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ALICIA PAULINO-GRISHAM: My name is Alissa Paulino-Grisham and I’m one of the founding partners of Disability Insurance Law Group. I have spent my entire career representing disabled claimants in pursuit of their disability insurance benefits against insurance companies. My partner, Mindy Chmielarz, and I worked together for many years at another firm where we started and ran the disability insurance department. In 2006, we created Disability Insurance Law Group with the idea that it would be a purely client-centered firm. All these years later, we are proud that we not only accomplished our goal, but never lost sight of our mission. MINDY CHMIELARZ: For years, I worked for a large insurance defense firm and became quite well versed in the delay and denial tactics utilized by these companies. I found that my sympathies were with the claimants, and started working for a fairly large plaintiff’s firm, where my partner, Alissa Paulino-Grisham, and I established their disability insurance claims department. Disability Insurance Law Group represents claimants at all stages of the disability claims process, from application through litigation. We prepare all claims, whether hired to assist with the application or handle the appeal, thoroughly, and with an eye towards litigation. We competently and aggressively represent our clients against their insurance company in order to ensure that they obtain the disability insurance benefits to which they are entitled. Not only do we have firsthand knowledge of how insurance companies handle disability claims, we use that knowledge to prevent unwarranted denials and get denied claims overturned. That knowledge, combined with our extensive experience and success in this highly complicated area of the law, make us uniquely qualified to handle disability insurance claims at all stages, and effectively communicate with insurers on our client’s behalf. ALICIA PAULINO-GRISHAM: Disability insurance claims involve a highly complicated and ever changing area of the law. Also, because these claims pose a significant financial liability for insurance companies, they are highly scrutinized and fiercely litigated by them. Many firms will claim that they handle these cases, but few have a true focus in this area of the law. Disability Insurance Law Group does. Because of our extensive experience and singular focus, we are very good at what we do, and have a proven track record of success in and out of the courtroom. We understand that disability insurance is supposed to be a financial safety net for our clients. It’s supposed to be there when their ability to earn an income or work in their occupation is compromised. Therefore, often, a delay or denial of benefits can be financially devastating. We know how important these benefits are to our clients, and this guides us throughout our representation. We never lose sight of what we’re fighting for. MINDY CHMIELARZ: Additionally, our clients always work closely with the attorney assigned to their claim and consistently remark on the time and effort we spend keeping them informed as well as our accessibility when they have questions and concerns. We understand how important it is for our clients to have a strong advocate. We have successfully litigated and resolved thousands of claims and have collected millions of dollars for our clients over the years. We are highly respected by insurance companies and their attorneys, and are, thus, able to resolve many conflicts fairly and quickly. Not only have we gotten numerous cases on our clients recommendations, but we have been retained by a number of insurance company claims representatives who have had to fight their own employer after applying for disability benefits. ALICIA PAULINO-GRISHAM: Disability Insurance Law Group has the knowledge, experience, and resources necessary to aggressively represent our clients rights at all stages of the claims process. If you have questions regarding your disability insurance claim or policy, contact us and we will be happy to discuss your rights and obligations under the law.

ALICIA PAULINO-GRISHAM: Hello. My name is Alicia Paulino-Grisham. And I’m one of the founding partners of Disability Insurance Law Group. Today I’m going to talk about how disability insurance companies use surveillance and hire private investigators to deny and terminate claims. Frequently, disability insurance companies will hire private investigators to follow claimants around and obtain video footage of them. Very often, the insurance company will obtain several rounds of surveillance. And this could occur over multiple days. This happens regardless of the amount of benefit at issue. They’re looking for any activity that they can point to and assert that the claimant is actually more functional than they claimed, essentially that the claimant is lying or exaggerating. Now, what we know is that video surveillance is usually just a snapshot of the claimant’s life. It cannot show the amount of pain the claimant is in when they’re walking across a room or when they’re grocery store shopping. This doesn’t mean that our clients can do this every day for eight hours or with reasonable continuity and consistency. However, this doesn’t stop disability insurance companies from taking the most innocuous video footage and blowing it out of proportion. The ability to turn on and off the camera goes a long way in creating the illusion that claimants are exaggerating their condition. Private investigators also usually conduct a thorough background check of claimants. They obtain social media posts, court records, and also employment records. Normally, people put their best foot forward when posting on social media. They show pictures at their daughter’s wedding or from vacations from long ago. They don’t typically complain about their aches and pains. Regardless, the insurance companies use these posts to suggest the claimant is really more active than they actually are. In most cases, we obtain the surveillance footage and the investigative report directly from the insurance company so that we are able to directly respond to that information. We work closely with our clients’ physicians so that they can explain how our client’s limitations and restrictions are not inconsistent with the information in the report and on the videotape. Disability Insurance Law Group has extensive experience in representing claimants at all stages of the disability insurance process and in directly challenging denials based on inaccurate and incomplete video surveillance. If you have any questions regarding a disability insurance claim or your disability insurance policy, give us a call. And we’d be happy to discuss your claim.

ALICIA PAULINO-GRISHAM: Hello. My name is Alicia Paulino-Grisham. And I’m one of the founding partners of Disability Insurance Law Group. We are often asked whether an award of social security disability benefits will guarantee that their disability insurance company will continue to pay their claim or approve an initial claim. Unfortunately, the answer is no. In fact, very frequently disability insurance claimants are actually shocked that after receiving an award of social security disability benefits, their insurance company denies their claim for disability benefits under their policy. Worse, under the majority of policies, social security benefits are a direct offset to the benefits received under a disability policy. Many claimants are shocked to receive a letter stating that they must pay all of their social security benefits directly to the insurance company. While an award of social security disability benefits is not dispositive of eligibility under a disability insurance policy, it is compelling evidence of the claimants disability. Under the law, disability insurance companies are supposed to consider an award of social security disability benefits when evaluating a claimant’s eligibility for benefits under the policy. However, most insurance companies do not appropriately follow this requirement. If you have a disability insurance claim, or your disability insurance company is demanding the retroactive payment of social security benefits, give us a call and we can discuss your claim.

MINDY CHMIELARZ: Hello, my name is Mindy Chmielarz, and this is Alicia Paulino-Grisham. We are the founding partners of Disability Insurance Law Group. Today we want to discuss the four most important things to remember when communicating with your disability insurance company. Alicia, what would you say is the first thing a claimant needs to remember. ALICIA PAULINO-GRISHAM: Never say never. Be careful with your language. Insurance companies frequently take information out of context and lull claimants into not fully or accurately explaining their limitations. For example, an insurance company may ask a claimant with a back injury how long can you sit. An unprepared claimant may assert 20 minutes. If the insurance company conducts surveillance and sees that claimant sitting in a car or in a traffic jam for 45 minutes or longer, they will often claim that the claimant is exaggerating their condition. While in reality, the claimant cannot sit longer than 20 minutes without a significant increase in back pain. So be careful with your language and thoroughly explain your limitations. If you’re only given a multiple choice question, write an explanation in an addendum or on the side of the paper. MINDY CHMIELARZ: A second thing claimants should know is to memorialize all communications. If you speak with your insurance company, make sure you send written proof of what was said and save the email, fax receipt, or proof of mail delivery. Very often the claim notes do not accurately reflect what the claimant told the insurance representative. ALICIA PAULINO-GRISHAM: The next thing to look out for is the surprise communication. Insurance companies like to catch claimants and their physicians off guard. They train their representatives to ask questions in such a way that it limits claimants and their physicians from fully and accurately explaining the claimants limitations. This often happens in surprise telephone calls, field interviews at the claimants home, or by rushing the claimant or their physician into completing misleading forms. Carefully consider every question posed, and if the right questions are not ask you have a right to add that information anyway. You have a right to also require that your attorney be present during all interviews. MINDY CHMIELARZ: This leads us to the last thing claimants should know. Remember you do not have to go it alone. It is best to seek legal representation before you or your physician speaks to the insurance company. We prepare our clients and our physicians for all communications with the insurance company and attend to all in-person and telephone interviews. If you have questions regarding your disability insurance claim or you or your physicians are being asked to complete forms or be interviewed by the insurance company, give us a call and we’d be happy to discuss your rights.

ALICIA PAULINO-GRISHAM: Hello. My name is Alicia Paulino-Grisham. And I’m one of the founding partners of Disability Insurance Law Group. Today, I will be talking about what you need to know before submitting a short-term or long-term disability insurance appeal. The vast majority of disability benefit claims are governed by ERISA, which is a federal statute that places strict deadlines and obligations on both claimants and insurance companies in the disability insurance claims process. In most cases, if you receive your disability policy through your employment, your claim for benefits will be governed by ERISA. Under ERISA, if your disability claim is denied, you must submit an appeal to the insurance company. Some policies require two mandatory appeals. You must submit all mandatory appeals. If you do not, you may be foreclosed from seeking benefits further. However, what your insurance company will likely not tell you is that the majority of the time, the only information that you can present in court to prove your case is the information you submitted during the application and appeals process. That means that you must essentially prepare your case for trial before your final denial. If you leave anything out that you would normally present in court to prove your case, the judge will likely never see it and never consider it. For this reason, we prepare every case like we were preparing it for trial. We first obtain a full copy of the insurance company’s claim file. This includes all emails, text messages, internal notes, medical reviews, surveillance video, and vocational information gathered by the insurance company. We also obtain comprehensive written and video testimony of our clients, their friends, their family members, and occasionally co-workers regarding our client’s condition, limitations, and work restrictions. We also obtain medical records and closely work with our client’s treating physicians to provide detailed testimony regarding our client’s condition and limitations. We often hire our own independent medical and vocational experts to assess our clients and provide independent expert reports. We then prepare and submit a detailed appeal letter outlining all of the information and the law and attack the insurance company’s rationale for denying the claim. ERISA is a highly complicated area of the law and can be an uphill battle for claimants who are unaware of their obligations and rights. We are dedicated to leveling the playing field for our clients and use our extensive experience in handling long-term and short-term disability insurance claims to aggressively seek the benefits our clients deserve. If you have questions regarding your disability insurance claim or policy, contact us, and we will be happy to discuss your rights and obligations under the law.

[MUSIC PLAYING] MINDY CHMIELARZ: Hello, my name is Mindy Chmielarz. And I am one of the founding partners of Disability Insurance Law Group. Today I am going to discuss some of the most common mistakes made when filing a claim for disability insurance benefits. Avoiding these mistakes is often the difference between a claim approval and a claim denial. The first mistake is waiting too long to file. All policies require that proof of loss be given within a specified period of time. This could be as short as 30 days, or as long as 365 days. Know your policy requirements. When providing information about your job duties, be detailed. Many people try to modify their duties or work on a reduced schedule despite their inability to properly perform their normal job duties. Beware, by making these adjustments you may be inadvertently changing your occupational duties or even risk getting fired. If you work in a modified capacity, and then go out on disability, or you are fired for not performing your job demands, the insurance company may claim that your job duties are now the modified, less strenuous set of duties, or that you are claiming disability because you were fired. Third, do not be lulled into not submitting sufficient evidence of your claim. It is your obligation to prove your disability. You must clearly explain and submit evidence of why you cannot work. Be sure to provide as much information as possible at the onset of the claim. Finally, educate your doctor early. Your treating physicians records are closely scrutinized by the insurance company representatives and their medical evaluators. It is very important that your doctors document your symptoms, restrictions, and limitations. The more information, your doctor has from you, the better the records will be. It is also likely that the carrier’s medical evaluator will contact your treating physician to discuss your claim. These evaluators ask questions designed to elicit responses that can be purposefully misconstrued, or they make including statements without giving your doctor the opportunity to explain how your medical conditions limit your functionality and prevent you from working. Your physician should be fully prepared before answering any questions and should be advised to ask that all communications are in written form so they can take the time to properly respond. At Disability Insurance Law Group, we work closely with our clients’ physicians to ensure that all medical records are fully documented, all communications with the insurance companies are accurate, and that the right information is provided. Understanding the disability insurance claims process before you file your claim can result in a timely approval and help you avoid unnecessary delays or the long and frustrating disability appeals process. If you have any questions, we encourage you to call Disability Insurance Law Group for a free consultation.

[MUSIC PLAYING] MINDY CHMIELARZ: Hello. My name is Mindy Chmielarz. And I am one of the founding partners of Disability Insurance Law Group. We regularly receive calls from claimants who have either been approached by their carrier about a lump sum settlement of their claim or who are interested in resolving their claim for a lump sum. When deciding if a lump sum settlement makes sense or is fair, you need to consider several factors. First, the value of your claim. Insurance companies determine a claims value based on its present value, the amount they would need to set aside in reserves today to pay you through the maximum benefit period, and then offer to settle your claim for a percentage of the present value. Present value calculations vary depending on the interest rate used and whether or not the insurance company applied a mortality rating. A higher interest rate results in a lower present value because the money set aside will grow faster with a 5% interest rate than it will with a 3% interest rate. Often, carriers put forth an unreasonably low present value because they apply an unrealistically high interest rate. Individual circumstances vary. Thus, you need to consider whether or not a lump sum settlement makes sense for you. While there is certainly value to getting rid of the stress put on you by the carrier, you do not want to accept pennies on the dollar. Finally, many claimants worry that approaching their insurance company about a lump sum settlement will raise a red flag. In most cases, if the insurance company is correctly approached, this will not occur. However, there are things to consider before approaching your company about a settlement. How long have you been on claim? If applicable, has the any occupation review occurred? The nature of the disability and the insurance company’s own internal policies on buyouts– some will not settle an undisputed claim. If you have been approached by your insurance company regarding the settlement of your claim or would like to discuss whether or not this is a viable option for you, please contact Disability Insurance Law Group via our website or our toll-free number, and one of our attorneys will be happy to speak with you.

[MUSIC PLAYING] ALICIA PAULINO-GRISHAM: Hello, my name is Alicia Paulino-Grisham, and this is Mindy Chmielarz. And we are the founding partners of disability insurance program. Today, we’re going to talk about what you need to know before completing any insurance claim forms. Mindy, what would you say would be the first thing a claimant would need to know? MINDY CHMIELARZ: Very often, insurance company claim forms are extremely limited. They’re not designed to elicit appropriate information or give the claims the opportunity to fully explain their limitations and restrictions, and they can even be designed to elicit information that is inaccurate and suggests that the claimant is not truly disabled. For example, claimant statement forms are usually very limited on space. Lulling claimants, it’s not fully explaining their condition. Likewise, claimant statements often fail to ask the claimant to explain why his or her symptoms prevent them from being able to perform the duties of their occupation. ALICIA PAULINO-GRISHAM: Similarly, attending physician statements usually provide extremely limited space to explain the claimant’s limitations. Frequently, attending physician statements are a multiple choice form only allowing the physician to check a box when describing the claimant’s limitations with no additional explanation. This can be extremely misleading and actually elicit false information about the claimant’s functionality. For example, the attending physician statement may ask how long a claimant is able to sit, and the treating physician is only given a few choices, one to three hours, three to four, four to six, or six to eight hours. The treating physician may select one to three hours because it is the lowest choice available. However, in reality the claimant cannot sit more than 20 minutes uninterrupted without increased pain. The ability to sit one to three hours suggests that the claimant can sit uninterrupted for up to three hours. We work closely with our clients treating physicians to train them to avoid these traps. MINDY CHMIELARZ: There’s also employer statements that you need to contend with. They usually just ask for a generic list of occupational duties without asking for the specific requirements of the claimant’s job or how that list may have been modified since the claimant took on the job. We also have our clients prepare an appropriate occupational duties list and, if possible, work with co-workers managers or human resources to get a full and accurate understanding of our client’s pre-disability job. ALICIA PAULINO-GRISHAM: Attempting to overturn a claim denial can be both emotionally and financially devastating. Understanding the common pitfalls goes a long way in avoiding claim denials. Disability Insurance Law Group has extensive experience in handling disability insurance claims. We have represented thousands of claimants just like you. We have the experience, knowledge, and resources necessary to aggressively advocate on our clients behalf. Contact us for a free consultation, and we’d be happy to discuss your claim. [MUSIC PLAYING]

ALICIA PAULINO-GRISHAM: Hi, my name is Alicia Paulino-Grisham, and I’m one of the founding partners of Disability Insurance Law Group. I would like to talk to you about the common definitions of disability contained in disability insurance policies. Very often, disability insurance policies will contain an own occupation period. There are different variations of the definition, but essentially it means that to be eligible for benefits you must establish that you are unable to perform the material and substantial duties of your own occupation. Under some policies, the own occupation period is the full duration of the policy. However, very often there will be a change in the definition of disability after a certain period of time from the inability to perform the material duties of your own occupation to the inability to perform the duties of any occupation. Usually this change in definition will occur after 12, 24, or even 60 months. The change in definition period is a critical time. In fact, it’s when we see the majority of claim denials. Your insurance company will engage in a thorough re-evaluation of your eligibility for disability benefits. This typically means that the insurance company will hire a medical professional to examine you or review your records, perform a vocational analysis, and often conduct surveillance of you and perform a full media investigation. Many claims are denied at this stage because claimants are unaware that they must submit sufficient proof of their eligibility for benefits under the new definition of disability. This is an entirely different standard. Well before the change in definition period, we obtain and submit information to the insurance company establishing our client’s eligibility for benefits under the new definition. We often hire our own medical and vocational experts, obtain testimony from our client’s physicians and family members, and prepare a detailed outline of our client’s eligibility under the new definition. The goal is to prevent a denial before there is ever a lapse in benefits. The good thing is you can get help. The best thing to do is contact an attorney with experience in disability insurance claims before the change in definition. Disability Insurance Law Group has extensive experience in representing claimants at all stages of the disability insurance claims process. If your definition of disability is about to change, you are currently going through a claim review, or your claim has been denied, contact us. We would be happy to discuss your case.

[MUSIC PLAYING] MINDY CHMIELARZ: My name is Mindy Chmielarz, and I am one of the founding partners of Disability Insurance Law Group. Many clients want to know how long an insurance company can take before they have to make a decision on a disability claim. The answer to that question usually depends on whether the policy is a private policy or group policy obtained either through an association or your employer. If you have a private insurance policy, one that you’ve procured on your own, then the answer to that question often depends on state law. Some states define how long an insurance company has to make a claim decision, and others leave it open. At Disability Insurance Law Group, we push the insurance company to make a decision within the elimination period. Elimination periods tend to last between 30 and 180 days. If you have a group disability insurance policy, one that was obtained either through your employer or a large association, then it is governed by the federal statute, ERISA. Under ERISA, an insurance company basically has 45 days to make a claim decision. However, they can take two 30-day extensions if they can explain why those extensions are necessary. Because the insured is an integral part of the claims process, it is imperative that you are prepared to obtain and provide the information required by the insurance company. Any delays on your part can cause delays on the insurance company’s part. At Disability Insurance Law Group, we work with our clients to make sure that the claims process is as smooth and expeditious as possible. If you have any questions about your disability insurance policy, or are thinking about applying for benefits, please feel free to contact us, and we’d be happy to answer any of your questions. [MUSIC PLAYING]

[MUSIC PLAYING] MINDY CHMIELARZ: My name is Mindy Chmielarz, and I’m a Founding Partner of Disability Insurance Law Group. Today I’m here to talk to you about what you need to know if your insurance company requires you to undergo an Independent Medical Examination. An IME is basically an examination set up by the insurance company with one of their doctors, or a doctor of their choosing, designed to further their investigation of your claim. As stated, these examinations tend to be anything but independent. Very often, the physicians chosen by the insurance company have little experience treating patients with similar conditions, and earn a substantial portion of their income from these examinations. This creates the very real potential for biased reporting. If you have questions about your rights under the policy, or your insurance company’s requesting that you undergo an IME, please feel free to contact our law firm, and we’d be more than happy to answer any of your questions.

[CALM MUSIC PLAYING] ALICIA PAULINO-GRISHAM: Hello. My name is Alicia Paulino-Grisham, and I’m one of the founding partners of Disability Insurance Law Group. We are often asked the question, how much will it cost me to hire Disability Insurance Law Group to handle my disability insurance claim? We handle the majority of our cases on a contingency fee basis. This means that our clients are not responsible for the payment of any legal fees unless we are able to obtain benefits for them. Occasionally, our clients will request that we handle non-litigation disability insurance claims on an hourly basis, such as an application or an appeal of a claim denial. In most circumstances, we can accommodate this request. Our team at Disability Insurance Law Group focuses our practice on representing disability insurance claimants at all stages of the claims process. We have the extensive experience, knowledge, and resources necessary to aggressively assert our client’s rights, in and out of the courtroom. Contact us and we would be happy to discuss your claim and fee options available to you. Thank you.

Transcript – GMA’s story on Cigna’s Denial Tactics

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