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    Robbed of Your Peace of Mind? Your Guide to Long Term Disability Benefits

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    The Key To Hiring The Right Long Term Disability Attorney

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    The Smart Long Term Disability Guide For Preparing Your Statement and Field Visit

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  • Social Security Disability Guide

    Your Rights To Social Security Disability Benefits - Your Guide to Getting Benefits Now

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Category Archives: Blog

What Does The Term “Disability” Mean In My Disability?

what does disability mean

There is no uniform definition of disability. You have to get your policy and review it closely. Disability is one of the most litigated policy terms because when you file a claim for disability, the insurer has to determine if you’re disabled based on the definition of disability within the policy.

what does disability mean

What are all the Various Types of Disability Policies?

There are “Own Occupation” disability policies which will pay a policy holder if they’re unable to engage in his or her own occupation.

Other policies are known as “Any Occupation” policies that pay if you’re unable to engage in any occupation but you’re reasonably suited to buy your training or experience. There are also policies that will pay benefits in comparison to your financial earnings prior to your date of disability and your income after you become disabled. You might be unable to perform duties of any occupation but if you don’t suffer a loss of income, you may not qualify for benefits.

What You Should do if you are Thinking About Applying for Benefits

If you have any questions about the terms of your disability policy and you’re thinking about applying for benefits, it’s time to contact Private Disability attorney Nancy Cavey, who can help you understand the terms of your policy and pick the right date to become disabled. Contact her today at 727-894-3188.

More Bad News About The Delay In Social Security Hearings

social security disability hearing delays

The time for Social Security Disability hearings gets longer.

The Social Security Administration doesn’t always make it easy for those who are disabled to get the Social Security benefits they deserve. It’s not uncommon for initial applications, and even requests for reconsiderations, to be denied and, as a result, the Social Security Disability applicant has to file a Request for a Hearing.

social security disability hearing delays

What’s a Request for a Hearing?

A Request for a Hearing asks that the case to be transferred to a Social Security Disability Administrative Law Judge to have a hearing on an applicant’s right to Social Security Disability benefits. At the end of fiscal year 2012, the average processing time was 353 days and, by the end of September 2014, it was over 454 days. The amount of pending cases has increased every month in 2014 and went over the one million mark by the end of November 2014. Clearly, justice delayed is justice denied!

What Else do the Statistics Show?

The number of Social Security judges has declined from 1,366 as of March of 2013 to 1,264 in November of 2014. That’s 100 fewer judges doing cases. Worse yet, the number of ALJ dispositions has dropped steadily from a high of 783,061 in 2012 to a low of 679,091 in 2014.

Unfortunately, the number of cases that are being denied at the ALJ level is also increasing.

We urge Congress to appropriate more funds or more administrative law judges and an increase use of senior attorney advisers to assist the judges in making decisions.

Need Help With Your Social Security Disability Case?

The Law Office of Nancy L. Cavey can help you with your Social Security disability questions and concerns. Give us a call today at 727-894-3188 to talk about your options!

Article sited from ALJ Hearing Processing Times and Pending Claims: The Statistics Tell All, December 2014, Volume 36, Number 11.

Do I Have To Cooperate During A Functional Capacity Evaluation In A Long Term Disability Claim?

FCE and IME disability long term disability

Disability policies generally require policy holders who apply for disability benefits to undergo an Independent Medical Evaluation or even a Functional Capacity Evaluation. If your policy allows for these and you’ve been requested to undergo such an examination, you have the duty to cooperate.

FCE and IME disability long term disability

What Happens if you Refuse to Perform Tasks Requested or Don’t try Hard Enough During the FCE?

Your claim can potentially be denied for “lack of cooperation.” In the case of Ortega-Candelaria v. Johnson & Johnson, 2014 WL 2696725 (1st Cir. June 16, 2014), Mr. Ortega-Candelaria applied for disability benefits and was asked to undergo a Functional Capacity Evaluation.

He refused to do lifting, carrying, pushing, pulling and climbing during the FCE and didn’t give his best efforts on tasks. Johnson & Johnson’s Plan discontinued his benefits, based on a lack of cooperation. The trial court ruled against him finding that the Plan terms required him to cooperate. Without such cooperation, Johnson & Johnson could legally reduce or terminate his benefits.

What Should I do if I’m Scheduled for an IME or an FCE?

You should immediately contact Long Term Disability attorney Nancy Cavey, who can explain to you your rights and obligations under your disability policy, what steps can be taken to safeguard the legitimacy of the evaluation, and how to be properly prepared for an IME or an FCE.

Remember, the IME or FCE is scheduled but for one purpose. That’s to deny your benefits! You need to protect yourself before your claim is denied. Call today at 727-894-3188.

What You Need To Know About A.L.S. And Your Claim For Long Term Disability Benefits

als long term disability

You may have purchased a long term disability policy through your employer, or on your own, to provide you and your family peace of mind if you became disabled. Unfortunately, long term disability carriers don=t always make it easy for those with Amyotrophic Lateral Sclerosis (ALS) to get the disability benefits they deserve.

ALS has gotten a lot of news lately because of the ALS ice bucket challenge.

als long term disability

Recent Epidemiological Studies About A.L.S.

Many Americans connect ALS. with athletes and sports because Lou Gehrig, the great Yankees first baseman, died of ALS. A recent epidemiological study revealed that physical activity, work, sports or exercise did not increase a person=s risk of developing ALS. In fact, the study showed that exercise appeared to offer some protection against the disease.

One interesting result of the study showed that a history of multiple hits to the head increased the risk of developing ALS.

Research revealed that men and women who had had at least two concussions, or other serious head injuries, were much more likely than other people to develop ALS. This finding is consistent with the results of a study in the European Journal of Epidemiology.

Getting The Benefits You Deserve as a Result of ALS

ALS is a progressive and fatal neurodegenerative disease. If you=ve been diagnosed with ALS, it=s time to make the difficult decision to apply for disability benefits. Before you do so, you should take the following steps:

1. Obtain your medical records and review them, making sure that there is an objective basis for the diagnosis;

2. Review what your physicians have had to say about the basis of your restrictions and limitations and any objective basis of those restrictions and limitations; and

3. Make sure that your doctor supports your claim.

Before you make a mistake that can destroy your claim, contact ALS Disability attorney Nancy Cavey, who can help you get the disability benefits you and your family deserve.

Article Cites to New York Times of Tuesday, September 9, 2014, Well Section.

 

What Sort Of Medical Treatment Will Trigger A Pre-Existing Condition Exclusion In An Erisa Governed Disability Plan?

pre existing disability ERISA

Many disability plans will have a pre-existing condition clause that prohibit the payment of LTD benefits, if you received medical treatment for a specific period of time before the start of the disability.

For example, in the case of Kutten v. Sun Life

Assurance company of Canada, 2014 WL 3562784 (8th Cir. July 21, 2014), Kutten’s ERISA long term disability policy had a pre-existing condition exclusion clause.

The policy defined a pre-existing condition as one in which the employee “received medical treatment, care or services, or took prescribed drugs or medication for the disabling condition 3 months before the start of the policy.

pre existing disability ERISA

What is Medical Treatment?

Kutten had a progressive eye disease. In 1994, his doctor told him to start taking an over-the-counter Vitamin A supplement. This supplement couldn’t cure the disease, but slowed the disease.

When Kutten applied for disability benefits, Sun Life determined that the Vitamin A supplements triggered the pre-existing exclusion clause as medical treatment.

The court in this 8th Circuit decision found that a Vitamin A supplement was not “medical treatment” because the “use of the supplement didn’t require the same medical intervention as prescribed drugs and medicines.” The court noted that the supplements were medical “in the sense they prevented or alleviated the progression of” the disease.

The appellate court reversed the decision, saying that the ordinary meaning of the phrase, “medical treatment,” encompassed the use of supplements.

What Should I do if I’m Thinking About Applying for Disability Benefits?

Get out your disability policy! You need to review the pre-existing disability clause and determine whether you have received treatment that would disqualify you for benefits. If you have, timing may be the key so that you don’t receive medical treatment, care or services in the applicable period of time that would disqualify you for benefits.

It’s time for you to contact a Disability attorney, like Nancy Cavey, who can help you make the difficult decision about whether to apply for long term disability benefits and when you should apply for benefits.

She can help you, regardless of where you live in the United States. Call today at 727-894-3188.

Am I Entitled To Attorneys Fees At The Expense Of The Disability Carrier If They Paid Benefits After A Lawsuit Is Filed?

attorney fees long term disability carrier

If you purchased your disability policy through your employer, your policy is covered under the ERISA law. The disability carrier has the discretion to pay your benefits and, many times, will improperly deny legitimate disability claims. Sometimes filing a lawsuit is what it takes to get your benefits granted.

attorney fees long term disability carrier

What about Attorneys Fees?

In ERISA cases, a court may, in its discretion, award attorneys fees if the parties achieve “some degree of success on the merits.”

Is the Mere Filing of a Lawsuit After a Plaintiff Files an ERISA-governed Disability Benefit Claim Sufficient to win an Award of Attorneys Fees?

It depends on where you live In the case of Koloff v. MetLife Ins. Co., 2014 WL 3420990 (E. D. Cal. July 14, 2014), Koloff asked for disability benefits and filed a law suit. The court dismissed the case because Koloff had failed to exhaust administrative remedies by allowing the carrier, MetLife, to make a decision. The court held in Koloff that a claimant doesn’t satisfy the requirement of “some degree of success on the merits” by achieving a “trivial success on the merits” or a “purely procedural victory.”

How About the Argument that the Law Suit was the Catalyst for Payment?

There is some case law support for what’s called “catalyst theory” for seeking attorney fees. The facts have to demonstrate that the law suit was a catalyst or linked to the decision to approve benefits. That will require discovery on the part of your attorney. The filing of the law suit is the key to getting you your benefits.

How will I Learn More About my Rights to Disability Benefits?

You can contact Long Term Disability attorney Nancy Cavey, who can help you get the disability benefits you deserve, regardless of where you live in the United States. Call today at 727-894-3188 for more information.

What Every LTD Policy Holder Needs To Know About Overpayment Of Benefits

ltd policy overpayment benefits

Many long term disability policies have a policy provision that reduces the amount of long term disability benefits by “other income.” If a long term disability carrier begins making disability payments, they will offer the policy holder the option to:

1. Reduce the amount of disability benefits by an estimated amount of deductible benefits, or

2. Allow the policy holder to elect to receive full payments, without reduction, in exchange for an agreement to notify the carrier of the receipt of other income benefits and to repay any overpayment incurred, as a result of receiving other benefits.

ltd policy overpayment benefits

What Happens When the Policy Holder Ignores Their Agreement to Repay any Overpayment?

In the case of Unum Life Insurance Company v. Pawloski, 2014 WL 6686327, Mr. Pawloski learned the hard way what happens when he ignored the agreement he signed to repay Unum an overpayment.

Mr. Pawloski began receiving long term disability benefits and Workers’ Compensation benefits, which were defined as “other income” in the disability policy. Unum paid Mr. Pawloski unreduced benefits and, ultimately, he settled his Workers’ Compensation case.

Unum made a number of fruitless efforts to obtain the details of Mr. Pawloski’s Workers’ Compensation settlement. Unum, ultimately learned that he had settled his case for $150,000 with $70,000 set aside for Medicare. The settlement was backdated and covered the same period of time that Mr. Pawloski had received unreduced benefits from Unum.

Unum, also made repeated attempts to get Mr. Pawloski to repay the overpayment. After Mr. Pawloski failed to respond, Unum filed a law suit in federal court against Mr. Pawloski seeking payment of repayment of the overpayment, together with attorney’s fees.

Federal District Judge Honeywell noted that 29 U.S.C. §(a)(3) provided that a civil action could be brought by Unum “to obtain the appropriate equitable relief … to enforce … the terms of the plan.” The judge found that:

1. Unum was a fiduciary under the ERISA plan which was entitled to enforce the terms of its policy,

2. That the Workers’ Compensation settlement was a source of money that Unum was entitled to as a deductible source of income,

3. Mr. Pawloski agreed to reimburse Unum,

4. He neglected to repay, and

5. An equitable lien was created in the amount of the overpayment as soon as Mr. Pawloski received the Workers’ Compensation settlement.

Mr. Pawloski suggested, in his defense, that he had already used or spent the specific sum he received in his Workers’ Compensation settlement and, therefore, he was not obligated to repay Unum.

Judge Honeywell rejected that argument suggesting that to allow Mr. Pawloski to spend all the money he received, knowing he violated the terms of his contract, “set a dangerous precedent.”

As a result, Judge Honeywell ordered Mr. Pawloski to pay $49,187.58 back to Unum without interest.

The Lesson Learned!

The Federal judges will enforce the overpayment provisions of long term disability contracts. Get out your policy and determine what “other income” means, so that you can plan to repay the disability carrier if you receive other income benefits, like Social Security Disability benefits for you or your family, Workers’ Compensation benefits, or even a settlement of any personal injury claims.

What You Should do Today!

You can learn more about reimbursement issues by contacting Long Term Disability Reimbursement of Overpayment attorney Nancy Cavey at 727- 894-3188.

What Is Overpayment Of Long Term Disability Benefits?

overpayment long term disability benefits

Many long term disability policies will deduct from your disability benefits any money you might receive for:

• Social Security Disability benefits,
• Dependent benefits,
• Workers’ Compensation, or
• Proceeds of a third party settlement arising out of an accident.

Many policies will provide the policy holder to either receive the full amount of benefits and agree to reimburse the carrier, if and when they receive any “other income” benefits. The amount that is owed back to the insurance and disability carrier is known as an “overpayment.”

overpayment long term disability benefits

What are My Options to Avoid Creating an Overpayment?

Alternatively, disability insurance companies can offer you the option to receive your benefits with an estimated reduction of the amount of other income benefits you might receive. So, for example, if you’ve applied for Social Security Disability benefits, your long term disability carrier can estimate the receipt of your Social Security benefits and pay you reduced benefits, while you’re pursuing your Social Security claim.

Once you receive your Social Security award, the carrier will adjust your long term disability payment, accordingly. If the long term disability carrier has denied your Social Security benefits, you may not have to pay them back.

What You Should do About an Overpayment of Disability Insurance Benefits

Each case is different and you should call today at 727-894-3188 for a free, no obligation consultation or to order a copy of her book, “Robbed of Your Peace of Mind: Everything You Need to Know About Your Long Term Disability Claim.” by clicking the link!

Why Every Long Term Disability Policy Holder Should Hire Their Own Social Security Disability Attorney To Assist Them In Getting Social Security Disability Benefits

hiring a social security lawyer LTD claim

Most long term disability policies will pay full long term disability benefits, but subtract from those benefits other income benefits, such as Social Security Disability benefits.

hiring a social security lawyer LTD claim

The Games the Representative Company Plays with Long Term Disability

Often, the disability insurance company will recommend that you use a service they endorse to help you get the Social Security Disability benefits. While these companies will claim that they represent you, and not the long term disability carrier, the reality is that often these representative companies develop your social Security claim based on medical conditions that only have a limited payment period under the terms of your disability policy. For example, mental illness is used as the basis of your Social Security Disability claim. Many policies will only pay for 2 years of disability benefits based on the mental nervous limitations of the policy. While the long term disability carrier will tell you that they’ll pay the representative’s fee as an enticement, the reality is that the long term disability insurance company and their recommended referral source is simply not working for you.

What You Should do Today

You should contact a lawyer, like Nancy Cavey, who can help you get both Social Security Disability benefits and long term disability benefits. She’ll help develop the right medical condition so you get the maximum benefits possible. Call today at 727-894-3188.

The Four Reasons Long-Term Care Insurance Gets Overlooked In The Estate Planning Process

long term care attorney tampa

One of the most commonly overlooked areas in estate planning is deciding whether you should purchase long-term care insurance.

long term care attorney tampa

Four Reasons Why Long-Term Care Insurance Gets Forgotten

Long-term care insurance is the only way to prepare for the future and protect assets that you might want to pass on to your relatives or loved ones.

It can also protect you from being a burden on your family!

Did you know that over 60% of people over the age of 65 need some kind of long-term care in their life? Medicare simply doesn’t cover many of the long-term care services that are required. It’s important that you assess your risks and determine whether long-term care insurance is right for you. But, in the meantime, let’s think about the reasons why long-term care insurance gets forgotten:

• I’m too young to think about long-term care;
• I already have medical insurance which should be good enough, isn’t it?
• I don’t want the added expense of long-term care insurance; and
• I have enough money set aside for a nursing home or other long-term care service.

What Long-Term Care Insurance Does

Long-term care insurance can help with the cost of adult care or assisted living facilities or interim care when an individual has lost the ability to do two or more of their daily activities. These activities include:

Bathing;
Dressing;
Eating;
Toileting;
Continence; and
Transferring.

There are medical conditions that can trigger the need for long-term care, even if an individual is still able to take care of their daily activities. A person with Alzheimer’s, for example, may need long-term care, even if they’re able to perform their daily activities. It is their mental incapacity that requires long-term care.

What You Should Do

Talk to long-term care attorney Nancy Cavey who will answer your questions about purchasing long-term care insurance, how to prepare a winning claim, and what to do if your claim for long term care is denied. Call her today at 727-894-3188.