Monday, September 12, 2016

Tell Congress to Fully Fund Social Security's Budget

On an average, disabled Americans are waiting 575 days to present their Social Security Disability claims at a hearing before a judge.  A record one million SSDI and SSI cases are currently pending. This is an alarming crisis.  
While disabled individuals wait for a hearing, utility bills go unpaid, families struggle to put food on the table and many face the risk loosing their homes.  
This problem is not happening by mere chance.  This situation has been caused by dramatic cuts in the Social Security Administration's operating budget.  Since 2010, the SSA's budget has been cut by 10%.  In the meantime, the agency's workload has increased due to the rise in the demand for services caused by the ageing of the baby boomer generation.  Services have been cut across the board.   Since 2010, the SSA has closed approximately 60 field offices and 500 mobile offices.
Unfortunately, the Republican controlled Congress is considering even deeper budget cuts.  A proposed bill envisions cutting the agency's budget by over $250 million in 2017.  These additional cuts will aggravate the current crisis even more.
Under the proposed house bill, the Social Security Administration would need to close all its offices for two weeks as a result of employee furloughs. And a looming hiring freeze can lead to even longer wait times and delays in all parts of the Social Security system, including retirement, survivors’, and disability programs. A Senate version containing a similar proposal for cuts provides slightly more funding, but still fails to address many critical agency resource needs.
Social Security advocates across the country are asking everyone affected to contact their representatives in Congress.  President Obama has requested funding for 2017 that would allow Social Security to begin reducing the disability claims backlog and to reduce other agency service delays.
Call your Members of Congress TODAY. You can find their contact information at and (upper right corner of each page).

Monday, September 5, 2016

NFL Player is Denied Long Term Disability Benefits

When it comes to disability insurance claims, it seems like all claimants are subject to the same hassles regardless of their financial status or social class.  Long term disability insurance companies are billion dollar giants that really don't care much about what individual policy holders think about them or about the negative effects that bad publicity can have against their businesses. Take the example of Haruki Nakamura, an Ex-NFL player who was recently denied long term disability benefits.  
Nakamura, a former safety for the Baltimore Ravens and the Carolina Panthers, purchased a 1 million dollar long term disability policy from Lloyd's of London that provided benefits in the event that, due to illness or injury, he became unable to "participate ever again in his occupation of football player". In August 2013, during a Carolina Panthers pre-season game against the Pittsburgh Steelers, Nakamura suffered a hit to the head and was diagnosed with a concussion a few days later. Nakamura was placed on the injured list in September 2013 and two days later was released from his Carolina Panthers contract due to his “concussion.”
In October 2014, Kakamura's treating doctor wrote a report stating that his patient would not be able to play professional football again due to the disabling effects of his concussion.  Despite the well documented evidence of the effects of concussions in football and the medical evidence on record, the insurance company chose not follow the recommendation of Mr, Nakamura's doctor.  Instead, the insurance company invoked its right to conduct its own medical examination by a doctor hired by them.   
After unnecessarily prolonging the application for benfits for more than 18 months, the insurance company denied the claim.  In many ways the actions by the insurance company in Nakamura's claim, resemble many other denials that I see on a regular basis.  The company's decision to deny benefits is typical of the insurance industry's arrogance.   For example, the insurance company claimed that Nakamura could return to play, however their own doctor cautioned Nakamura to consider the “probable long-term effects of repetitive concussions” before making the decision to go back to football.  This leads me to believe that the insurance company knows that it doesn't have a strong case but it denied the claim merely to force Mr. Nakamura to compromise his claim. 
Another aspect of Nakamura's claim that resembles some of the issues faced by my clients is that the insurance company seems to be preying on the highly subjective aspects of disabilities claims caused by concussions.  Nakamura has alleged that due to the concussion he suffers from headaches, vision problems, fatigue, depression and suicidal thoughts.  Unlike usual orthopedic injuries suffered by football players, the subjective effects of head trauma are a lot harder to assess with objective tests.  
Nakamura has filed his complaint in the North Carolina Superior Court.  To read a copy of the complain click here.  Since Nakamura purchased his policy individually, his lawsuit is not covered by ERISA.  As you can see from the complaint, he is entitled to a jury trial and damages for unfair and deceptive practices.  If his claim had been governed by ERISA, such legal remedies would not have been available to him