist in order to demonstrate the full value of their related damages. This expert witness can testify about the extent of pain the victim suffers, how it affects his quality of life, as well as how much compensation will be needed to pay for future treatment.

    Experts on Cost of Injury Issues

    Life Care Planner - Life care planners are utilized to offer testimony on areas such as disability management, the cost of future care expenses, helping figure out the loss of income, and more. These skilled experts may also provide testimony in the areas of an individual’s earning capacity, reduced ability to perform a prior job, future earning capacity, the severity of the disability, life expectancy, and other related topics.

    Vocational Specialist - Vocational experts testify concerning the types of jobs available for an injured party given the residual functional capacity, and the effect of an injury on a person’s ability to perform any type of work on a sustained and consistent basis. VEs can also provide testimony regarding a person’s past work and any transferable skills. Their testimony can establish diminished earning capacity.

    Rehabilitation Specialist - Rehabilitation specialists focus on helping an injured party improve and restore functional ability following an injury – they could be a physical therapist/occupational therapist/speech therapist. They may also work with those who have permanent disabilities such as spinal cord injuries or a loss of limb. These experts can provide evidence concerning future rehabilitation needs and associated costs.

    Which specific experts will be necessary for your case is dependent on the specific facts of each case.  Some cases require many; others require few.  A skilled and experienced attorney familiar with disabling injuries can help guide your case by choosing the experts most appropriate for your injuries and incident. 

    Quick Guide to Louisiana Accident and Injury ClaimsI've written a book Quick Guide to Louisiana Accident and Injury Claims. This is a helpful and informative guide that will lead you through some of the common mistakes that can wreck your personal injury claim.  Discover why you may not even need an attorney! Get answers to your questions about recorded statements, paying medical bills, getting your vehicle repaired, negotiating a settlement, and much more! Don't make a costly mistake that could cause you to accept a settlement that is too small to cover your medical bills and lost wages! You need to read this before you talk to an attorney or insurance adjuster.  I'd love to send you a copy. Just click here to receive your free copy of my book Quick Guide to Louisiana Accident and Injury Claims.

     If you or someone you love has suffered a disabling injury requiring hospitalization or causing you to miss work, give us a call at 985-240-9773.  We have the experience to guide you through this difficult process and advise you on both the injury and the disability aspects of your claim.

  • How can I best present my case at my ALJ hearing?

    Having handled hearings for many New Orleans and other Louisiana Social Security disability claimants, I am often asked – how can I present my case most effectively at my Social Security disability hearing?

    At your hearing, your testimony should focus on the following:

    • Your physical symptoms, including your pain, its severity, and the resulting restrictions;
    • Your functional capacity: ability to sit, stand, walk, lift, carry, manipulate, and travel;
    • Your current daily activities and any changes to your activities and life due to your disability;
    • Maybe the requirements of the jobs you held in the last 15 years – exertional, skill, and stress levels; and
    • Your current medical treatment: length, frequency, medication, etc.

    Sometimes having friends, family or co-workers testify can help, but usually, the ALJ is more interested in your specific testimony.  Plus, new regulations do not require ALJs to even comment on this witness testimony. 

    As a Louisiana Social Security disability lawyer, I have developed and polished many effective techniques for winning benefits. If you or someone you love is fighting for Social Security disability benefits, give us a call at Louisiana Disability Law.  We have the experience to guide you through this difficult process and present the best possible case for you before the Administrative Law Judge.

  • How does a long-term disability attorney help in my claim?

    I have spoken to many people who I simply could not help because all they did was what the disability insurance company told them to do all the way up to the time they received their final administrative denial letter.  Basically, all they have to support their claim is the minimum information the insurance company wanted.

    A good long-term disability benefits attorney will help you “stuff the administrative record” with documents and evidence helpful to your claim.  Much of it the insurance company will hate but has no choice but to accept into the record.  They hate this evidence because it makes their job much more difficult.

    How does a long-term disability attorney help your claim?Filing a successful long-term disability claim appeal includes more than just filling out forms. You must know how to use the forms and how to supplement the administrative record beyond what the insurance company asks you to provide.  To launch the best possible claim or appeal, a good disability insurance attorney will position your case for success with additional medical, vocational and financial evidence.

    This evidence is key to proving that you are disabled! And proving that the long-term disability insurance company made an arbitrary and capricious decision.

    What does a Long-Term Disability Lawyer do?

    A long-term disability attorney can help you find and acquire supporting medical and vocational records, job description evidence, plus written statements from family, co-workers and friends, and much more to support your claim. 

    In addition, depending on the case, an experienced long-term disability attorney may do any of the following:

    • Arrange for an IME (independent medical exam) or FCE (functional capacity exam) or other medical testing (CTs, MRIs, blood work) that can help confirm you are disabled and fulfill demands for “objective medical finding” stated in the insurance policy.
    • Help draft your application or appeal to argue against common misrepresentations
    • Connect your limitations to an inability to perform your job’s actual duties
    • Work closely with your physicians, medical and vocational experts to help ease any difficulties in completing their statements in the best possible light, and protect them from harassment by the insurance company.

    One reason so many long-term disability appeals are denied is because the information requested by the insurance company is vague and (in my opinion) designed to help them deny your claim. The forms and information presented to claimants by the insurance company generally make no mention of submitting specific additional evidence.

    A good, experienced long-term disability attorney can help you fight back from the beginning and stuff the administrative record with good evidence necessary to win your claim.

    8 Specific Actions To Take Before Filing Your Long-Term Disability Claim Report If you're preparing to file for long-term disability, we've created a checklist of "8 Specific Actions to Take Before Filing Your Long-Term Disability Claim."  All we need is your name and email address, and we'll send you the checklist right away.  Don't make a costly mistake before you've even applied! Just click here to receive your copy of "8 Specific Actions to Take Before Filing Your Long-Term Disability Claim."

     

  • Will new ERISA Disability regulations affect your disability claim or appeal?

    As of right now, beginning January 1, 2018, the regulations that control ERISA disability claims and appeals will change. I feel this is great news because these new regulations will provide much-needed protections to many short and long term disability claimants. 

    Will new ERISA Disability regulations affect your claim or appeal?

    These important changes to ERISA law are the result of the Department of Labor’s review of ERISA legal cases since 2000. With these new rules, DOL acknowledged that ERISA rules are inadequate from a claimant’s standpoint.

    As the Federal Register states in the Final Rule, “…[group] disability cases dominate the ERISA litigation landscape today. …Insurers and plans looking to contain disability benefit costs may be motivated to aggressively dispute disability claims. Concerns exist regarding conflicts of interest impairing the objectivity and fairness of the process for deciding claims for group health benefits.”

    Existing ERISA law and regulations make it easy for insurers to deny valid disability claims without penalties, and the legal remedies and due process for claimants are very limited.  This has resulted in many disability insurance companies handling claims in unfair and in some cases deceptive manners. 

    The new ERISA disability regulations will help level the playing field for claimants.

    The new rules will apply to both short term and long term disability benefits plans provided through your employer.

    There are seven main rule changes.  Here is a summary of each:

    Certainly, the new ERISA disability regulations come as bad news for disability insurers who do not play fair. These changes will affect their administrative costs, increase burdens of handling claims, as well as increase litigation risk and add new legal complexities that work against them rather than for them.

    1. Disability Insurance claims and appeals must be adjudicated in a manner designed to ensure independence and impartiality of the persons involved in making the benefit determination.

      This rule means there must be no conflict of interest, no unprincipled benefit denials or other breaches of fiduciary duty.

      This could result in significant changes to disability insurance offices and could provide a fertile area for litigation discovery to see if disability insurers are truly administering claims in an impartial manner.  For example, if companies promote those who deny claims over those who pay claims, the impartiality of the persons involved could be called into question.

    2. Disability Insurance denial notices must contain a complete discussion of why the plan denied the claim and the standards applied in reaching the decision, including the basis for disagreeing with the views of health care professionals, vocational professionals, or with disability benefit determinations by the Social Security Administration (SSA).

      This new regulation requires the ERISA disability insurer to tell you clearly in your denial letter why your claim was denied. If the disability insurer disagrees with SSA, this regulation seems to require them to say why.  If they disability insurer disputes your own doctor, this regulation seems to require them to set forth exactly why.  This rule seems to require the ERISA disability insurance company to list the disagreements out and explain in detail the basis for each of their findings.

    3. Claimants must be given timely notice of their right to access their entire claim file and other relevant documents and be guaranteed the right to present evidence and testimony in support of their claim during the review process.

      Did you know that you currently have right to receive your entire claim file?  Many who file claims do not even know to ask for their claim file. While the insurance company is required to provide your claim file to you, they are not required to explicitly tell you.  Under this new rule you must be notified by the insurer of your rights to access your claim file and all other insurance company documents necessary for you to properly file and develop your claim.

    4. Claimants must be given notice and a fair opportunity to respond before denials at the appeals stage are based on new or additional evidence or rationales

      With the new ERISA disability regulations, you will have the right to review and respond to new information before the Plan makes a decision on appeal. If your appeal is denied, and the denial is based on new or additional evidence, the insurer must give you fair notice and a fair chance to respond.

      Currently, it is common for the disability insurance company to receive all of your evidence and arguments disputing their decision, and then they take that evidence and have another review that essentially refutes your evidence.  You are not given another chance to dispute or refute what they have and then your claim is denied. 

      This rule seems to provide you a full and fair review by providing a right to review and respond to new evidence or rationale developed by the insurer during the administrative review prior to the appeal decision. This may be a very helpful rule.

    5. Plans cannot prohibit a claimant from seeking court review of a claim denial based on a failure to exhaust administrative remedies under the plan if the plan failed to comply with the claims procedure requirements unless the violation was the result of a minor error.

      This rule takes away the insurer’s argument that you did not get a final decision from them before going to court.  This is important because sometimes the insurance company’s strategy to deny a claim is to cause delays by withholding documents or information, or they may use other frustrating maneuvers like simply not responding to your appeal or claim. 

      The new ERISA disability regulations prevent you from being barred from suing the insurance company if you fail to complete the internal appeals process when (1) the insurance company behaves wrongly or (2) procedural errors occur. If that happens, the court reviews the disputed decision without regard for the insurer’s decision.

    6. Certain rescissions of coverage are to be treated as adverse benefit determinations triggering the plan’s appeals procedures.

      This rule amends the definition of an “adverse benefit determination” to now include a rescission (withdrawal) of disability benefit coverage that has a retroactive effect. So, a retroactive rescission of coverage is considered to be a denial of benefits that sets off the Plan’s appeal process.

    7. Required notices and disclosures issued under the claims procedure regulation must be written in a culturally and linguistically appropriate manner

      Disability denial letters must be written in a manner and language that is understandable to the claimant, or otherwise include information of the availability of language services.

    Certainly, the new ERISA disability regulations come as bad news for disability insurers who do not play fair. These changes will affect their administrative costs, increase burdens of handling claims, as well as increase litigation risk and add new legal complexities that work against them rather than for them.

    8 Specific Actions To Take Before Filing Your Long-Term Disability Claim Report If you're preparing to file for long-term disability, we've created a checklist of "8 Specific Actions to Take Before Filing Your Long-Term Disability Claim."  All we need is your name and email address, and we'll send you the checklist right away.  Don't make a costly mistake before you've even applied! Just click here to receive your copy of "8 Specific Actions to Take Before Filing Your Long-Term Disability Claim."

     

  • What is a 'disabling injury case'?

     

    My office is now accepting disabling injury cases. But, you may wonder, "What is a disabling injury case?"

    An injury case is any case where an injury occurs due to an automobile crash, 18-wheeler crash, slip-and-fall, workplace injury or other torts.

    disabling injury case is any injury case that requires hospitalization and an extended period of treatment or time off from work.

    For example, if you are involved in a crash with another vehicle on Hwy 90 in St. Charles Parish and as a result, you have significant back pain, you may have a disabling injury.  If you are hit from behind on River Road and tear your rotator cuff, requiring surgery and physical therapy, you may have a disabling injury.  Let’s say you work on the river and are involved in an incident that causes head trauma – you may have a disabling injury. 

    If you or someone you love is in an accident and suffer a disabling personal injury that requires hospitalization and you to miss work, give us a call at Louisiana Disability Law at 985-240-9773.  We have the experience to guide you through this difficult process and advise you on both the injury aspects of your claim and the disability aspects of your claim.

  • How do I get to the Social Security office in Metairie, LA for my hearing?

    The Metairie Social Security hearing office is located at 1 Galleria Boulevard in Metairie, Louisiana. 

    • To get to the office, take Causeway Boulevard to Galleria Drive which is located just South of Interstate 10 between the Holiday Inn and Circle K.
    • Once you turn onto Galleria Drive, proceed down to the end.  It will be 2 stop signs.
    • Take a left onto Galleria Boulevard and proceed to the building.
    • Pass up the Contract Parking Garage.
    • If you need to be dropped off, you can be dropped off in the pullout in front of the building entrance.
    • Park in the Visitor Parking Garage.  Take a ticket.  Handicap parking is on the left by the elevators.
    • Go through the double glass doors to the elevators.  Take the elevators to floor 7L.
    • Exit the elevator and follow the brown walkway across the lobby to the building elevators.
    • Take a building elevator to floor 20.
    • Exit the elevator and you have arrived at the Social Security hearing office.
    • Proceed to security for your screening.
    • Have your picture ID and hearing notice with you.
    • Remember that you cannot bring weapons such as guns, pocket knives, fingernail files or chemicals such as pepper spray or mace into the hearing office.

    If you have more questions about your upcoming hearing and what to expect, check out our blog post What to Expect at an SSDI Hearing.

    If you need legal help or have specific questions about your case, give us a call at 985-240-9773 or fill out the contact form to the left.