Get Answers to Your Legal Questions in Our FAQ

Dealing with a legal issue whether it be applying for and receiving disability benefits, fighting for a personal injury claim, or navigating through a divorce, 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 family law, 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, your personal injury claim, or your Louisiana divorce. If you have a question that is not answered here, please call the legal team of Loyd J Bourgeois, LLC at 985-240-9773.

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  • 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. 

  • 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.

  • 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 LJBLegal 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.

  • How long do SSDI benefits last?

    You will receive Social Security Disability Benefits for as long as you remain disabled under the Social Security laws. However, if you remain disabled at the normal Social Security Retirement Age, you will be converted over to Retirement Benefits instead of SSDI.  

  • How long does it take for Social Security to make a decision on my SSDI claim?

    In Louisiana, the first decision is usually made within four to six months after you initially file for disability benefits. If you are denied at the initial application stage and request a hearing to appeal the decision, Social Security statistics indicate that a final decision will take an average of over one year in Louisiana to get that decision. As of April 2015: the New Orleans Social Security Disability/Houma Social Security Disability average processing time was 402 days; the Metairie/Kenner/Baton Rouge Social Security Disability average processing time was 308 days; the Shreveport Social Security Disability average processing time was 335 days; and the Alexandria/Lafayette/Baton Rouge Social Security Disability average processing time was 293 days. For more information, see blog posting: How long does it take to get SSDI benefits after I am approved?

  • Do I have to attend the examination set up by the insurance company?

    In most cases, yes. However, the terms of the long-term disability policy will dictate whether or not you must comply.

    Most policies require that you cooperateDo I have to attend the exam set up by the insurance company? with the long-term disability insurer’s investigation and/or see their doctors.

    Your long-term disability benefits policy will tell you this information, which is why you need to read it carefully.

    Should I attend the Disability Insurance Company's Exam Alone?

    Another question is should you attend this visit alone. In my opinion, you should not. It is not unheard of for these consulting examiners to make reports to the insurance company that are completely different from what occurred.

    You will be well served to have a family member or close friend travel with you to the exam and remain in the room with you the entire time.

    After the exam, you should write down everything that occurred and request a copy of any documents that the examiner completed.

    Review the documents carefully before leaving and bring any inconsistencies to the attention of the examiner immediately.

  • Do I have to go through the administrative appeal?

    Yes. Under ERISA and federal law, you must exhaust your administrative remedies. That’s a fancy way of saying that you must follow the process. If you are denied by the insurance company, you have to appeal first to the insurance company again for the administrative review. If you are still denied, then you can take the matter to court.
    However, if you try to skip the administrative review and go directly to court, the court will most likely say that you failed to exhaust your administrative remedies and can dismiss your appeal. 

  • How long do I have to appeal a denial?

    The answer depends on where in the process the denial was rendered. If you were denied by the insurance company, either initially or after receiving benefits, you generally have 180 days from the date of the denial to request an administrative review. If your administrative review resulted in a denial, you may have up to three years to bring a federal court claim depending on the statute of limitations for similar claims in your state. For example, in Louisiana, I want to bring a long-term disability denial case to federal court within one year from the administrative denial. 

  • What is ERISA?

    ERISA stands for the Employee Retirement Income Security Act of 1974. ERISA is a federal law that sets minimum standards for retirement and health benefit plans in private industry. ERISA does not require any employer to establish a plan. It only requires that those who establish plans must meet certain minimum standards.

    ERISA covers retirement, health, and other welfare benefit plans (e.g., life, disability and apprenticeship plans). Among other things, ERISA provides that those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct. The law also contains detailed provisions for reporting to the government and disclosure to participants. There also are provisions aimed at assuring that plan funds are protected and that participants who qualify receive their benefits.

    Because ERISA is a federal law, and your employee benefits plan is governed by it, any dispute you have with your long-term disability insurer will be heard in federal court and not by your local state court.