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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

Opting Out Of A Social Security Disability Video Hearing

social security video hearing

The Social Security Administration (SSA) uses video hearings to catch up on its backlog. However, having a video hearing isn’t always in the best interest of a Social Security Disability applicant because, many times, the Social Security decision is made on the basis of credibility.

Social Security Disability attorney Nancy Cavey thinks it is important that you have a hearing in front of an administrative law judge as opposed to a video conferencing. Far too often, administrative law judges seems to be paying far more attention to their computer screens then actually watching a claimant testify. It is stunning to get a decision finding that the Social Security Disability applicant isn’t credible when the ALJ has spent the hearing looking at their computer and not the applicant.

Objecting to A Social Security Video Hearing

The regulations provide that the prior to scheduling a hearing, SSA notify you that it may schedule your appearance by video teleconferencing. You have the right to object and you, or your representative, must notify SSA within 30 days after receiving the notice.

If you received such a notice you should immediately call your Social Security Disability attorney to find out their position on whether or not you should appear by video conferencing or whether you want to have an in person hearing with an administrative law judge. There is no doubt that having an in person hearing will take longer but you want to make sure that you get the Social Security Disability benefits you receive by having a fair hearing.

What You Should Do If Your Social Security Disability Claim Has Been Denied

If your Social Security Disability claim has been denied it’s time to contact Social Security Disability attorney Nancy Cavey who can help Florida residents get the Social Security Disability benefits they deserve. Contact her today at 727-894-3188 for a free no obligation consultation.

What Every Social Security Disability Recipient Needs To Know About Discharging Your Federal Student Loans As A Result Of Total And Permanent Disability

social security disability student loan discharge

Federal Student Loans, including FFEL, Direct Loans and Perkins Loans are eligible for forgiveness if the student loan debtor is found to be “totally and permanently disabled” (TPD).

social security disability student loan discharge

The Department of Education is required to accept a Social Security Administration Notice of Award for Social Security Disability Insurance (SSDI) benefits or Supplemental Security Income (SSI) benefits as proof as a borrower’s total permanent disability, if the Notice indicates that SSA will review the borrower’s continuing eligilbity for benefits once for every five (5) to seven (7) years.

However, if your Notice of Award indicates a disability review less than five (5) to seven (7) years, you can still qualify for a discharge of your Federal Student Loans if your physician will certify your disability. Information about applying for total permanent disability discharge can be found at disabilitydischarge.com.

The good news is that you can authorize representatives, like Student Loan and Social Security Disability attorney Nancy Cavey, to handle your TPD application, deal with any request for information or denials and help you with post discharge monitoring requirements.

What You Need To Do If You Have Student Loans and Applying For Social Security Disability

If you are a Federal Student Loan borrower who has applied for Social Security Disability benefits and awaiting a decision or have received a Notice of Award, it’s time to contact Nancy Cavey who can help you regardless of where you live in the United States.

She routinely represents social security disability applicants and student loan borrowers in securing a disability discharge. Contact her today at 727-894-3188.

Chronic Fatigue Syndrome Gets A New Name

new name for chronic fatigue systemic exertional intolerance disease

The Institute of Medicine (IOM) has recommended a new name and new diagnostic criteria for Chronic Fatigue Syndrome. According to Institute of Medicine, the term, “Chronic Fatigue Syndrome can result in stigmatization and trivialization and should no longer be used as the name of this illness.”

The suggested new name is Systemic Exertional Intolerance Disease and the new diagnostic criteria being suggested requires that the patient have the following three symptoms:

1. A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social or personal activities that persist for more than six (6) months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong, is not the result of ongoing excessive excretion, and is not substantially elevated by rest, and

2. Post-exertional malaise, and

3. Un-refreshing sleep.

At least one of the two following manifestations is also required:

1. Cognitive impairment; or

2. orthostatic intolerance.

The complete report, Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness, is a must read for those with CFS! Find it here: http://www.iom.edu/reports/2015/ME-CFS.aspx

If you or a family member has been diagnosed as having Chronic Fatigue Syndrome you’ll find this article refreshing. The report acknowledges that “seeking and receiving a diagnosis can be a frustrating process for several reasons, including skepticism of healthcare providers about the serious nature of ME/CFS and the misconception that it is psychogenetic illness or even a figment of a patient’s imagination.” We, at The Law Office of Nancy L. Cavey, applaud the Institute of Medicine’s article and taking on the myth that Chronic Fatigue Syndrome is all in a patient’s head.

What To Do If You Have Been Diagnosed with Chronic Fatigue Syndrome or Systemic Exertion Intolerance Disease

If you or a family member has been diagnosed as having Chronic Fatigue Syndrome or Systemic Exertion Intolerance Disease, it is time to contact Social Security Disability attorney Nancy Cavey who can help you get the disability benefits you deserve. Give us a call today at 727-894-3188.

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.