Welcome to the Law Office of Cavey & Barrett's Official Blog where you will find useful information about Florida Disability and Social Security Claims.
We care and make it a point to blog about the disabled and we are passionate about the issues that affect those who are applying or waiting for claims in Social Security Disability, Veterans' Disability Compensation, and Long-Term Disability Insurance benefits. We do our very best to blog about important topics such as advances in the various disability claims processes, advances in medicine, upgrades to the various disability benefits programs, anything to do with social security and other areas of disability.
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Long term disability carriers, like ETNA Life Insurance Company are in the business of collecting premium and not paying benefits. In the case of Capone vs. ETNA Life Insurance Company, 22 Florida Law Weekly Fed C368 cited as 592f3d1189 (11th Circuit 2010), Mr. Capone sustained an injury to his spine when he dove head first into the ocean after witnessing others doing so. ETNA denied the claim on the basis that “alcohol had necessarily caused or contributed to the employees injury”.
In the great decision, the 11th Circuit took ETNA to task for the policy language that “accident” means.
The court held that the cause in the policy providing coverage for bodily injury “cause by accident” could be interpreted as providing coverage of injuries caused by “accidental means”. Accidental means are injuries that are a result of an unforeseen act, involuntarily or unintentionally done and not from injuries, which, while expected, rose from a conscious voluntary act without any intervening circumstances. Since Mr. Capone has witnessed others diving off the dock with no problem, the court held that his injury met the accidental means standard.
If your claim for benefits have been denied by a carrier like ETNA Life Insurance Company, contact ETNA claims denied attorney Nancy Cavey.
If your employer is dropping your short term disability coverage, you may want to read this article. Learn about your Short Term Disability coverage and how the economy has effected it.
Nancy Cavey, ERISA Long Term Disability attorney who practices nation wide, knows that groups like dental hygienists or doctors are professional organizations who may offer disability policies to their members. Questions do arise about whether or not a disability policy offered through a professional association that offers a group discount are individual policies not subject to ERISA.
Can you and your family survive on 60% or less of your current income? Probably not. I suggest that you buy a supplemental private disability insurance policy. Protecting yourself is key to avoiding serious debt if you become disabled and these benefits are generally not taxable and the carriers are more likely to pay your disability benefits without a fight.
There are many stumbling rocks in the disability process. Before a medical professional considers filing a claim for disability benefits, there is help available. You have a difficult decision to make about whether and when to apply for disability benefits and how to maintain your practice as you move through the disability process.
Most americans work but do not prepare for illness or injury according to Business Wire. The risk of having a work related injury is 3 out of 10. Disability insurance can be risk when dealing with a long term or short term disability policy.
LaShondrea Tucker and employee of a Essex County, N.J., insurance company was sentenced to 364 days in jail in connection with her role in a three-person scheme to steal more than $94,100 by filing fraudulent disability insurance claims.
A man in Canada who became a disabled paraplegic after contracting herpes from unprotected sex lost a $200,000 disability award Friday when the Supreme Court of Canada sided with his insurance company in a ruling that concluded that his misfortune, while tragic and unexpected, was not an accident.
Are you a disabled veteran who has applied for Social Security Disability benefits? You can get both Social Security Disability and Veterans' benefits. There is nothing that stops you from getting two federal disability checks from two separate federal agencies. Think about it: medical records are the basis of your claim for both Social Security Disability and Veterans' benefits. Make sure that both the Disability Examiner or your VA and Social Security Disability Claims Examiner are aware of all of your medical treatment, including your military treatment, names of your doctors and addresses of your providers. That will make it easier for your records to be gathered by both the Social Security Administration and the Veterans Administration.
You can speed up the approval of both disability claims by making sure that both the Social Security Administration and the Veterans Administration are aware of all of the medical treatment you're receiving.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
If you're applying for SSI disability benefits and your spouse works, this may prevent you from getting SSI. If you get SSI, the amount earned by your spouse can potentially reduce the amount of your check.
However, if you're applying for Social Security Disability benefits (SSDI), then your spouse's earnings have no effect on your claim. It won't impact your eligibility to apply for disability benefits, to get disability benefits or have any impact on the amount of your benefits.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
To be eligible to file an application for Social Security Disability benefits you have to be insured. What? Now, I know that you haven't completed a disability application or paid a premium, so what do I mean by being insured?
The payroll deduction that your employer makes into the Social Security system is how you become insured. You have to be in the workforce for 20 out of 40 quarters to be insured.
If you have a gap in your work history because of illness, you may have lost your insured status for Social Security Disability, or you may simply have never worked.
If that's the case, the Social Security office will take an SSI disability application. What's that? SSI covers individuals who aren't eligible for Social Security Disability and don't have assets in excess of $2,000.
To be eligible for SSI, you must have a physical or mental impairment (or both) that:
(1) is considered severe;
(2) lasts for at least 12 months, or is anticipated to last that long based on your medical records;
(3) prevents you from working at the lightest job you held in the last 15 years;
(4) prevents you from performing suitable other work based on your age, education, work skills, and physical or mental limitations.
If you are not insured for Social Security Disability purposes, you may still be eligible for SSI.
At Cavey & Barrett we can help you determine whether or not you meet the criteria to be insured for Social Security Disability.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
You have three choices: you can give up, file a brand new Social Security Disability application, or you can file an appeal.
I'm a fan of Winston Churchill, and my motto is "Never give up!"
You have to understand that most initial disability applications are denied and, in fact, are also denied a second time at the "request for reconsideration" stage.
Your chances of winning at the disability hearing stage level rise significantly, particularly if you have attorney representation.
We rarely contemplate having you start over with a new application and only suggest it if there is some technical reason for your denial. At Cavey & Barrett we can analyze the basis for the denial and help you decide whether or not you should appeal or file a new claim for disability application.
Of course, at Cavey & Barrett we find that the best course of action is normally to file a timely appeal. In fact, we suggest that you file it as soon as possible.
At Cavey & Barrett we can help you with the appeal process and, in particular, help you fill out the disability claim forms to make sure that you have properly explained your functional limitations and the difficulties that you have. Never give up on your claim!
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
At Cavey & Barrett we find that most disability claimants who have been denied Social Security Disability should appeal their disability denial instead of filing a new disability application.
As we've explained, it's in a claimant's best interest to move your case to the disability hearing stage. Unfortunately, there are hoops that you have to jump through before you get to that administrative law judge. You first have to have your disability application denied, file a request for reconsideration, be denied, request a disability hearing, and finally (at long last) get in front of the administrative law judge where your chances of winning are significantly increased.
Every time you file a new disability application you start all over again and stop your progression through the disability appeal process.
This isn't to say that there aren't situations where you may want to start with a new application instead of appealing. For example, you may have been denied because you were still working or you've earned too much to be considered as being disabled. In that situation, it would make little sense to file a disability appeal but rather file a new application once you've stopped working.
At Cavey & Barrett we find that every situation is unique but that generally the best course of action is to file an appeal.
Sharon Barrett can provide you with expert legal advice on your Social Security denial and whether you should file a new application.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
Absolutely. Your notice of denial will provide you information regarding how you go about filing an appeal.
There are some things that you need to be aware of:
(1) The majority of Social Security Disability claims are denied. Nationally, about seven out of 10 initial claims are denied and eight out of 10 requests for reconsideration are denied. In Florida, the denial rate is approximately 64.9 percent;
(2) A large percentage of Social Security Disability claimants who are denied and who decide to appeal are eventually approved for benefits. Follow Winston Churchill's famous statement, "Never give up!"
(3) At each step of the disability evaluation process, you have the right to file an appeal if you've been denied. At Cavey & Barrett, we can assist you with filing the necessary paperwork and make sure that your appeal is timely filed;
(4) The disability appeal has to be filed within 60 days of the date of the denial. Unfortunately, Social Security Administration is rather strict about holding you to that 60-day timeline;
(5) The first appeal takes about 60 to 90 days, and you should expect to be denied;
(6) The request for reconsideration also takes about 60 to 90 days and you should expect to be denied once again;
(7) At the next stage, you can file a request for a hearing and, unfortunately, it will take 24 to 26 months to get a hearing. There are cases in which Cavey & Barrett may be able to get a request for a hearing put on a quicker basis if you qualify for a compassionate allowance.
Remember to appeal, appeal, appeal. Your best chances of obtaining Social Security Disability benefits are before the administrative law judge.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
Yes! Many Social Security Disability applicants have medical conditions that get worse, get better, get worse, get better... This cycle can keep on repeating itself and is found in situations like fibromyalgia, back problems, lupus, MS, and depression.
Because your condition may get better and worse, some disability applicants should really think twice about giving up their claim, even when it seems their condition might be improving.
If your condition is improving and you choose not to file an appeal on a claim within the 60-day appeal period, you'll be forced to start over with a brand new application, which will cause you to start all over again, getting back in line.
Because it takes so long to get a hearing in front of an administrative law judge, we rarely recommend that Social Security Disability applicants stop pursuing their Social Security Disability claim. You never know what your physical or mental condition might be like by the time you get in front of the administrative law judge.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
The second step in the Social Security Disability evaluation process is filing a request for reconsideration. There are some secrets that you need to know:
(1) when you file your request for reconsideration, provide updated information regarding any visits you've made to doctors, hospitals, and clinics since you filed your initial application together with the addresses of those medical providers;
(2) If you have the most recent medical records, submit them with your request for reconsideration. Why? Your request for reconsideration can be held up while the office of disability determinations waits for your updated medical records. However, keep a copy of your request for reconsideration and the medical records that you have submitted. Send this information to the Social Security Administration by certified mail, return receipt requested;
(3) Keep a copy of your original disability application and review it when you submit your request for reconsideration. Why? Unfortunately, Social Security Disability applicants will sometimes leave off the names and addresses of medical providers or even forget physical or mental conditions for which they have been treated. If you have forgotten something, you want to include that information on your reconsideration appeal;
(4) Consult with Cavey & Barrett before you turn in your request for reconsideration. You have sixty (60) days to file your request for reconsideration, and every day you wait adds more time to the process. Schedule an appointment with Cavey & Barrett so they can review your initial Social Security Disability application, the denial letter you received from the Social Security Administration, and help you properly prepare and timely submit your request for reconsideration.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
The answer depends on you and your needs. We find that some claimants benefit from having representation at Cavey & Barrett from the very beginning, so that they understand the Social Security Disability claims process and get assistance in filling out their initial application. Others find that Cavey & Barrett assists them in avoiding missed deadlines and having to avoid the stress of dealing with the Social Security Administration.
More often than not, Social Security Disability applicants come to Cavey & Barrett after their initial application has been denied. While we are more than happy to represent you at any stage in the Social Security proceedings; we think that getting an attorney after the first denial is crucial in advancing your claim to the hearing stage.
At Cavey & Barrett, we think that waiting to get representation until just before your Social Security hearing is tempting fate. Why? During the course of your claim, Cavey & Barrett make sure that the Social Security Administration receives your ongoing medical records and is kept up to date with your medical treatment. We prepare a brief for the court prior to the hearing, setting forth the reasons why your claim should be accepted and, of course, if we have to go to a hearing, we prepare your court hearing. Waiting untill the last minute doesn't help anyone prepare for your big day in front of the administrative law judge.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
People who apply for Social Security Disability benefits are in a different position from those who are already getting Social Security Disability benefits. If you are receiving Social Security Disability benefits and are working on a trial work period, you can only work nine (9) months in a 5-year period and earn $960 per month.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
Have you read your long-term disability policy? Does it provide that future benefits can be withheld to recover any overpayment arising from a retroactive payment of benefits such as Social Security Disability benefits?
In the case of White v. Coca Cola Corporation, the United States District Court for the Northern District of Georgia upheld a provision in Coca Cola's long-term disability plan that allowed Coca Cola to withhold future benefits to recover a retroactive payment of Social Security benefits in the amount of $38,124.90 that Mr. White received.
They reduced Mr. White's payments for 60 months to recover the overpayment, and he appealed. The court agreed with Coca Cola and found that they were entitled to reduce future long-term disability benefits because of the lump sum payment of Social Security benefits.
At Cavey & Barrett we can assist you in reviewing your long-term disability policy to determine whether or not your long-term disability carrier is entitled to recoup any overpayment for Social Security benefits.
At Cavey & Barrett it's not uncommon for long-term disability applicants to come to our office with a letter from their employer about continuing their healthcare coverage through COBRA.
Federal law requires employers with 20 or more employees to provide COBRA healthcare continuation coverage, and there are specific time limits for choosing this coverage.
Unfortunately, many long-term disability applicants are also applying for Social Security Disability benefits and are in need of medical treatment. They have not become Medicare eligible and are facing a gap in their health insurance coverage.
While there is no one-size-fits-all answer, there are considerations that each long-term disability applicant should consider in making the difficult decision about continued COBRA coverage or alternative coverage:
1. Are you eligible for COBRA?
2. Do you have any dependents who have medical problems which require ongoing medical treatment?
3. Do you have coverage available to you under a spouse's employer?
4. Where are you with the Social Security Disability process? COBRA generally allows you and your dependants to keep group health coverage for 18 months after your employment ends.
There is an additional 11-month extension available when qualified beneficiaries are determined by the Social Security Administration to be disabled. This would provide 29 months of healthcare coverage.
You become eligible for Medicare 24 months from the SSA determined date of award.
5. Have you been awarded SSDI, and do you have dependants? If all of the qualified beneficiaries in your family are disabled and meet the SSDI eligibility requirements, all the qualified beneficiaries in the family are entitled to an 11-month extension of the general 18-month COBRA coverage. This will provide 29 months of COBRA coverage.
6. What will your COBRA coverage cost? You will have to talk to your Human Resources Department to determine how much COBRA coverage will cost.
Generally the first 18 months of coverage can cost as much as 102 percent of the cost of the plan of those who are still employed.
7. What do you anticipate your medical needs to be in the next 18 months?
At Cavey & Barrett we suggest that you estimate what medical treatment you are going to require in the next 18 months and what it would cost without insurance? Look at your deductibles and estimate the cost of medication, diagnostic testing, and hospitalization.
If you are facing significant medical treatment, it may be wiser to pay the higher COBRA premium so that you can get the medical treatment you need.
8. What would be the cost of any COBRA premium increases? If you get the 11-month disability extension, the premium for those 11 months may go up to 150 percent of the plan's total cost.
9. Have you priced any individual health plans?
You have 60 days to make the COBRA election.
At Cavey & Barrett we provide our long-term disability/ERISA clients with advice as to their COBRA and insurance options. We will help you determine your insurance costs under COBRA, the medical benefits you might require in the future and alternative medical care sources.
At Cavey & Barrett we can also refer you to lower cost healthcare options such as Drug Company and state pharmaceutical assistance programs, various government programs such as Medicaid, Veterans' Assistance and State and Local Health Services.
The decision that you make regarding your medical care is not only financial but one that will impact your health as you are trying to deal with your disabling condition and recover.
At Cavey & Barrett we assist our Long-Term Disability/ERISA clients in dealing with the challenges they confront in the disability claims process.
These questions include:
(1) What are my benefits when I'm going to start working?
(2) How do I file for Social Security?
(3) Should I COBRA my health coverage?
(4) Do I have alternative sources of healthcare?
(5) How do I make the health insurance gap between my Medicare eligibility and the loss of my healthcare?
For assistance with these questions and your long-term disability or Social Security Disability application, contact Cavey & Barrett, your Social Security Disability and Long-term Disability experts.
At Cavey & Barrett we are seeing a "slow pace strategy" by long-term disability carriers. We have found that carriers aren't "receiving paperwork," asking for the same information over and over, suggesting that they need information, indicating that there is a delay in getting information from physicians. These are all delay tactics that the carriers are using to delay payment to you.
With stock prices down and a lack of investment income earnings, disability insurance companies are taking longer to determine disability claims and to pay long-term disability benefits.
If you are experiencing any of these problems with your long-term disability or ERISA carrier, immediately contact Nancy Cavey at Cavey & Barrett to assist you in your long-term disability claim. There are things that can be done to expedite the handling of your long-term disability or ERISA claim. Remember, long-term disability insurance companies think that they can outlast long-term disability claimants. Our advice and counsel help you understand what your carrier is doing and help you prepare yourself financially.
It is important that medical professionals understand their long-term disability policy so they can prevent the disaster of being disabled and being unable to recover the benefits they deserve.
Did you know that there are three types of disability policies? Do you know which kind you have?
The first is an individual disability policy, which you may have purchased directly from a carrier and which provides you long-term disability benefits in the event of sickness or injury.
Do you know that there are two types of individual policies? The first is a general policy that insures you against being disabled and being able to perform all work, while an "occupational" policy provides you disability benefits if you can't perform the material and substantial duties of your own occupation. Obviously, an occupational policy will provide greater coverage to a medical professional who would be entitled to these benefits even if they were able to engage in another occupation.
The second type of long-term disability policy is a group policy which is made payable to the participants of professional associations or medical practices. Group policies provide benefits based on a percentage of your base salary. These benefits normally pay 50-75 percent of the base salary and limit the maximum amount of benefits you are entitled to per month, regardless of your base income. It is not uncommon for these group policies to reduce benefits when you receive income from other sources such as Social Security Disability, Workers' Compensation, or even a 401K distribution.
Employer sponsored disability policies are typically the least expensive policies and provide employees with disability insurance based upon a percentage of the base salary as part of the employer's overall benefit package.
Unfortunately, group and employer sponsored policies are governed by the Employer Retirement Income Security Act of 1974 (ERISA). For a lot of ERISA attorneys, that acronym is named: "Everything Ridiculous Since Adam." ERISA deprives medical professionals the right to a trial by jury, the possibility of punitive damages, and it significantly affects your administrative and litigation rights.
The most an aggrieved medical professional can recover in an ERISA lawsuit is the amount of the benefits due, the interest cost and a discretionary award of fees.
There have been rulings by the court that disability claims brought by business partners or even sole shareholders of organizations who purchased individual insurance coverage, the owner of the business is covered by ERISA.
Unfortunately, at the time disability policies are sold to organizations, one of the primary factors is whether the applicant is interested in tax savings or coverage. Unfortunately, most organizations will opt for the least expensive policy that is taxable rather than for expanded coverage.
ERISA policies have a number of disadvantages. These will require you to have an administrative appeal before you can sue. If the plan provides the administrator with the discretion to determine the claim, courts generally overturn that decision if the administrator has acted arbitrarily and capriciously. So long as the record reflects a rational basis for the decision despite overwhelming evidence, the court will uphold the decision.
Unfortunately, the court is limited to reviewing the evidence that was in the file at the time the administrator made the decision. As a result, you can't offer additional documentation or even testify in front of a judge.
Despite these disadvantages, medical professionals are not doomed to having their claims denied. It is important that a medical professional consult with an attorney before filing a claim so that you understand the definition of disability, or if what is covered under base earnings can provide you with an opportunity to get your medical and financial house in order, develop supporting medical evidence before you file your claim for disability benefits.
Disability insurance companies do target high-end policies issued to medical professionals for denial or termination with the hope that ERISA will limit their exposure.
Don't make yourself a target for claims denial. Contact the law office of Cavey & Barrett to assist you in reviewing your disability policy, to assist you in your pre-claim filing preparation, and to assist you in reversing denials of disability claims.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
Unfortunately, it's not uncommon for the long-term disability insurance company to use the medical release which you signed to communicate directly with your treating physicians without notice to you. They will also tell your treating physician their version of your medical condition and your policy terms in an attempt to get the physician to release you to some form of employment.
In the case of Safon v. Wells Fargo & Company, Long-term Disability Plan, 522 F.3d 863 (9th Cir. 2008), The court noted that the ERISA regulations call for a "meaningful dialogue" between the claims administrator and the beneficiary. The court held that direct contact with a treating physician without informing the long-term disability claimant was a direct violation of the ERISA fiduciary duty to communicate.
The court noted that Met Life seemed to have "disregarded this responsibility in various ways - the opacity of its communications with Safon, the fact they communicated directly with her doctors without advising her of the communication, and the fact that it took various of her doctors' statements out of context or otherwise distorted them in an apparent effort to support a denial of benefits."
The Safon court imposed a rule that if a claims administrator communicates with a treating physician, it must disclose that fact "to the patient at a meaningful time."
At Cavey & Barrett, we routinely advise long-term disability carriers that the medical releases that they have obtained from you are now void. And we also contact the treating physicians and advise them under no circumstances to speak with or communicate with your long-term disability carrier. For these very reasons, we want all communications with you and your treating physician to come through our office so that we can make sure that the information that is being provided to the long-term disability carrier support your claim and that it is accurate.
Nancy Cavey, an experienced long-term disability/ERISA attorney based in Pinelas and Hillsboro counties, Florida, helps you navigate the long-term disability maze.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
Nancy Cavey, Hillsboro and Pinelas Counties disability insurance company lawyer, suggests that longer-term disability applicants call and:
(1) get a copy of their policy;
(2) read the policy and the directions for filing their claim and follow every step;
(3) make a copy of everything you send to the disability carrier;
(4) send everything to the long-term disability carrier with return receipt request to prove that you sent the material;
(5) if you speak with the adjuster, which Nancy Cavey does not suggest you do, document every telephone conversation;
(6) if you have a high monthly benefit policy, be prepared for surveillance. The disability insurance company will hire an investigator to videotape you;
(7) consider consulting Nancy Cavey to assist you through the disability claims application process. Nancy can assist you before you file, during and after the claim has been filed;
(8) remember that disability insurance companies review files on an ongoing basis. Simply being paid does not mean that your benefits will continue. If your checks start coming late or stop, contact Cavey & Barrett for assistance in protecting your rights to the long-term disability benefits you paid for to protect your family.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.
We represent clients all over Florida including: Tampa, St. Petersburg, Sarasota, Bradenton, Venice, Ft. Myers, Naples, Orlando, Lakeland, Gainesville, Daytona, West Palm Beach, Ft. Lauderdale, Miami, Miami Beach, Jacksonville, Tallahassee, New Port Richey, Hudson, Safety Harbor, Largo, Palm Harbor, Port Richey, Clearwater, Indian Rocks Beach, Dunedin, Spring Hill, Brooksville, and all other cities in Florida.
If you or someone you know has been effected by a hour and wage claim, disability or social security claim in Florida, do not hesitate to Contact Us before you speak with an insurance company. There is no obligation to hire a lawyer and the consultation is FREE.