Navigating the world of disability insurance claims can be challenging, especially when your disability benefits have been denied or terminated. Whether you're working with an attorney or going it alone, there are four essential documents you must obtain to improve your chances of a successful appeal.

Let's dive into the documents needed for your disability benefits appeal!

1. A Copy of Your Complete Insurance Policy - Many employees only receive a summary of their disability insurance plan, but to appeal a denial or termination effectively, you'll need the entire policy. Here's what you should look for:

• Statute of Limitations: Find out the time frame you have to file a claim or an appeal. Strict rules apply, so understanding and following them is crucial.
• Definition of Disability: Each policy defines disability differently, often comparing it to your job description and earnings. Pay attention to the terms related to your ability to perform the essential duties of your job and any income reduction requirements.
• Coverage Period: Know how long you can be covered under the policy if you're found disabled.
• Short-term disability coverage typically lasts 12-26 weeks before transitioning to long-term disability if applicable. Be aware of any limitations for mental health conditions and the change in eligibility criteria after one to two years.
• Pre-existing Conditions and Date of Eligibility: Check if there are waiting periods before your coverage starts and any exclusions for pre-existing conditions. Some policies may not cover conditions that existed before your employment or insurance under the plan.
• Offsets: Understand the list of offsets the insurance company can use to reduce your benefits, including social security, other insurance policies, or even withdrawals from retirement funds.
• Limitations to Coverage: Be aware of exclusions for work-related injuries or illnesses. There may be exceptions, so know the rules. For instance, if your workers' compensation claim is denied, you might be eligible for short-term disability while you appeal the workers' compensation decision.

2: Your Job Description and Personnel File - When preparing to appeal a denied disability claim, your job description and personnel file are vital. They help demonstrate your inability to perform the essential duties of your job due to your disability.

Here's what you should do:

• Request Your Personnel File: Begin by obtaining copies of your personnel file, which includes details about your employment history, evaluations, and any disciplinary actions.
• Obtain Your Written Job Description: Get a copy of your job description, as it outlines the specific tasks and responsibilities associated with your position. Your attorney will analyze this document to identify essential duties you can no longer perform due to your disability.
• Provide Evidence of Work-Related Struggles: To establish eligibility for disability insurance benefits, you must demonstrate that you struggled at work, failed to meet expectations, or encountered difficulties completing tasks.
• Gather evidence such as performance reviews, work-related emails, and any documentation reflecting these challenges.
• Rely on Medical Evidence: Medical evidence is crucial in supporting your disability claim. Consult your physician, who can review your job description and offer their professional opinion on tasks you can't perform due to your medical condition.
• Highlight Discrepancies: Your attorney will scrutinize the discrepancies between your job requirements and your abilities resulting from your disability. Any tasks in your job description that you can't perform are essential for your appeal.
• Document Missed Work and Productivity Decline: Keep records of missed work days and declining productivity, as this evidence links your disability to work-related issues.

3: Gathering Your Complete Medical Records - One of the most common reasons for denied disability claims is incomplete medical records. You can improve your appeal by obtaining your complete medical records. Here's how:

I. GROUP I MEMBERS, TEACHERS, AND EMPLOYEES, ARE ACTUALLY ENTITLED TO FOUR CATEGORIES OF BENEFITS UNDER NHRS

1. Retirement Pension Payments
2. Disability Pension Payments
3. Death Benefits
4. Health Insurance Continuation

II. NHRS IS A DEFINED BENEFIT PLAN

 As a defined benefit plan, NHRS pays members a monthly benefit for their lifetime. This is different from a Defined Contribution Plan (such as a 403b or 401k), which is limited to the amount the member puts in their account. When a defined contribution account is emptied, the payments end. By comparison, as a Defined Benefit Plan, the NHRS pension provides a set amount of monthly income for the member’s lifetime, (it may be adjusted for cost-of-living increases). The amount of the monthly pension paid is calculated based upon a formula of factors including Creditable Service (years of service in an NHRS job) and the member’s Average Final Compensation (an average of the highest three or five years based on year of vesting).

III. CREDITABLE SERVICE (ALSO REFERRED TO AS “SERVICE CREDIT”) IS A KEY VARIABLE IN DETERMINING A MEMBER’S NEW HAMPSHIRE RETIREMENT SYSTEM (NHRS) PENSION BENEFITS

Members earn creditable service, while they are contributing to NHRS through their NHRS-covered employment, or when they are contributing to NHRS on their earnings from an NHRS employer-funded disability plan. 

 Members may also be able to purchase or add back service credit lost in certain circumstances such as when an employee loses service credit for time away from work due to military service or workers’ compensation, or if an employee loses credit due to an employer’s enrollment oversight or due to a withdrawal of contributions due to termination of employment followed by a return to NHRS employment.

The rules for these circumstances vary and the members must seek advice as to whether they might be eligible and/or how to take advantage of this right. However, it is an important right to consider as creditable service is a primary factor in the calculation of pension benefits and it’s important to get credit for all years served in the system.

Over the course of the summer many young people will seek out part time or seasonal employment, and businesses welcome the added labor during the busy holiday seasons. There are, however, additional regulations and rules that determine how people under the age of 18 can be employed.

To help employers and young people seeking work understand these guidelines and regulations, the New Hampshire Department of Labor publishes a list of frequently asked questions around youth employment. That list can be found on the NH DOL website here, however we have also included the questions and answers below.

When is the NH Youth Employment Certificate, also known as "Working Papers," required?

The Youth Employment Certificate is required for any youth 12 to 15 years old and must be on file at the employer's place of business within three business days of the first day of employment. Employers are required to have on file at the work place, at the time employment begins, written permission by the parent or guardian of a 16 or 17 year old permitting the youth's employment (RSA 276-A:4).

Do youths under the age of 18 need to have a NH Youth Employment Certificate?

For 2016, there will be no cost-of-living adjustment for Social Security and SSI benefit rates. This means that the government has determined that the cost-of-living has not risen since last year, and benefits will hold steady until the review next year. 

Each year the government assesses cost-of-living around the country through a Consumer Price Index – which measures changes in the price levels of essential goods and services around the country – and then adjusts benefits accordingly. If the cost-of-living goes up, the government must increase Social Security and SSI benefits.

While everyone enjoys seeing an increase in his or her benefits, the good news is that the average cost-of-living has not risen this year. Without an adjustment to cost-of-living, retirement earnings, exempt amounts and the maximum earnings subject to social security tax will also hold steady.

With the NFL’s conference championship games this weekend, many Americans will be laying small bets between friends, family, and co-workers. While certain sporting events are ingrained into the very fabric of national culture, the unofficial betting around these events is mostly illegal.

One common phenomenon is the office betting pool or bracket- often a lighthearted and social activity- however it is important to consider the legal status of this practice. Despite the fact that every year billions of dollars are wagered in unofficial office pools during the Super Bowl and March Madness, your office gambling is likely illegal.

Statutes in almost every state prohibit office gambling pools, and in every state but Nevada, gambling on college sports is illegal all together. Despite the questionable legal status of these office pools, they persist across the entire country. 

• Some estimates suggest that total betting on the Super Bowl last year exceeded $10 billion
• College football wagers are estimated to total over $60 billion
• Estimates suggest that 50 million American’s participated in March Madness office pools in 2015, with over $2.5 billion on the line
• All of this activity is dwarfed by fantasy football, which attracts over 30 milllion American’s annually, with over $10 billion changing hands each year

The common thread in all of these cases is that the vast majority of the gambling occurs outside of official venues or channels. While the office sports betting pool is a common practice, and generally thought of fondly, it is still illegal. While some states have considered legislation to allow for small-scale office betting on specific events, such as the Super Bowl or March Madness, policy change has yet to be realized. 

In the meantime, it is important to understand that these gambling rings are not yet legal. Employers who turn a blind eye to the practice expose themselves to legal repercussions, and employees should not feel pressured into participating. With specific inquiries contact Rice Law Office, PLLC for a free phone consultation at 603-528-5299 or visit our website for helpful articles and information.

There is growing recognition that mental health plays a large role in workers’ compensation, and that care extending to mental health can help people return to work more quickly. Mental health issues account for nearly a third of all new disability claims in Western countries, and are the leading cause of disability in high-income countries. 

A majority of workers pursuing a workers’ compensation claim will experience depressive symptoms within a year after their injury.  An injury that prevents an employee from going back to work also impacts their family—an injured worker’s family members are three times more likely to be hospitalized in the three months following the work injury.

There are things that you and your employer can do to reduce the risk of a mental health extending your disability.  First, its important to acknowledge that mental health is an important part of the recovery process following a work injury. There should be no stigma for workers seeking treatment if they are suffering from a mental health condition.

Employers can put in place screening processes to identify cases in which an injured worker faces an increased likelihood of a mental health condition, and facilitate access to clinical treatment.  As we understand the impact of mental health care in recovering from a work place injury there is an opportunity to improve the care injured workers receive.

If you have any questions regarding a work related injury that you have suffered you should contact an attorney to understand your rights and protections.  Rice Law Office offers free consultations-- give us a call.

These frequently asked questions are drawn from the New Hampshire Commission for Human Rights. Visit their website for more information.

1. Is a pregnant woman entitled to maternity leave?
   
   

Yes, an employer must grant a female employee leave for the period of time she is physically disabled due to pregnancy, childbirth or related medical conditions.

2. Is there a set period of time for maternity leave?
   
   

No, there is no set period of time for maternity leave. It is based on the period she is disabled as determined by a physician, usually the employee's personal doctor.

Summer intern season is in full swing, and so are wage claim lawsuits from former interns seeking compensation for their unpaid work. We’ve written about this issue previously, however the latest round of lawsuits features some high profile companies and multimillion-dollar settlements for disgruntled former interns.

In the latest case, Grant v. Warner Music Group, two plaintiffs brought a collective action lawsuit for a group of former interns. The plaintiffs maintained that they should have been classified as employees, but were paid nothing or below minimum wage 

Without the work performed by the interns, the plaintiffs allege, Warner would have been forced to hire paid employees. This is a classic determinant of whether interns must be paid for their work, and Warner Music Group agreed to pay a settlement of $4.2 million.

Similar claims against Viacom and NBCUniversal this spring resulted in two settlements in favor of the unpaid interns—Viacom settled for $7.2 million and NBCUniversal for $6.4 million. For more information on when you should pay your interns see our previous post, or DOL Fact Sheet #71, which addresses internship programs under the Fair Labor Standards Act.

Photo courtesy of Wikimedia user Jericho under a Creative Commons Attribution 3.0 Unported License.

Every employer in the country is required to display Family Medical Leave Act (FMLA) forms in a prominent position in the work place, but some employers have been using expired forms since the U. S. Department of Labor (DOL) issued forms expired on February 28, 2015. On May 27^th, the DOL issued a new set of FMLA forms with an expiration date of May 31, 2018 to address the lapse. 

The new FMLA forms are the same as the previous set in every way, except that disclosure language has been added for the Genetic Information Nondiscrimination Act (GINA) indicating that medical providers should not share information regarding an employee’s genetic testing or genetic family history.

The new language has been added to several of the FMLA forms, including WH-380-E, WH-380-F, WH-385, and WH-385-V. The issue of genetic testing is a new one for employers, and will likely become a topic of interest in the years to come. The new disclosure language is meant to provide protection for employers who accidentally receive genetic testing or genetic family history information.

The new forms can all be found on the U.S. DOL’s website, www.dol.gov but are also listed here for your convenience:

• Certification of Health Care Provider for Employee’s Serious Health Condition (WH-380-E)
• Certification of Health Care Provider for Family Member’s Serious Health Condition (WH-380-F)
• Notice of Eligibility and Rights and Responsibilities (WH-381)
• Designation Notice (WH-382)
• Certification of Qualifying Exigency for Military Family Leave (WH-384)
• Certification for Serious Injury or Illness of a Current Servicemember—for Military Family Leave (WH-385)
• Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (WH-385-V)

In the case, EEOC vs. Abercrombie & Fitch Stores, Inc., the Supreme Court found that an applicant for a job at the retail store, who wore her hijab to an interview with Abercrombie & Fitch had engaged in a religious act that afforded her protection from religious discrimination.

The young woman in question, Samantha Elauf, interviewed for a position at Abercrombie & Fitch but was not ultimately hired. During her interview she was wearing a hijab, which would have violated Abercrombie & Fitch’s dress code prohibiting head coverings.

While her interviewer did not specifically ask if the hijab was worn for religious purpose, or whether this would necessitate a workplace accommodation, the company suspected that Elauf’s faith would necessitate wearing the hijab in the workplace. After the interview Ms. Elauf was determined to be a sufficiently qualified candidate, however was turned down for employment, as her hijab would have violated Abercrombie & Fitch’s dress policy.

Ms. Elauf filed suit claiming that the decision not to hire her was a violation of law.  In the initial trial the court sided with Ms. Elauf, and found that Abercrombie & Fitch’s decision constituted religious discrimination. That ruling was overturned in the 10^th Circuit Court of Appeals, leading the Supreme Court to take up the case. Abercrombie & Fitch argued that its policy applied to all hats, and thus was not a decision made on the basis of religion. The Supreme Court, however, found that her wearing of the hijab was a religious act and therefore protected.

Employees in the United States have long enjoyed protection against religious discrimination, but this new Supreme Court ruling extends this protection even further. Under the old standard employers could not make hiring decisions based upon a prospective employee’s religious practice, but the new ruling will provide this protection even in cases where applicants have not indicated that they will require religious accommodation.

There is a long standing, if unspoken, bargain between students seeking work experience and companies looking to identify young talent—internships. Students are given the opportunity to gain hands on experience, as well as a potential “tryout” for full time employment, while employers are given access to low (or no) cost labor as well as the chance to preview young talent for prospective future employment.

This bargain, however, is coming under fire as individuals are successfully challenging their classification as “interns” in the courts. While it is acceptable under the law to provide no pay to an intern, recent court rulings have further specified the types of employees that can be classified as “interns”. Specifically, the Fair Labor Standards Act (FLSA) requires that interns who work in the capacity of a regular employee receive minimum wage and overtime. Failing to meet obligations under FLSA exposes employers to a range of liabilities and legal action.

How, then, do you know when an intern is functioning in the capacity of a regular employee? The distinction can become somewhat difficult to decipher, however there are some general guidelines to follow. Interns shouldn’t be hired into specialized roles that no other employee in the company could fill, nor should an intern replace an employee. The availability of training and mentoring is helpful for distinguishing interns from employees, but the training should be general and not for the immediate benefit of the company.

A defined period with a specific start and end date also helps distinguish internships from employment, and it should be clear that a job is not guaranteed at the end of the internship period. It’s also important that both the employer and intern acknowledge that the position will be unpaid from the outset. Generally, interns are supervised and their work closely reviewed as part of the learning process—this helps distinguish them from paid counterparts.

While these guidelines are useful, there is a growing gray zone between internships and employment, and the Department of Justice is increasingly active in pursuing infractions. From the employer’s perspective, it’s best to consult with counsel on the structure and expectations for unpaid internship programs. For students looking at unpaid internships, consider what you’re being asked to do—it may be that your prospective employer should be paying you to fill that role!

Every year the New Hampshire Department of Labor releases a list of top 10 most common labor law violations. As it turns out, the new list released for 2014 is identical to the 2013 list, however it still provides a good guide as to the common compliance pitfalls in New Hampshire employment. Here’s the list: 

1. Failure to pay all wages due for hours worked, fringe benefits, breaks less than 20 minutes, etc. (RSA 275:43 and Lab 803.01)
2. Failure to keep accurate record of all hours worked. (RSA 279:27 and Lab 803.03)
3. Failure to have a written safety plan, joint loss management committee and safety summary form, of required. (RSA 281-A:64 and Lab 602.02, 602.02, 603.02, and 603.03)
4. Employment of Undocumented Workers Prohibited. (RSA 275-A: 4-a)
5. Failure to secure and maintain workers compensation coverage and misclassification of employees. (RSA 275:42 I & II and RSA 281-A)
6. Failure to provide written notice to employees of their wage rate, pay period, pay day and a description of fringe benefits, including any changes. (RSA 275:49 and Lab 803.03)
7. Failure to pay 2 hours minimum pay at their regular rate of pay on a given day that an employee reports to work at the request of the employer. (RSA 275:43-a and Lab 803.03 h, i, j)
8. Illegal employment of workers under 18 (not having proper paperwork, hours violations, or working in a hazardous environment). *RSA 276-A: and Lab 1000)
9. Illegal deductions from wages. (RSA 275:48 and Lab 803.03 b, e, f)
10. Failure to pay minimum wage for all hours worked. (RSA 279:21)

The proliferation of social media has now extended into the business world. It is common practice for corporations to connect with consumers through Facebook, Twitter, and other cyber-media channels.   While social media represents the most modern form of promotion and advertising, its explosive growth has left employers and employees with many heretofore unimagined policy challenges.   If an employee has accrued many followers or friends while posting on behalf of the company, what happens to the account after the employee leaves the company?  If an employee has a social media presence on behalf of the company, how can the company manage the content posted by the employee? In order to enjoy the advantages of modern social media channels, corporations need to be prepared with equally modern policy.  Here’s a quick introduction to handling social media related policy challenges:

• Specify that the social media account belongs to the company, and that upon termination of employment the employee forfeits al l access to the account.
• Passwords are considered confidential proprietary information.  Be clear that passwords cannot be changed without explicit direction to do so.
• Corporate policy restricting the content employees may post on social media sites must be carefully framed.  It is ok to protect confidential information,but recent National Labor Relations Board(NLRB) guidance memos indicate that too much restriction may constitute a violation of employees’ right to discuss terms and conditions of employment.
• A prospective house bill would prohibit employers from requiring current and prospective employees to disclose social media passwords.
• Social media offers the opportunity for corporations to connect with consumers and the public on an individual basis, and is particularly effective in targeting the young and computer literate demographic.  While each company is unique, a social media presence is a logical practice is this digital age. 
• If you have questions about your company’s policies, contact Rice Law Office today.

Internal investigations are always sensitive matters, and in many cases employers will request that employees maintain confidentiality regarding the ongoing process.  However,not all policies of this nature are lawful. In 2012 the National Labor Relations Board (NLRB) found that some confidentiality policies constituted a violation of employee’s Section 7 rights.  The landmark case involved Banner Health’s policy of prohibiting employees from discussing any detail of an internal investigation with their coworkers.  The NLRB determined that there must be a “legitimate business justification that outweighs employees’ Section 7 rights” in order for such a policy to be lawful.

It is hard to say when business interests outweigh employees’ rights, and judgment regarding the validity of confidentiality policy will certainly be on an ad hoc basis.  However, the NLRB has released a set of guidelines under which confidentiality policy for internal investigations maybe valid. These include circumstances under which:

• Witnesses need protection
• Evidence is in danger of being destroyed
• Testimony is in danger of being fabricated
• There is need to prevent a cover up

There is a further a distinction which allows employers to request confidentiality, although they may not require it.  In all circumstances, internal investigations require careful and appropriate handling on the part of the employer so as not to violate employee rights. If you are uncertain or uncomfortable with the requirements of your employer during an ongoing internal investigation, you should not hesitate to contact legal assistance.