Employee Survival Guide® - Navigating ERISA STD and LTD Disability Claims Process: Insider Strategies for Securing Your Benefits

Episode Date: February 22, 2024

Have you ever been thrust into the bewildering maze of disability claims? Fear not, because Mark is here to guide you through this critical journey. On today’s episode is a comprehensive roadmap of the ERISA disability claims process, where Mark unravels the intricacies of both short-term and long-term disability benefits. Each step, from the initial claim to the potential transition to long-term benefits, is packed with nuances and essential tactics. Mark dissects the importance of a detailed narrative, the power of medical documentation, and the subtleties of communicating with your employer and the claims person at the insurance carrier. Plus,  Mark will explore the protections offered by the FMLA and ADA, ensuring you're armed with the knowledge to protect your job and income during challenging times.In this episode, Mark delves into the art of compiling a robust claim file, the challenges of mental health claims, and the strategic use of insider strategies for dealing with insurance carriers.  He also uncovers the significance of fiduciary responsibilities and the potential of surveillance tactics. For those already on long-term disability,  Mark discusses the importance of remaining vigilant and the necessity of applying for Social Security Disability Income (SSDI) as part of the process.Lastly, should you find yourself at the precipice of an ERISA litigation battle, Mark will equip you with the strategies to win at the administrative level before you ever reach court.  Mark will explore the federal court process, the importance of engaging an experienced ERISA attorney, and how to craft a narrative that resonates with a judge. Winning disability cases at the administrative level is no small feat, but with the right approach—which Mark will meticulously break down—success is within reach. So tune in and let’s ensure you're prepared to secure the benefits you rightfully deserve. If you enjoyed this episode of the Employee Survival Guide please like us on Facebook, Twitter and LinkedIn. We would really appreciate if you could leave a review of this podcast on your favorite podcast player such as Apple Podcasts. Leaving a review will inform other listeners you found the content on this podcast is important in the area of employment law in the United States. For more information, please contact our employment attorneys at Carey & Associates, P.C. at 203-255-4150, www.capclaw.com.

Hey, it's Mark here and welcome to the next edition of the Employee Survival Guide where I tell you, as always, what your employer does definitely not want you to know about and a lot more. It's Mark here and welcome to the next edition of the Employee Survival Guide. Today we're going to talk about filing and how to file disability claims with your employer's short-term and long-term disability carriers under their plan documents. This area of law is covered by what's called the Employee Retirement Income Security Act, an acronym called ERISA, E-R-I-S-A, sometimes a word or an acronym that scares people away, but in reality, it's quite

simple. And I'm going to go through the steps today to explain that process. Approximately, there's 14 different steps you can go through, at least, as I gathered my notes today. And I'm going to help you walk through them on your own. And whether or not you have an attorney, you have the ability to do this. And I'm going to show you how to do it. So let's dig into it. At what point in time in your career are you going to file for

short-term and long-term disability benefits? Typically when, and you can't predict the future, some adverse medical event happens, or let's say you get in an accident or have a back injury, and you're unable to work. And you have to do what? You have to replace your income in some way. And so that's what short-term disability benefits do. They provide for sometimes 60%. And a good employer will provide 100% replacement for six months of your salary. That's a good deal. So if you want to know the value of your employer, check the HR portal and see how much STD benefit do they provide for 60 or 100 percent. If it's 100, it's a nice employer. The next thing is you also want to consider the story of your case. You know, we work. I work in a world of narrative and stories, people's stories they bring to me.

You as well have a story. Something happened to you. I need you to gather up your facts from start to finish. For example, you've been working with an employer for many years. You have performance reviews. And then the event happens, whatever that event is, diagnosis of cancer, multiple sclerosis diagnosis, inability to work, car accident, what have you, you have to write the story. Because when you file your claim for disability benefits, it's really important to provide them with a detailed sworn written

affidavit about what you went through. Because somebody has to tell the story about what you're going through in terms of your ability to work or not work, your functional capacity. I know that sounds maybe not intuitive to you, but in reality, you have to share your facts with the employer's plan carrier. Typically, it's an insurance carrier, and you want to provide them as much information as possible. I call it the kitchen sink approach to ERISA because you can include just about anything you ever wanted to include. Now, by example, I take chronic fatigue, for example, CFIDS. I used to do them years and years ago, and we used to include every research study that we can find and put it into the claim file just to oversaturate the employer with the objective evidence in support of what's chronic fatigue syndrome.

And so by putting in everything you can think of, the medical documents, et cetera, it supports your story. Then you have to correlate and craft and tell your story through your narrative of how all this information pertains to you and your inability to work. So crafting the narrative is a crucial part of your story. Second thing is, so number one is gather your facts and write up your story as your narrative. Number two, document your disability with your medical providers and also with your employer. When I say document, go to your providers and your primary position, and then also get your secondary and third reviews by experts in the areas which maybe it's an autoimmune

disease you want to get documented so that you're creating facts supportive of your disability, which you would then take that medical claim files from each doctor and submit it in your claim file to the short-term disability carrier because they're going to ask for it. So going to get to your medical providers to provide diagnosis is one thing, but getting them to write letters on your behalf saying that you are not able to work because of the disability, stating why you're not able to work. Maybe you have lifting restrictions. Maybe you have inability to get out of the disability, stating why you're not able to work. Maybe you have lifting restrictions. Maybe you have inability to get out of bed.

Maybe you have just actual treatments for whatever the conditions you're under. So getting the medical documentation with your medical providers, submitting it to the insurance carrier when you file your application, but also documenting that back to your employer, you'd have to actually write a letter from your physician to your pre-employer saying, I have a disability. I need to go out on long-term disability or short-term disability. And the reason why you do that is because you need to document

under the state and federal laws, sometimes city law, to substantiate the fact you have a disability. No one can know it unless you tell them you have it. So that's the third point is looking at is protecting yourself with other disability laws, such as the ADA, the use of reasonable accommodations, and then the Family Medical Leave Act. When I speak about applying for short-term disability benefits, at that time of your life when you're going out and making that application, you have several different statutes covering you at one

time to protect you. The ADA, which is the Americans with Disabilities Act, is designed to protect you against discrimination. It also provides a vehicle for discussion about reasonable accommodations, meaning I can't work, I have a disability. I need to request reasonable accommodation. Well, guess what? The short-term disability is a reasonable accommodation. It's provided by your employer because you have a good employer. They care. They know people get sick. The FMLA is also a statute that covers you. It does something very different. It protects your job for up to 12 weeks. And the employer can't fire you. OK, so you can come back within 12 weeks.

But sometimes people can't come back within 12 weeks and that they're made on disability, short term disability longer. Short term disability itself lasts on almost all these policies and plans six months. So that's longer than 12 weeks. So how do you deal with the overlap there? And you're going to have to figure out at some juncture when the FMLA ceases after 12 weeks, three months, that you have to decide for yourself, am I able to come back to work or not? And you'll know this because your, your body will tell you, or you'll know your limitations.

Don't make this one mistake that I see a lot is having your doctors tell you that you're not able to return to work. They're not the functional capacity expert, you know, vocational experts. There's just physicians. And some people make the mistake of allowing the physician to make decisions about their income. Returning to work is returning to

work and full income or your job. So doctors are doctors. They're not expert medical, I'm sorry, they're not expert job experts and vocational experts to tell you. So don't make that mistake. Work with your physician and have your physician support your claim for benefit and also make your own assessment of whether you're able to return to work. The Feminine Medical Leave Act, the ADA, Insurance of Disability have a built-in procedure where you can actually experiment with returning to work part-time to see if it's viable for you to return to work. So explore that. Read the plan document. I'm sorry to be a lawyer here, but I have to read the plan document and tell clients what's happening. So

why can't you read it? So it's in your HR portal. It's right in front of you. You can actually read it. It says all the things in plain English. It's written that way so that I can understand it and you can understand it about what happens. So if there's a partial return to work, it's in there. They encourage you to return to work if possible. They want you to get better. That's the presumption. Okay. I have different feelings about that according to different fact patterns because I think employers want to get sick people out.

But not all employers. I mean, employers that will pay for children disability plans, long-term disability plans, they do care and they care about their retention of their employees. So I'll get, I don't want to go down a tangent right there, but so assessing your laws to protect yourself during this process at stage three, it's really important. I know I said a lot about the ADA and accommodations and the Femme and Medical Leave Act, but they're there for you to protect yourself. And the next thing I have to do, step four here is obtain company application for both the short term disability plan application and also the long-term disability. Why both at the same time? Because you don't know if you're going to be going on to long-term disability. I tell the clients to request both applications, fill them both out.

I even tell them to fill them out at the same time and submit them. So that way we get that off the deck, whether or not you use the LTD application or not. You're just trying to buy insurance for the future of what if, because you don't know what the what if. You're just dealing with the here and now of a disability and how am I going to get through this. And so fill out the company applications. They're quite lengthy, but they're going to ask you, in essence, are you able to work or not? And they actually ask you questions related to your functional capacity, to the minute detail of things about daily activities. Fill all the information out. Don't lie, okay? Just fill out the best you can in terms of what's there. And then they're also going to ask you to get, you know, supporting medical information as well. It's self-explanatory in the application itself. Step five of the process, you submit your application with detailed sworn narrative. I

talked about the medical files you've gathered in support of your STD claim, and you submit it to the plan administrator. Who's the plan administrator? In the Short-Term Disability Plan document, you will see at the very end of it, probably the last two pages, the administrative section. It tells you who the plan administrator is, and it tells you who the claims administrator is. There are actually two people or two entities. Short-term disability plans are legal entities unto themselves. So you need to understand that there's a plan administrator, which typically is a plan sponsored, the employer, the HR department, and feel free to contact the HR department about it. Then sometimes the plan administrators will hire contract with insurance carriers to provide the

claims administration of the plan benefit to you. Sometimes they confuse you as well with even doing FMLA benefits. And, you know, it's just an insurance racket. They're just trying to make a lot of money to service these companies. So you submit your detailed sworn narrative, the story about your case, your medical files, and then you have to step six, wait 45 days. Well, it seems like a long time, but that's what ERISA, the statute, requires. The plan administrator, claims administrator, has 45 days to review your claim. Do they do it faster? Maybe, sure they do.

But they also have the ability to request an additional 45 days, so a total of 90 days, to review your application for short-term disability. And it may seem like a long time. Well, there's no income coming in. You're sweating it out. and you have to wait. Just wait. That's all there is. So you have the ability, and I will say this later on, to examine the issue of what's called Social Security Disability Benefits

if you are totally disabled and you're not going to return to work. You might want to apply for Social Security Disability Income benefits from the federal government earlier in the process, even during the short-term disability claim process. you actually, I apologize, step seven, you have to answer all their questions provided by the carrier to you to support your case, because they'll ask you lots of questions and follow after you submitted your application. I'm sorry, I jumped around my notes here. So they're going to ask for additional information, maybe from your doctors after they submitted information, just go through that process and give them everything they request. after they submitted information, just go through that process and give them everything they request. And, you know, if you need to go out onto the web and find NIH, National Institutes of Health,

research studies, you can go get them and include them in part of your claim. Again, kitchen sink approach, everything that supports your case. Let's say a fibromyalgia or multiple sclerosis, you have to get these research studies to document what it is you have. But I will tell you as a side note, there are a category of disabilities that are self-evident. Cancer, believe it or not, fibromyalgia and chronic fatigue are now recognized disabilities with the federal government and insurance carriers. I said multiple sclerosis. disabilities with the federal government and insurance carriers. I said multiple sclerosis. There's a variety of diseases, disabilities that are self-evident that basically the insurance carriers are not going to challenge you to a large extent. They may take a stab at you

if you are unrepresented by counsel. That's a kind of a knee-jerk reaction by insurance carriers, and it was a cheap shot, but it happens a lot. Be aware of that issue. So there are a category of disabilities that will fly through the STD process that I see on my end that I usually don't have a problem with. I can say that one issue I have seen where employers or plan administrators insurance carriers on short-term disability challenge people is mental health. Let's take a quick break. It's Mark and we have a new product for you. It's called the Employee Survival Guide or EmployeeSurv survival.com. And it's a site that you can obtain PDF products that I've created myself as spending too many hours, way too many researching and writing about it.

For example, the performance improvement plan or beating them. And the second one about negotiating severance negotiation agreements to the most important topics that we see in terms of the web traffic and podcast traffic we have. So check out employees survival.com and see if this can try to help you and you don't need an attorney to use it. Thank you.

Unfortunately, the stigma is self-perpetuating among the insurance industry itself about the psychosomatic nature of mental health. But you and I also know that mental health is having a new birth in terms of awareness in our culture, which is great. But nonetheless, in the short-term disability and long-term disability area, they get challenged by the insurance carriers to determine whether you have it or not. So it's really important in the mental health area to document bipolar or chronic depression, major depression, and anxiety type of disabilities with your psychologists and psychiatrists. Step eight, I call it decision day on the short-term disability. Read the decision when you get it.

If it says approved, it's going to say very little about why it was approved. Same goes for a long-term disability. When you get the decision, it's going to say approved. They don't tell you squat about the why. If it's denied, they tell you a lot about it. So what happens if it's denied, they tell you a lot about it. So what happens if it's approved? Then you have six months of benefits, either at 60% or 100% of your salary. And at that juncture, if not even before, you begin working on your long-term disability application, because

if you hadn't filed it by this point, that's why I say filed in the beginning and get it off with, it may be to a different carrier altogether. You may not have the same carrier. And you're basically going to redo the same process over again. Same medical information, same narrative information. Now you have the benefit of one thing. The short-term disability was approved. Well, it was approved on your basically disability from your own occupation, the job you are doing before you went out on disability. So that helps you. You have a carrier, part of the employer's plans say that you were approved for disability

based upon your medical evidence. That's one step closer to getting the approval for long-term disability. There's the same standards that apply for short-term disability as they apply for standards for long-term disability, meaning that you have to be disabled under the plan definition of disability from your own occupation for the first, I think, first two years, and then own any occupation after two years, depending upon what the definition disability is in the plan. So read the plan. Don't sit there and say, I don't know what this is. It's plain language. It's pretty simple. It's set forth in categories of understanding under the plan document. It's not written in verbose legalese type of nonsense that I have to read all the time,

because Congress mandated that the plans must be written in a way to be understood by just everyone, not just lawyers. So step nine, we're going to review the FMLA-ADA job accommodation process because you're at the short-term disability stage, which is now approved. But as I said before, under step three, you're looking for job protections by federal statutes and state statutes. At this juncture, at step nine, you're at the FMLA end date and ADA overlap into unpaid leave of absence. If the STD claim was not approved, if it was approved, then you'll continue to get benefits for the duration of the short-term disability, which is six months. But you also want to take a look at job accommodations that, it's really simple at this stage. If you're on claim for a short-term disability, you're going to remain on claim. And you don't really have to work too much with your employer about accommodation,

but recognize that the ADA is there. You're on an accommodation, short-term disability, that the ADA is there, you're on an accommodation short to disability, a leave of absence, a paid medical or paid disability leave of absence. So figure out where you are in your process and monitor it. Make sure that you're and the employer's, you know, acting in good faith with you. At the end of the FMLA period of time, I want you to ensure that you have the understanding that your job is no longer protected. And you basically go off of FMLA. So that statute goes away and you're left with just the ADA accommodation leave of absence, short-term disability. At that point, when the short-term disability benefits ends, you should be teed up for your application for long-term disabilities already in the pipeline with the insurance carrier being reviewed. So there's the overlap, and you shouldn't have any break in disability benefits if you coordinate them.

That's why I said start your disability application for short-term and long-term at the same time. They may confuse the insurance carriers and the employee administrator, but we don't really care about them. The fact that you file it, they have to deal with it. They may respond by saying, well, we have to wait until your short-term disability is approved or denied first. That's true. It doesn't mean they can't review your LTD benefit or because you already filed it and you can begin to shove into the pipeline everything you put into your short-term disability everything you put into your short-term disability, you put into your long-term disability.

Let's see, the step 10 at the LTD application contents, it's everything you did in your short-term disability. Your narrative, your medical documentation, the decision of approving or denying the short-term disability benefits. Generally, it's approved about 95% of the time, in my opinion. And then you answer all questions regarding the employer, the plaintiff administrator, the insurance carrier about the, are you ability to work, your functional capacity. And then you would get documentation from your, I say this, a vocational expert. If you type in a search word for Google for vocational experts in your area, let's say vocational experts in, let's say, Connecticut, you would uncover people who actually assess jobs and your medical information to determine, do you have the functional capacity to work? They're out there because they're out there making a living, real people doing this job

because people have issues related to workers' comp and there's vocational people out there to tell us the functional capacity that you have. It's very important you have that because the insurance carrier is not going to, they're going to have somebody vocationally internally assess you, but they're not going to give you any type of reports. If you give them a report ahead of time of functional capacity that you're unable to do your job, that's going to help your claim get approved. And any additional medical information you can get. I mean, you can't stop providing enough medical information from experts to support you. Two, three, four, you know, second opinions.

It really matters to provide those letters and those reviews. Go through the effort. You have health insurance, so why not use it to your benefit? Stay within plan, of course. And even if you have to go out of plan to get something that is really valuable in terms of somebody's expert's opinion, do that and document that part of the claim file. If you need to get research studies to support your cause, include that in your application. Let me say something. When you're applying for short-term and long-term disability benefits, you're building an official claim record of your application.

And no one can tell you what you can and cannot put into it. You can put an affidavit by your family members about what they saw and experiencing with you. You can just put just about anything that's relevant material to supporting your claim. And it's open-ended. And there's no real rules defining what you can and cannot put into it. So I encourage you to put a lot of information. Here's another thing. There's so much available information on the web. And I want to actually make a stab at this. If you even Google something about, let's

say it's an insurance carrier and you, or it's a company and basically type in litigation with long-term disability against, you know, whatever the Hartford, you would come up with case decisions that you can read that maybe support. And maybe you type in the phrase multiple sclerosis in the search string. You would come up with case decisions. You can print if they're favorable and include if they're in the last couple of years. And there's something that's similar

to what's happening in your storyline, you can include that case decision in the appeal record. I'm sorry, in the application for the LTD benefit. So there's a lot of information you can include. I know we're in the era of the AI development issue, but be careful here that searching, development issue. But be careful here that searching using an AI chatbot or device on Google or something, be careful what it's going to include because it may include information that is not real or not material to your own situation. But do the research to find out what is it picking

up because it may provide hints of information you can scour to support more information. Everybody has a claim out there for disability benefits at one point in time or another. These cases are out there publicly. Whenever I file a federal case in court, the case gets live. I mean, the complaint is published. We can see it. So if you do due diligence, you can search cases to find other people who've had the same problem with the same insurance carrier. A long time ago, maybe last 10 years ago, maybe longer now, doing this too long, Sedgwick Claims Management was the noted target amongst my colleagues not to target under ERISA for basically just bad insurance practices. And the courts took notice and the plaintiff's ERISA disability bar had made great efforts to gaslight their activities to a large extent. So there's a lot of material out there about Sedgwick claims management. Now let's get to step 11, the LTD decision day. And it's when you get your denial of benefits or you get your approval. I'll start with the approval first. The approval letter is going to be

short. It's going to say you're approved. It's not going to provide a rationale to you. It's going to say you're approved. It's not going to provide a rationale to you. ERISA does not require the insurance carrier to provide the rationale. Who cares? The fact you got your claim approved, that's what matters. If your claim is approved, then you're in the pocket for a period of time getting coverage and, you know, take a sigh of relief. Not just yet, because the plans typically have a recertification,

sometimes annual, definitely annually, sometimes even monthly, but I haven't seen this in a while. They used to do it quarterly, but generally annually, they'll recertify the claim benefit and ask you, you know, and go through a process and get your doctor to sign off. And that seems rational because you want to have, they want to have updated information. You may have improved and they have a right to because they're paying you. So go along with the process. That information regarding annual certification is in fact written in the plan documents or read it, be aware of it. Don't be naive about it. If the claim is denied, this is where the next stage of the discussion between step 11 and step 14, when you file your case in federal court, God forbid you ever do that. This is where the

bulk of information I want you to understand. And it's really where the hard work of your first part of the case of building your medical file and your narrative pays off. If the claim is denied and you did everything you could to support yourself in the LTD benefit process by supporting yourself, saying you were not able to work in your own occupation, meaning your job, you had a functional capacity review saying that supports you unable to do it. The employer, the plaintiff administrator and the insurance carrier in the decision of denial has to state specifically. This is very, very important. You read this or listen to this. In the denial letter, it has to say all the rationale used to support the denial and then also referred to documentation to support that.

That's critical because you need to go into the denial letter, examine that same information, and determine whether that was cherry-picking the file or were they on target and they have a sound decision in their favor. Now, there's an appeal process here. Congress envisioned when they wrote this law back in 74 that you can appeal, it's going to sound a little ironic, but to the plan administrator. Who? The insurance carrier. Well, that sounds weird because I just made a decision to not deny benefits. Why am I going to appeal to them? But that's the way the process is set up. You appeal to the insurance carrier, plan administrator, whatever, whomever they have designated, they'll tell you. And you have a period of time to do this. Generally, you have 180 days to do it. Again, the plan document will tell you how long you have to

file your appeal. So file the rule or follow the rules regarding the appeal process. Again, it's in the plan document. Read the plan. So the appeal process, what do you do first? The first thing I always do is request after receiving the denial letter the same day I receive it, I file or send off the email fax in any way to document. I can get it there. Back to the claims, the insurance carrier, whoever is deciding this. And I'm asking for what's called an ERISA, E-R-I-S-A, that's the acronym for ERISA of the Employee Retirement Income Security Act, a 502c document request. The document request requests everything the plan administrator, claims administrator, used to support their denial of the claim.

Every document and evidence they use to support the denial claim. That's a 502 document, 502c document request. Just write that into your little reline of your letter. You're making a document request under ERISA 502c. They will know what it means. They then have legally 30 days to respond to you and provide that same medical evidence. Typically, it's the claim file. So you ask for all those things that were used to support their denial and also ask for the entirety of the claim file so you know exactly what was in the claim file at that moment in time when the decision was made. Very important part. When you get that claim file back, all those documents back, I would encourage you somehow, some way, if you want to scan it in, you know, PDF maker has,

Adobe has an ability to put bait stamps on things, put a number on what you received. Because when you submit your appeal, you can also put your own number about what you're submitting so everybody knows what was sent and received back from the insurance carrier and what was sent again on appeal so we have a complete record of all those documents. It's free. It's in Adobe. You can easily do that. Next thing on the appeal process is get your medical documents in order. This may sound a little crazy, but you already submitted medical documents. They denied the claim based upon the medical documents you submitted.

Well, guess what? You need to go back to your medical providers and saying, hey, they denied it. Do you agree or disagree? And get them to do more testing, get them to write more letters, anything you do to advocate that you're still disabled, because you know you're disabled, you can't work, you need disability benefits. And so the medical team has to support your efforts here. If they're not, find another doctor that does this. They're not, the doctors are not accustomed or aware of ERISA. That's why I'm trying to tell

you all this backstory, all these steps that go in the process. You have to marshal all this yourself. If you want to hire a lawyer like myself, you can do that. But it's incumbent upon you, if you want this benefit, you have to fight for it. This is your full-time job. I know it's difficult, but you have to go through this process. Most important thing about the documentation for your medical providers, your team, is they have to state that you're totally disabled from your own occupation. That's what the letters have to say. In quotes, Mrs. Jones is totally disabled from her job as an executive assistant. And they say why? Due to cancer, due to multiple sclerosis, due to her

functional incapacity. The next step in the appeals process is when you get the claim file, go through it and see if the insurance carrier has, my favorite thing, they cherry pick the file. What I mean by is they choose things that are self-serving to their own decisions. And it's just a knee-jerk reaction in the insurance industry to deny your claim. And they're just going to pick favorable information. These are people who are looking at the claim file internally from an insurance carrier point of view, and their job is to deny a claim. I know that sounds strange, but I'm going to say something very opposite to

that. Under ERISA, the plan administrator, claims administrator persons, those individuals act as fiduciaries. If you know what a fiduciary is, it's someone who's acting in your own interest to protect you to do something for you because under the plan, both the short-term and long-term disability, you're considered what's called a participant because you're an employee, but you're also called something even more greater. It's your superpower. You're called a beneficiary. A beneficiary of what? Well, the fiduciary's actions. Fiduciary protects the beneficiary. Oh, well, this is an insurance care denying claim. How is it protecting the beneficiary? That's the ironic nature of this process. The law is there.

Your job is to show how they did not protect you and how they cherry-picked the standard of review is, did the insurance care claims person act in an arbitrary way to ignore material evidence that was submitted to it, medical evidence that you were totally disabled? Was it arbitrary and capricious? Look up the definition of what it is. It means selective. It means intentional. It means omissions.

It means misinformation. It means a lot of things. and put it into your narrative because every interaction with the carrier after the denial of a claim is crucially important. And I'm getting to a point where I'm trying to say to you, when the fiduciary doesn't take your calls or doesn't answer you in a matter of weeks after whatever, you need to be dogged determination to get them on the phone or to write letters every day if you need to, to get them responding to you. For example, let's say you wrote, there's a denial decision and you want simple answers to some question you had and they just refused to answer you.

And you wrote letters every day for, let's say, 30 days. And you sent it by prior to mail. It probably cost you a lot, but nonetheless, you sent it in or you emailed it every single day and they didn't respond to you. The fiduciary has committed an act of just ignoring you, and they can't do that. And you've documented by sending letters every day saying, I got no response. This is the 10th time, 11th time. That's the dogged determination that I go through trying to document bad behavior of an insurance carrier. Now, that is not going to be the baseline of every single case. It's going to be your insurance carrier is going to be reactive and responsive to your

request for information. I'm just telling you the horror stories I've had to deal with. And they're real. They happen. So understand that the interaction with the fiduciary, the claims person on the phone you interact with, they have a legal material obligation to act in your best interest. Well, they denied the claim. Well, I know, but the standard is you have to show that they have ignored you, that they have, this is the one that happens most often, misrepresented information to you about the benefit or how to obtain it. That's why it's really important. And if you want to record the call, record the goddamn call.

So you have it and you can basically include the recording in part of, in a transcript. You can get an AI device to transcribe the call. The other thing is, understand something. When you're calling to an insurance carrier, they are also recording the call. Why do they do that? To protect themselves. To protect themselves from these claims to individuals who are well-trained, sometimes they make mistakes. So I say to people, record the call. When you get the claim file back, look for transcripts. Some insurance carriers call them

soap notes or whatever. They're just literally the interactions. Mrs. Jones called today and this is the following was discussed. And usually it's verbatim. Usually there's an AI device there that's recording and transcribing. Much like what I'm doing on this podcast right now. There's an AI device in the background recording a transcript. So the ease of information of technology that's out there, use it to your advantage and then try to demonstrate to the claims person that they're not acting in your best interest. Why am I spending so much time on this? Because it happens so many times. I always look for it

because they're always just people who are not well-trained or whatever. It just does happen. It's an easy, easy go to get information. Just being aware that the insurance carrier representative maybe had a bad day, whatever it was. They have to act in your best interest at all times. It's 100% fiduciary responsibility. So I think you're getting the fact here that they have to act in your best interest, but you have to act as your own advocate to really protect yourself, to support your claim at every juncture, knowing full well you can be kicked off the game for whatever reason if you're not on top of what you're doing with the carrier. So document every call with them, write them letters, be really vigilant to create an elaborate, extensive claim file.

What does it do? It sheds lights on the employee or the plaintiff administrator's practices. That's what you're trying to reveal to who? Well, you're building a claim record. This thing is fluid. It's live. It's a claim record for who? A federal court in the future who's going to turn back and look at the retrospective

of what you did in your narrative and your interaction with the claims and the insurance care to determine one thing. Did this carrier with Ms. Jones act in an arbitrary, capricious manner? And if you point out every little step of the way that this fiduciary was just screwing you, that judge, both conservative and liberal, will take notice under ERISA because they're required to. So there's a built-in longitudinal process that I'm describing to you because I've done it. I've done it for many, many cases. It's you have to follow this process. It works. And it works so well that you may not ever get to court.

That's the point. If you do this job really well, self-advocating, advocating for yourself and building a claim record and making it look like there's some lawyer like me, an original lawyer behind the scenes, you may get your claim approved because the insurance carrier can see it. I'm trying to give you a pattern of behavior to deal with the claim, both in short-term and long-term disability, because the carrier may think you have a lawyer and a RISA attorney. There are not many RISA attorneys out there. I don't know if you know that. So if you put down the pattern and make it look like it, it's's free so why don't you just try to see if you can do that

and by the way if you want to add emotion in your narrative use it sparingly when needed to make a point but don't over emotional the the narrative uh just state the facts man what happened and just run through it and and what took place uh run through it and what took place and keep it clean because it's just helpful for everyone. We know you're going through a lot, but just try to be objective about your fact pattern, your narrative. Next thing and step four, I apologize, appeal process, get the vocational expert. I think I've already talked about that for the functional capacity review, get additional

medical information. Step five, write the appeal. Well, write an appeal. What are you talking about, write an appeal? It sounds legal. No, just write a letter to the claims administrator, the insurance carrier. Your narrative is, dear so-and-so, to my concern, et cetera, I've received a denial letter, and here's why it should be reversed. And you go into it, and you state all the things of your argument about why,

medically speaking, you're not capable of performing your job because you're, quote, totally disabled under the definition of the plan. You can do this. You don't need to have an attorney do this. I know that's a daunting effect, but a task here, but you can do this. You have, marshal the narrative and the medical information to support yourself. Anybody can look at the information of their narrative and the medical and make a story about why it should be approved. You have the medical claim file. You have the claim file from the insurance carrier because you requested it under 502c and you got back what they had thought about internally. There's a lot of information in there. Arguments to make a near appeal. Okay. I apologize. I have

to do this, but you need to be aware of it. And this is where when you research case decisions on ERISA disability benefits in a Google search, you're going to come across these same arguments, and I'm going to give them to you. I already talked about one of them. It has to do with the standard of review. The standard of review in most cases is arbitrary and capricious. or some losing track, there were plans that had no language having to do with they reserved themselves discretion to interpret in the measure of the plan. The insurance companies got smart about it. They realized that, well, let's just include, we have full discretion to interpret the plan. And they did that. And all 99% of the plans have this language, if not all of them.

So everyone knows the standard review in ERISA is an arbitrary capricious standard review. It just means that the company has to act in a way to provide a substantial review of your information in an objective, fair, reasonable manner designed to protect you, the beneficiary, and they can't ignore material evidence that's there in front of them. If they do, then it becomes arbitrary. So it's self-evident what the definition. Then there's another standard, another issue that when I do an appeal at the appeal level of the insurance carrier, I'm trying to break down and disrupt the arbitrary capricious review process, the standard review. I'm trying to show at every avenue that when they talk to Ms. Jones on the telephone, they misrepresented the plan language and the plan benefit.

I'm going to bring that to light. I'm going to show that they weren't acting in her best interest. I'm attacking the substantial weight review and the arbitrary capricious nature of their behavior by saying, here's why. So one of the additional ways I can do that is when a short-term disability plan is self-funded by the employer, meaning that if you're approved for benefits, the short-term disability benefits are going to come out of the coffers of the plan sponsor, the employer. That's what's called a structural conflict of interest. It's not an ability to say, aha, we destroyed the arbitrary comparison review standard and we're now left with the default standard of de novo review,

which I did not state, and I apologize, but that is the de novo, that's the default standard of de novo review which i did not state i apologize but that is the de novo it's the original standard review the congress envisioned when they created the statute and they said that any court would have to look at the the claim file brand new without any deference to the plane administrator it's not something you need to be really concerned about because it won't occur in your case most Most cases are decided under the Arbitrary Capricious Standard Review. Because of the discretion language in the plan, read it, you'll see they reserve themselves discretion to interpret the plan. The structural conflict of interest typically plays out in the short-term disability format. I have seen it play out in the long-term disability format.

There was a Supreme Court case, Black and Decker versus Nord, I think. I'm now just dating myself. But where that structural conflict of interest argument came out and the Supreme Court discussed it, it doesn't break the standard of review, arbitrary and capricious, but it's a factor in evaluating whether the arbitrary and capricious nature had occurred in the case. I'll leave it at that at this point. The next part of the argument you want to have is really it's your narrative about the, does the medical evidence support your disability? Are you totally disabled? Does the experts, I'm sorry, vocational assessment support your total disability under your own occupation? And it's really the marshalling of all your medical evidence, your narrative, your outside information from maybe your family members, their affidavits. Here's the day in the life of Ms. Jones. She's unable to do work. She can't even carry bags from the grocery store to her front porch. Just use every little piece of information you can. I want to say something as a tangent right now, when you're going through this process, I don't mean to alarm you, but I'm

going to just share it. And it has occurred in cases I've worked on. Insurance carriers are in the business of doing what? Taking premiums from an employer and also from employees because you pay for LTD carrier insurance through your payroll. But they don't want to do one thing, pay benefit. And I know that's very opinionated on my part, but when you're in my shoes looking at cases, you really see how that conclusion can appear on very good cases where it's backed up with medical information, yet they're still denying claim for very, very nice people who are just helpless. And, you know, their income is impaired because it can't work. I've seen this happen. I've seen this happen. So I'm about to describe to you is when you're on claim for benefit, well, short-term, long-term disability, but mainly long-term, be aware of something.

There are people hired by insurance carriers to do one thing, to follow you. There's a lot of technology to allow them to eavesdrop upon you. If you're naive to this, then wake up. It occurs. They can't invade your privacy, but they use, you know, things like boom mics sitting on a street. So when you go about this process, just be aware of different cars in the street. You know, if you live in a dead end like I do, you know, you see who comes and goes. Just be aware of that.

You know, if you want to look at your cameras that appear off your front door, you know, see who's watching. It does happen. And I haven't seen it happen in a while, but they're out there. And what they're looking for is evidence that, and this is a real story, is people who go to the grocery store and, you know and the plastic bags you take out, you're carrying like five on one hand and five on another hand. Well, that's a lifting restriction. And if you have a lifting restriction in your claim file and you're carrying the gallon of milk, whatever it is, they're going to take a picture of that and they're going to use that against you. And that's a real true story. That actually happened several times in cases. So be

aware of that. I don't think the private surveillance happens a majority of the time, but you need to be aware that it's there. They do it, especially in workers' comp cases, okay? Because people fake workers' comp all the time. I'm sorry, it does happen. That's why there's a lot of fraud that takes place. I don't see as much fraud in the long-term disability area as much. You would hear about it. We don't see it. I don't see as much fraud in the long-term disability area as much. You would hear about it. We don't see it. I don't read about it as much. But not to say that the practices by insurance carriers to deny claims, they will use surveillance as a means to support their decisions.

So be aware of that issue. Step 13 in the process, sorry, I mislabeled my numbers. in the process, sorry, I mislabeled my numbers. The long-term disability policy requires you, even before decisions made on long-term disability, to apply for social security disability income, a federal government process where you can apply for benefit. And what you need to know is this, you get the same amount of money in disability benefit. It just comes from due to different sources. And the social security disability benefit you receive, that decision that you're totally disabled and unable to do your job, it's a different definition under the social security regulations than the long-term disability plan document. So you can't use the social security disability income decision to support the long-term disability decision.

They're just two different standards. I just won't waste any of your time on it. Just ignore it. There are some overlap in the area, such as chronic fatigue syndrome, fibromyalgia. The federal government, under Social Security Disability Income, has approved it for disability benefit. income has approved it for disability benefit. And so for a partial use of that information, I have used it as well in case decisions to support that is a recognized disability. But today it is really a recognized disability. In the past, the last 20 years, we had to argue with that. There was not a somatic nature of these conditions. It was real. It was something

happening. So the long-term disability carrier plan document will require you to apply for social security disability income benefits, apply for it, follow the procedures. Short note on SSDI and SSDI lawyers. SSDI lawyers will only get involved when you have to denial your decision. That's when they get involved. And their fees, and I'm not an SSDI attorney, their fees are regulated and paid for under the statute. So that's when you can approach an SSDI lawyer in the beginning process of applying, but they're really not going to get involved until you are denied claim. They're out there. You can search for them. You can call me, email me, I'll direct your attention. Now, the appeal process that you've just filed for long-term

disability, step, I think we're on 14. Once you exhaust this process, and this process is the same as the STD, it's 45 days up to 90 days for the plan administrator, claims administrator to render a decision. It's required by law. They'll notify you at 45 days, they need an additional 90. But once they get to 90, they have to do one thing. They have to give you a decision. And if they don't give you a decision, I'm going to give you a little cheat. It's called deemed denied, a futility. And if you use that language when writing to the claims administrator and saying, hey, listen, I've documented in the calendar, you didn't get decisions, it's due by now, and you're now a month late, not going to be a month late, but a week late, you document that

they actually failed to do it. It's an easy grab of an argument that you can make in court if you had to, that you went through the process, you're in good faith, complied with all their requests for information, you documented everything, you provided everything you needed to do. You're exhausted at this point. I guarantee you that. And you have a right to what? A decision.

You're the beneficiary. The fiduciary is screwed up and it's not done its fundamental job of rendering a decision under the plan. The plan controls what they do. So if you see it and it's a futility aspect because they just didn't comply with the deadlines and they're going to try to mess with you and say, well, we're going to extend it again. That's not true. You need to call a fertility or their inability to keep the required 45-day and 90-day deadlines and hold them to it. And they'll just try to, you know, I had cases where they go

past the 90 days and I document it. I document several times. So everybody's aware of that. So under ERISA, you have this appeal process I just discussed where you're just, in summary, providing all the medical information again, taking a stab at the arguments of why they denied it and challenging them. And they have written a decision now again that is at the end of this appeal process and rendered an appeal decision, guess what, folks? Sometimes you can file a second appeal because maybe this is more information you have to provide to them because your disability is ongoing. And if the plan restricts you to only one appeal, then the plan does that. If it doesn't say that, you can file a second appeal to perfect

your record of your case. Why is that important? Because you're dealing with, in essence, administrative law. And administrative law is really controlled by the record itself. I'm going to talk about another subject. When you get into a federal court, which is the appeal of the appeal, I know that's crazy, but you have to go to federal court to appeal the decision of the appeal of the plan claims administrator. That's the process that Congress envisioned and created under ERISA. You have to file that. But once you file that complaint, your record is closed. You can't add to it. You can't add to your record once you file your complaint in a federal court. It's closed. There's issues of limited discovery in federal court, but I'll explain that beast in

a second. But when you start this process from day one of your STD claim, all the way to the point where you got your denial of your appeal of your LTD denial claim. You've created a record. That record is set in stone by both you and the plan claims administrator. And everything you did to doggedly to advocate for yourself, it's all there. As you wanted to create your record, they're going to create their record. If you want recordings, you can do that. If you want video, you can do that. You put all your stuff that supports yourself into your record. You can be really if you want video. You can do that. You put all your stuff of the support yourself into your record.

You can be really creative about it. Video is a great way to do document that you have no functional capacity to do a lifting issue. But so that record's closed once you get to federal court. OK, once you file that complaint. Obviously, when you file a federal complaint in court, there's this implicit nature that you have to get higher an attorney. complaint in court, there's this implicit nature that you're going to have to hire an attorney. There are ERISA attorneys. I'm a part of a large group, unaffiliated practitioners who are all across the country who are there who want to help you. And they're in every city and every state. And when you're looking for an ERISA attorney, look for the acronym ERISA and disability benefits that they advertise for. There are they're out there. Please look for them. You'll find and you're searching a lot more SSDI lawyers out there.

Sometimes they're also ERISA attorneys. But make sure you're working with an ERISA attorney when you're dealing with this type of claim, because. working with an ERISA attorney when you're dealing with this type of claim, because generally, if you have the ability to get an ERISA attorney involved in the beginning, they're going to run you through the same process I just described at length with you and advocate and push. These are really super smart, aggressive people who've been in the trenches for a long time dealing with insurance carriers, and they know the history that I'm describing to you in summary, and they know how to deal with insurance care. They're good friends of mine. They've been doing it for a long time. They're committed people. So they're out there for you to find them.

If you want to find an attorney, a risk attorney in various states, call me, email me, whatever, I'll direct your attention. So filing your case in federal court is the ultimate appeal of your denial of your appeal by the claims administrator. And filing a complaint in federal court is something, it's not a small task. You can file pro se. I have seen people do it and successfully do it. But the process of filing and litigating an ERISA case in federal court is very different, very different than a standard civil matter. I filed over, I'm losing track, maybe close to 200 cases in federal court. I think about 150. I'm losing track.

The federal court process for ERISA cases is different in this regard. There's no or limited discovery. And second, there's no jury trial. There's no discovery, no jury trial. So what do you have? You have a federal judge, very good friends of mine, esteemed judges on the bench who become familiar with ERISA because one third of their docket is employment cases and ERISA is employment. So they get up to speed very quickly. Typically, the attorneys are more adept and aware of the issues than the federal judge,

but the federal judge, the federal bench, they're good and they have a lot of resources to support them, other judges as well, to help them. But they're going to be aware of the process I just described to you. And they're looking at, and I've designed this process for one person involved here, and that's the judge. And I can't impress upon you that this entire process, if you follow it and add your creativity to it, the judge will take notice. Assuming that you have a total disability, well-supported by the facts and well-supported by the medical evidence, and the chicanery and the gimmickry and the gains played by the insurance carrier will be evident in your fact pattern because you'll have pointed it out. And the judge sitting there is acting as the appeal panel of the insurance carrier's appeal process

and looking for what? Gamesmanship. They're looking for did they act in an arbitrary and capricious manner towards you as the beneficiary? Did this fiduciary breach that fiduciary capacity of dealing with you, which is a claim. You can have that. At the juncture, at the federal court level, there are two claims, if not three, I'll describe them in general basics. Section 502A1B, that's just what it is. It's a claim for benefits. It's a claim for benefits, whether you're applying for a short-term disability, long-term disability, pension benefits,

other types of benefits under RISA, but generally it's a claim for benefit. There's another claim that I oftentimes use, and I've talked about it, and it's the 502A3 claim. That's the breach of fiduciary duty by the plan claims administrator towards you. And it's misrepresenting claim benefits, misrepresenting plan benefits, omission of information, cherry picking, all this kind of junk that happens that they're not acting your best interest. You call it out in your fact pattern and you use an A3 claim to do that. It's a separate claim. There's a third claim. The third claim is a little bit different. It's section 510 of ERISA, which goes to the employer. And it's the employer

interfering and retaliating against you to deny benefit. So employer-focused, not plan administrator-focused, not plan insurance carrier-focused, but the employer's focus. not plan insurance carrier focus, but the employer's focus. What did the employer do to disrupt your claim for benefits? And you would know it that the fact pattern is going to, it's, it's involvement by the HR department or someone trying to prevent you from getting benefits. There are rarer cases, but they do exist. I have a current case pending where that is alleged. It was a short term disability case and the employer was taking efforts to interfere with the ability of the individual to obtain benefits because it was a self-insured employer sponsored. Coming out of payroll, coming out of the coffers of the employer. And so we targeted the employer on that and it was a self-evident Section 510 retaliation. There also was a discrimination claim as well built into it. So if you have discrimination based upon disability and you

have a fact pattern that's people that are just not treating you well, you're more likely not going to have a 510 retaliation claim in your case because the employer is trying to interfere with your ability to do what? Get your benefit. So you have these claims to assert in federal court. You have your record of your case, that's your administrative record. And so how does the federal court process look like? What do you do? Well, you file a complaint several pages long saying, you know, you can, I generally, sorry, I put my entire fact pattern of my narrative that you created that we talked about into the body of the fact section of the complaint. So I'm making my complaint, what? Rather lengthy because I want the court to be just inundated.

You know, tears in the eyes, just, you know, got to get a cup of coffee because I'm going to be reading this long fact pattern. Why? Because I'm trying to tell a story of the tale of woe, the shit that you had to go through to prove your case with this claims, the insurance carrier, to support yourself and how you've just been just at every turn just been screwed. And I'm trying to create that story. The judge has to read my story that I'm writing on your behalf. That's why the lengthy fact pattern is very important. The nuances of every telephone call and every interaction with the claims individual is very, very important to cast a light upon the practices because I'm trying to demonstrate that the practices were abusive. demonstrate that the practices were abusive. They were not objectively examining your evidence, and they were just engaging in wholesale cherry picking and just substantial avoidance of the material facts of your case that you were totally disabled. So I have the power to create that setting of the story in the fact pattern. That's how long my fact patterns can get.

It sometimes upsets federal judges, but I respectfully disagree because I'm trying to do something even larger. When I file a federal complaint in a federal court in an ERISA case, I'm also trying to demonstrate to another body of a court system. It's the court of appeals. So the federal district court is the trial court, okay, although there's no trials in these cases. There's a court above that is the court of appeals, okay? And a court above that is the Supreme Court of the United States. That's what these cases mean. They can go all the way to the Supreme Court of the United States. I had the privilege of being a part of a case that went to the Supreme Court of the United States.

States. I had the privilege of being part of a case that went to the Supreme Court in the United States. If you sit in the ass and watch a case go through the motions, it's pretty awe-inspiring how our process works, okay? There's a system here to protect you, the beneficiary, under ERISA, and it goes all the way to the Supreme Court in the United States. So when I'm drafting a complaint, I'm writing for a longitudinal time period because I don't know what's going to happen to this case. I'm trying to create a record. My court complaint is part of that record. And I'm going to continue to develop that court case all along the way. By the way, as a side tangent, the case, and I'm going to alert you to this because it's very important. There are limitations periods that you need to be aware of. this because it's very important. There are limitations periods that you need to be aware of.

And that's what the Supreme Court case that was involved with and dealt with. It was a Hartford insurance carrier, I think it was. They put into their plan, that individual must bring one case before the federal court within one year of denial of benefits or something like that. I'm doing this by memory. So they limited such limitations to one year. Typically, it was up to six years, I believe, or it was even longer. So check your plan document, read the plan document, and go through and read through all the way through the past administrative process and denial of the appeal to the plan administrator and look at how many years or time period you have to file your lawsuit in a federal court. And it's going to say it right there because it has to.

So read it because most insurance carriers now try to carve down these such limitations. And maybe six or 10 years, I'm losing track, but they definitely, I now see a one-year limitations period because they want to do what? To deny claims. If one year, if you can control that in your plan document, that's what the plan administrators are doing now. They're putting language in their own plans to do that. It's perfectly legal. The Supreme Court case I just described allows them to do that. And so it's more likely that you're going to have a one year limitations period to bring a lawsuit. Okay. So it's very important. The actual process of the federal court procedure of dealing

with your case on your complaint, it really is a one-step process. You're going to file your, I'm sorry, two-step process. You're going to file your appeal and your complaint to federal court, and the employer is going to respond, and they're going to deny by an answer and saying deny. And the next step in the process for you is to file a motion on the administrative record to the court. Some people will call this filing a motion for summary judgment. But filing a motion for judgment on administrative record is a slightly different vehicle. It's an ERISA created by case law practitioners, and the courts understand what it is.

Essentially, what you're asking the court to do is take a look at the case of the complaint and the administrative record that you've compiled and make a determination based upon the review, which is basically arbitrary and capricious. And the court will go through that process and render a decision. Once it renders a decision, it will give you in writing whether they found arbitrary and capricious behavior and decide to remand the case back to the plaintiff administrator with instruction. That happens a lot. And typically, if that happens, basically your claim is going to get approved and the case is going to go away.

If it is denied, and it means the court says, no, you don't get your benefits because the plan did exactly what it needed to do, you have to then, unfortunately, think about, if you need to, file an appeal to the Second Circuit or the Court of Appeals in your jurisdiction within a required period of time, there are timelines to do that. So it gets more complicated. But if you have a serious, severe case and you need this disability and it's very important, you have the ability to go through that process to appeal to the next level. to appeal to the next level. Again, administrative record is set. The court record is set. You're now dealing with the district court having an argument that they got it wrong, and you want to make an argument that it needs to be reversed. You have the ability to do that. So I'm going to stop at that juncture because getting too far afield of really at this juncture in federal court, you're going to need a lawyer who's a practitioner, who knows the rules. Don't waste your time trying to figure it out yourself.

Unfortunately, it's too esoteric. The rules are all there for you, but when you get the experience of a lawyer involved, it pays off because the person can fly through the process and hone in on the arguments and to perfect your case. So I hope you found this elaborate process informative. It does work. And I'm going to just close by saying it's unlikely you're going to hit federal court in your case. Most insurance carriers, if you follow the process I've described to you with building your case and your narrative and building your medical evidence to demonstrate you're totally disabled, it's more likely than not that they will back off and approve the claim on the LTD. It's more often not these days than it had been in the past. It doesn't mean they can't send you to federal court because they deny your claim but if you show them that there's a maybe a ghost

lawyer in the background got in this process that's the point and you can do that if you need to hire an arrest attorney to help you through the appeals process because what i've just described to you is just daunting i hope it's not so daunting and I hope you can have the ability to try, but the risk of attorney is there to help you if you want to go find them. The problem is that you got to give up some of your fees or your benefits in the event that you win your case. And the alternative, you pay lawyers hourly rates to also do this as well. So when you think about that decision to hire a lawyer, think about the investment of your money into the process because of the resulting return is the aspect of a benefit being paid to you and without use of litigation. So I always try to win cases at the administrative

level. That's why I have this elaborate process I've described to you, because it does work. It works majority of the time that the insurance carriers back down and they realize that there's a lawyer present, obviously present, and I'm making arguments. And they have to basically statistically say, okay, well, we're not going to win on this one because he's got the right points. He's making the right arguments. So it's worth the investment, because he's got the right points. He's making the right arguments. So it's worth the investment, finding an ERISA attorney, and just go through that process. I tried to give you just about everything I had in my brain to just dump on this to explain and process for you. It's a little overwhelming. I'm sorry, but it does work. You can play it back and revisit the different points. But in summary, the fact pattern is controlling.

It's a fluid thing going all the way through. The medical evidence needs to support what you're saying. If it doesn't, make it support by getting the right people involved. Make your arguments to them why you're disabled and why you need the income benefit from them. With that, good luck to you on your case. Hope you win and be well. If you like the Employee Survival Guide, I'd really encourage you to leave a review. We try really hard to produce information to you that's informative, that's timely,

that you can actually use and solve problems on your own and at your employment. So if you'd like to leave a review anywhere you listen to our podcast, please do so. And leave five stars because anything less than five is really not as good, right? I'll keep it up. I'll keep the standards up. I'll keep the information flowing at you. If you'd like to send me an email and ask me a question, I'll actually review it and post it on there. You can send it to MCARUY at CAPCLaw.com. That's CAPCLaw.com.