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  • Long Term Disability Guide

    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

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.

Cognitive Problems As A Result Of Multiple Sclerosis And Your Rights To Social Security Disability Benefits

multiple sclerosis disability attorney tampa

One of the most devastating consequences in MS are cognitive problems. It is not uncommon for those with MS to have problems with attention, processing speed and working memory because of problems in connectivity between areas of the brain.

multiple sclerosis disability attorney tampa

How Can I Win my MS Social Security Disability Claim?

To win your Social Security Disability claim, you have to prove that either you meet a medical listing for MS or establish that, because of vocational factors, you can’t return to the lightest job you’ve held in the last 15 years or other work in the national economy based on your age, education, transferrable skills and restrictions and limitations.

It’s important that the cognitive problems do develop so that the Administrative Law Judge understands the difficulties you have with attention, processing speed and working memory! It takes a team effort to get the disability benefits you deserve. Make sure that you’re represented by a Social Security Disability attorney who specializes in MS claims and can work with your physician to get the necessary documentation to establish the functional and non-functional restrictions and limitations you have, including cognitive problems as a result of your MS.

What You Should Do Right Now If You Suffer From MS

Call today at 727-894-3188 for a free, no obligation consultation and you can learn more about your rights to Social Security Disability by ordering a free, no obligation copy of our book, “Your Rights to Social Security Disability Benefits.”

 

What Every Social Security Disability Applicant Should Know About The 5 Steps Used In Determining Their Rights To Social Security Disability Benefits

5 steps social security disability applicant

The Social Security Administration (SSA) doesn’t make it easy for those who are disabled to get the benefits they deserve. SSA uses a 5 Step Sequential Evaluation test when it reviews every Social Security Disability applicant. So, if your doctor has told you to stop working, you should apply for Social Security Disability benefits. Before you do so, ask yourself the following questions:

5 steps social security disability applicant

Step 1: Are you gainfully employed?

You must establish that you are gainfully employed or that you are earning less than the federal benefit rate (FDR). If in any month, after the period you claim you are disabled, you are gainfully employed earning $1,090 dollars, regardless of the severity of your disability, you’re not entitled to Social Security Disability benefits.

Step 2: Is your medical impairment severe?

If you have a medical condition that results in limitations and restrictions, you have a severe impairment. For example, if you’ve had back surgery that’s limited your ability to lift more than 10 pounds, you have a severe disability.

Step 3: Does your impairment meet or equal a medical listing?

The Social Security Administration has a disability handbook called the “Blue Book of Impairments” which lists all recognized disabilities. If your disability doesn’t meet or equal the Listings, which you can find at the SSA website, the SSA evaluation process will proceed to Step 4 and Step 5.

Step 4: Can you perform your previous type of work?

If your disability doesn’t meet or equal the Listings, you can still be found disabled based on vocational factors found at Step 4 and Step 5. At Step 4, you must show that you can’t do any previous work that you did for the last 15 years that lasted more than 30 days.

If you’ve had back surgery and your doctor says that you can’t lift more than 10 pounds, and your previous work for the last 15 years was a Stocker, you’ll satisfy Step 4 because your job requires heavy lifting.

Step 5: Can you return to any of the work in the national economy?

SSA will determine, based on your restrictions and limitations, whether there is other work that you’re capable of performing. They will consider your pain, side effects and any psychological problem you have. It’s important that you have a Social Security attorney represent you because most cases are decided at the hearing at Step 5.

The Administrative Law Judge (ALJ) will present the Vocational Evaluator a hypothetical based on a mythical individual just like you. The ALJ will ask the vocational evaluator questions about whether there is other work this mythical person might be capable of performing in the national economy taking into consideration your age, education and skills you have learned at other jobs.

Having an attorney represent you to make sure that the hypothetical given to the vocational evaluator is accurate and correct!

What You Should Do Next!

Don’t make a crucial mistake and attempt to represent yourself in a Social Security Disability hearing.

While your doctor told you that you’re unable to work, it takes more than just your doctor’s word to get you the Social Security Disability benefits you deserve.

Contact Social Security Disability attorney Nancy Cavey today at 727-898-3188. She can help you get the Social Security Disability benefits you deserve.

Can I Collect Unemployment Benefits And Supplemental Security Income Benefits?

While you can collect Supplemental Security Income (SSI) benefits, any Unemployment benefits you receive count as unearned income which will reduce the amount of your SSI benefits.

Supplemental Security Income Benefits Questions?

Applying for SSI and need some guidance? Contact Supplemental Security Income lawyer Nancy Cavey today for a complimentary, no obligation consultation at 727-894-3188 to help you with any questions you may have. We are here to help you with your situation if you are in need.

What Is “Disability” For The Purposes Of Collecting First Responder Workers’ Compensation Benefits?

first responder workers compensation benefits

If you’re a First Responder, Section 112.18 of the Florida Statutes provides that any condition or impairment caused by tuberculosis, heart disease or hypertension resulting in total or partial disability or death is presumed accidental and be suffered in the line of duty, unless contrary evidence is shown by competent substantial evidence.

first responder workers compensation benefits

Of course, you’ll have to successfully pass the physical examination upon entering into employment which did not reveal any evidence of any such condition for the presumption to be applicable.

You are also required to show that you were disabled and restricted from working before you’re entitled to compensation or medical benefits.

What medical evidence is required to establish disability?

In the case of the City of Jacksonville Fire and Rescue Department v. Battle, Mr. Battle was a firefighter who had successfully passed his pre-employment physical. He developed hypertension and heart disease and underwent a catheterization. He was taken out of work following the procedure for 3 days by his doctor.

The City of Jacksonville denied his claim on the basis that he wasn’t disabled, notwithstanding the fact that his physician had restricted him from working for 3 days.

As expected, the First District Court of Appeals upheld the Judge of Compensation Claims’ finding that Mr. Battles was disabled and restricted from working because of the catheterization.

What should I do if my First Responder claim has been denied?

Contact Florida Workers’ Compensation First Responder attorney Nancy Cavey who can help you get the Workers’ Compensation money benefits and medical benefits you deserve. Call today at 727-894-3188.

Is It Inconsistent For Me To Apply For Unemployment Insurance And Social Security Benefits?

That’s a great question and many Social Security Administrative Law Judges believe that collecting Unemployment Insurance and Social Security benefits is “double dipping.”

What’s the inconsistency?

When you apply for Unemployment Compensation benefits, you’re certifying that you’re able to work.  Yet, when you apply for Social Security Disability benefits, you’re certifying that you can’t work.  Which is it?

What’s the Social Security rule and policy?

The Social Security rules and policy provide that the “receipt of unemployment insurance benefits does not preclude the receipt of Social Security Disability benefits.”  It is only “one of the many factors that must be considered in determining whether the claimant is disabled” and “a person can qualify for Social Security Disability benefits, even though they remain capable of performing some work.”

Therefore, the Chief Social Security Judge has issued a Memorandum to the Administrative Law Judges advising that it is “SSA’s position that individuals need not choose between applying for unemployment insurance and Social Security Disability benefits.”  (Cite to the Memoranda of Chief ALJ Frank Cristaudo, dated November 15, 2006 Ref. No. 07-11; and August 9, 2010 Ref. No. 10-1258.)

So, how do the Tampa Bay Social Security judges apply this ruling?

Unfortunately, despite the Chief Judge’s pronouncement, some Administrative Law Judges simply won’t award SSDI benefits during a period of time in which you’ve collected unemployment benefits.

Others will award Social Security Disability benefits during a period of time in which you collected unemployment, if you can show:

1.         You can only work part-time at less than presumed SGA levels due to medical impairment;

2.         Can only work in a sheltered or accommodated work due to disability;

3.         Can only work sporadically due to a medical impairment producing episodic incapacity to work;

4.         Meets a medical vocational (grid) rule directing a finding of disability);

5.         Filing in the alternative to preserve rights because you’re unsure of whether your medical condition meets the disability and duration requirements when filed; or

6.         You honestly but mistakenly believed that you could work.

What should you do if you’ve applied for both Social Security Disability and Unemployment benefits?

Be sure to tell your disability attorney that you’ve applied for both because you can be assured that the Social Security Administrative Law Judge will ask you questions about the receipt of your unemployment benefits.  You should be prepared to answer these questions honestly and accurately.

What should you do if your Social Security Disability claim has been denied?

Contact Tampa/St. Petersburg Social Security Disability attorney Nancy Cavey today who can help you get the Social Security Disability benefits you deserve.  She can answer any questions you have regarding the receipt of unemployment compensation benefits and your Social Security Disability application.  Call today at 727-894-3188.