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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: Long Term Disability ERISA and Private Disability Insurance Claims - Page 2

Making The Decision To Hire An Attorney To Get Your Long Term Disability Benefits If Your Claim Has Been Denied

hiring a long term disability attorney

You bought your long term disability policy to provide you and your family peace of mind if you were unable to work. You’ve even made the difficult decision to apply for disability benefits knowing that your physician and employer have supported your claim. Yet, you’ve gotten a denial from the long term disability carrier.

No matter how angry or upset you are, don’t walk away from your long term disability claim. As a disability attorney, I know that very few people look forward to protracted litigation but there are times in life when the only right course of action is to pursue your claim.

hiring a long term disability attorney

What you should do if your claim has been improperly denied

If your insurance company improperly denied or treated your claim with a total lack of regard, it’s time to get a long term disability attorney involved.

When you’re forced in that position, you want to make sure that you’ve hired the right long term disability attorney for you.

You can order your free, no obligation copy of my book, “Hiring the Right Long Term Disability Attorney for You” by contacting my office at 727-894-3188 for a free, no obligation consultation.

Only an experienced disability attorney can understand the terms and conditions of your policy, the reasons for your initial denial and outline and implement a strategy for getting the long term disability benefits you deserve. After all, you purchased your disability policy to provide you and your family peace of mind. Don’t let the long term disability carrier rob you blind! Call us today to discuss your options – 727-894-3188.

The Five Things Long Term Disability Carriers Try To Do To Complicate And Even Deny Your Long Term Disability Benefits

5 things long term disability insurance carriers do

I’m sure that you purchased your long term disability policy to provide peace of mind if you became disabled. You may have every intention of returning to work but simply continue to be disabled while you’re recovering.

5 things long term disability insurance carriers do

Don’t think that the long term disability carrier is sitting idly by while you’re collecting disability benefits. There are five things that long term disability carriers can do to delay or even deny your long term disability benefits. These include:

1. Obtaining an Independent Medical Evaluation (IME) by a physician who has been paid to say that you are not disabled;

2. Having a field investigator knock on your door, unannounced, for the purposes of taking a statement about your Activities of Daily Living;

3. Seeing strange vehicles in your neighborhood following you to and from doctor’s offices, the grocery store or even to the children’s school and securing surveillance of your activities;

4. Contacting your neighbors and even your co-workers about your hobbies and daily activities;

5. Having the long term disability carrier’s peer reviewer or consulting doctors call your attending physician in an effort to convince your doctor that you’re capable of engaging in part-time employment.

What you should do to protect yourself

One of the quickest ways to provide yourself with peace of mind is to secure the services of an experienced long term disability attorney who can:

1. Help you complete the Activity of Daily Living forms submitted to you by the disability carrier;

2. Provide advise on what to expect and how to handle field representatives, surveillance and vocational evaluations used by disability insurance companies to deny claims;

3. Provide disability advice on what to expect and how to handle an independent medical evaluation (IME) or a Functional Capacity Evaluation (FCE);

4. Advice on how you should communicate with your physician about your occupation and how to fill out the disability forms;

Getting the go-to book

You should also order the no obligation copy of my book, “The Smart Long Term Disability Consumer Guide For Preparing For Your Statement and Field Visit – See more at: http://www.caveylaw.com/the-smart-long-term-disability-consumer-guide-for-preparing-for-your-statement-and-field-visit/” that explains to you the games that long term disability carriers play in disability claims.

Be prepared and be forewarned. You should be ready to take on insurance companies so that you can get the disability benefits you deserve. Call today at 727-894-3188 for a complimentary consultation.

Should I Handle My Own Long Term Disability Claim?

handle your own disability claim

Sure! Anyone can handle their own disability claim. However, it is rare for those who are unrepresented to be successful in an appeal to get the disability benefits they deserve.

Long term disability attorneys, such as Nancy Cavey, have the knowledge and experience to handle your long term disability claims.

Unfair carrier tactics

Many long term disability carriers will often take advantage of policy holders by employing unfair tactics to delay and deny your claim. They’ll ask for the same information over and over, contact your doctors needlessly and drag their feet before making a decision on your claim.

Having a long term disability attorney can put you on an equal footing. It sends the carrier a message that you’re serious about the handling, preparation and presentation of your long term disability claim. They know that you’re determined to get the long term disability benefits you deserve.

Be sure to check out our long term disability guide, “Robbed of Your Peace of Mind” written by our very own Nancy Cavey. This book is a useful tool when trying to navigate the long term disability claims process.

How To Deal With Erisa Disability Insurers Claims And Reimbursement For Social Security Overpayments

overpayment ERISA disability lawyer

Many Long Term Disability plans provide that the policy holder must properly refund any lump sum retroactive Social Security Disability payment and send the overpayment amount within 30 days of the receipt of the notice from the Long Term Disability carrier. If you fail to make reimbursement, many carriers will claim reimbursement of the overpayment of disability benefits that occur due to your receipt of Social Security benefits pursuant to 29 U.S. Code Section 1132(a)(3).

In Great – West Life and Annuity Insurance Company v. Knudson, 534 U.S. 204(2002), United States Supreme Court addressed a carriers’ right to enforce a reimbursement provision in an ERISA plan.
In Knudson, the carrier paid Ms. Knudson’s medical expenses and then filed a law suit in state court to recover damages, as a result of her motor vehicle accident. The funds that were recovered in the tort action were paid into the Special Needs Trust and Great Life filed an action in court asking for reimbursement of the sums it had paid out on her behalf from the Special Needs Trust.

overpayment ERISA disability lawyer

The U.S. Supreme Court held that whether the carrier was entitled to reimbursement on a legal or equitable basis depended on the nature of the Plaintiff’s claim and the underlying remedies claimed. The court held that if restitution was equitable in nature, the Long Term Disability carrier’s action had to seek, not to impose personal liability on the policy holder, but to restore the funds or property in the policy holder’s possession. Because the monies had been placed in a Special Needs Trust, the court held that the monies were not in the policy holder’s possession.

The practical result of the Supreme Court opinion is that the carrier has to prove the amount that is due, establish that they’re entitled to reimbursement on an equitable basis and establish that the policy holder has the funds in their possession.

If these three things are not established then the carrier is generally, not entitled to reimbursement.

However, that doesn’t mean you’re off the hook. A Long Term Disability carrier can reduce your future benefits by the receipt of the overpayment and will, generally, reduce your benefits until they have received the full amount of the overpayment. The end result? Long Term Disability carriers get their money back one way or another.

What should I do if the carrier is claiming an overpayment?

Contact Overpayment Long Term Disability Benefits attorney Nancy Cavey today to learn more about whether the carrier is, in fact, entitled to reimbursement, strategies for dealing with the reimbursement claim and causes of action that may arise, as a result of collection activities on behalf of the carrier. If the carrier has hired a collection agency that’s harassing you regarding overpayment, there might be a Fair Debt Collection Practice Act (FDCPA) or state consumer violation that can help resolve the overpayment issue favorably for you!

How Do Long Term Disability Carriers Use Position Statements To Deny Fibromyalgia Claims?

long term disability carriers position

Many long term disability carriers are in the business of collecting premiums and not paying benefits to fibromyalgia policy holders. Many long term disability carriers will deny fibromyalgia claims on the basis that fibromyalgia is largely based on self reported symptoms and that there isn’t any objective evidence of restrictions and limitations.

long term disability carriers position

It’s not uncommon to see a denial letter language that describes fibromyalgia syndrome as a functional somatic syndrome. The denial language will say that FMS sufferers symptoms are “exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient’s belief that they have a serious disease.” Barsky A. Borus J: Functional Somatic Syndromes (review). Ann Intern Med. 1999: 130:910-921.

Further, the long term disability companies will cite to an outdated study in the Journal of Rheumatology of 1996 called the “FMS Consensus Report.” The outdated report concludes that “only a minority of FMS patients are unable to work.”

Long term disability carriers use this study to justify claims denials on the basis that “at a minimum, FMS claimants should be able to perform sedentary or light work.”

If your claim for long term disability benefits has been denied, contact fibromyalgia long term disability attorney, Nancy Cavey, at 727-894-3188 who can help you get the benefits you deserve no matter where you live in the United States.

Are There Disability Plans That Are Not Governed By The Erisa Statute?

erisa disability plans

The Employer Retirement Income Security Act of 1974 governs employee welfare benefit plans, including disability insurance plans.

erisa disability plans

ERISA is not a plaintiff friendly statute and, fortunately, there are plans that are not governed by ERISA. These include plans by:

• Churches;
• Government;
• Entities;
• Plans maintained for the purposes of complying with Workers’ Compensation; and
• Plans maintained outside the United States for the benefit of persons for non-resident aliens.

The great news is that if you’re employed by a government agency such as state or a local government, your long term disability benefits are not governed by the ERISA statute.

You can learn more about your rights to short and long term disability benefits by contacting governmental plan disability attorney, Nancy Cavey, who can help you regardless of where you live in the United States.

How Can I Obtain A Copy Of My Disability Documents?

disability documents

Your employer should be able to provide you with a copy of the summary plan of description (SPD) which provides you with a description of the benefits that you may be entitled to as a result of disability, the definition of disability and how to make a claim for benefits.

disability documents

You can also request relevant documents from the plan under a 29CFR Section 2560.503-1(N)(8) if your benefits have been denied. Long term disability carriers are required to provide you with a copy of documents to:

• Rely on in making the benefit determination;
• Submit, proceed or generate in the course of making a benefit determination, regardless of whether relied upon;
• Demonstrates compliance with administrative procedures in making benefit
determinations in accordance with the plan documents; and
• In a case of denied disability benefits, constitutes a statement of policy concerning the denied treatment, regardless of whether relied on in making the benefit determination.

If you’re thinking about applying for disability benefits or your claim has been denied, you should obtain these important documents to learn about your rights.

If you have questions about the disability claims process or your claim is wrongfully denied, long term disability attorney, Nancy Cavey, can help you get the disability benefits you deserve. Call her today at 727-894-3188.

Why The Definition Of Disability In Your Long Term Disability Policy Is So Important

definition of disability

Long term disability carriers don’t make it easy for those who have disability policies get the benefits that they deserve. There are many important provisions in your disability policy including the definition of disability, duties and regular occupation. You should read your policy closely before you apply for disability benefits so you understand these crucial terms.

definition of disability

The definition of disability

The definition of disability will determine the scope of the coverage provided by your disability carrier. Normally, the policy provides for disability payments if you’re unable to engage in your “own occupation” which is usually the first 24 months of disability. After 24 months, the definition of disability will change to “any occupation.” You should note that your disability policy does not ensure your job but rather, ensures your occupation.

Variations in the definition of disability

Many disability policies will define disability on the actions or skills required of your regular occupation. The variations include:

• The ability to perform each of the material duties of the regular occupation;
• The ability to perform the important duties of the occupation; or
• The ability to perform the substantial material duties of the occupation.

That’s why it’s so very important for you to obtain a description of your occupational duties from your employer and compare that to the duties that you know you actually perform. Many times long term disability carriers will use the wrong definition of occupation and/or the duties of the occupation in wrongfully denying claims.

THE DEFINITION OF REGULAR OCCUPATION

Unfortunately, many long term disability policy holders believe that they have insured their occupation as performed by their employer. Unfortunately, that may not be the case. Many long term disability policies will define material and substantial duties based on the regular occupation as performed in the national economy and as defined by the Dictionary of Occupational Titles. Rarely, does a policy provide that the definition of a regular occupation is that occupation performed by the policy holder for a specific employer at a specific location.

What you need to do before you file a claim for benefits

It’s crucial that you understand the definition of the regular occupation and disability before you apply for disability benefits. Crucial mistakes can be made in the application and in your medical records if your physician doesn’t understand what your occupation involves and document how you are able to perform duties of your regular occupation. It requires teamwork to submit a winning disability application.

You can learn more about your rights to long term disability benefits and how to complete a winning disability application by contacting long term disability attorney, Nancy Cavey, who can help you regardless of where you live in the United States.

Help! My Claim For Long Term Disability Benefits Has Been Denied

disability help long term disability

If your disability benefits are covered under a group disability policy through your employer, your claim is probably governed by the ERISA statute. If your claim has been denied, the ERISA statute provides that you must file a claim within 180 days of the denial or you won’t be able to file. If you don’t file it timely and then try to file a lawsuit, the disability carrier will claim that you haven’t “exhausted” your remedies.

disability help long term disability

Filing multiple appeals

Many long term disability policies will also provide for a second level appeal to allow you to once again challenge the disability carrier’s denial. The deadline is often shorter than the 180 days provided for the first level appeal. You are required to exhaust all mandatory internal appeals before you can file suit.

Why should you appeal the denial?

The ERISA statute requires that you “exhaust” all mandatory internal appeals before you file a lawsuit. If you don’t, your suit will be dismissed. By the time the case is remanded., the appeal deadline may have expired. It’s a double whammy for the unexpected.

Do I need a lawyer?

Yes! The ERISA statute is a complex federal law with precise regulations. Most attorneys just don’t have the knowledge or experience to properly handle an ERISA governed long term disability appeal or lawsuit. Unfortunately, many general practice attorneys will miss deadlines or fail to address critical issues on appeal or worse yet, not submit all the winning documentation as part of the appeal process. Unfortunately, unrepresented claimants often make the same fatal mistakes.

When should I hire a lawyer?

Let’s be frank! A claim for long term disability insurance benefits is won or lost at the appeal stage because, simply speaking, there is no trial in an ERISA case. Once the internal appeals have been exhausted and a lawsuit is filed, no new evidence can be introduced. There are no trials, there is no hearing, there is not deposition. A federal Judge simply reviews the claims file. Holding your best evidence is just using strategy.

If your claim for long term disability benefits has been denied, call long term disability attorney, Nancy Cavey, today to learn more about filing an appeal within a 180 day deadline. Don’t delay! Time is your enemy!

What Is Erisa And Why Should I Care That My Long Term Disability Carrier Might Be Governed By Erisa?

erisa lawyer disability tampa st petersburg

What you need to know about the claim forms

ERISA is shorthand for the Employer Retirement Income Security Act of 1994. It’s Federal legislation that governs how insurance companies handle disability claims and it gives disability carriers a “get out of jail free card.”

In most ERISA governed claims, a court can only overturn the long term disability carrier’s decision if you prove that the denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil court and it’s the “get out of jail free card” that disability insurance companies, like UNUM Provident, MetLife, Cigna/LINA, Aetna, Lincoln Financial, Prudential and The Hartford use to “play hardball.”

erisa lawyer disability tampa st petersburg

Claims denial and appeal

If your long term disability claim has been denied or terminated, the ERISA rules provide that you’ll have 180 days in which to file an appeal. You should request a copy of your complete file from the long term disability carrier and hire an experienced long term disability attorney to represent you in the appeals process.

Once the appeal letter is submitted under the ERISA statute, the long term disability carrier will have 90 days in which to review the material and decide whether it’s going to overturn or uphold the denial.

Filing the law suit

Once the internal appeals process is exhausted, you’ll have the right to file a lawsuit in Federal court. However, no additional evidence can be submitted. The Judge is limited to reviewing the claims file. There are no depositions, hearings or even trials. That means that neither you or your treating physician is going to be able to testify.

The court will simply review the medical and vocational proof in the claims file. The appeals letter is, quite frankly, your trial and that’s why it’s crucial that you have an experienced disability attorney represent you in the appeals process.

How the Federal Judge makes a decision in an ERISA case

In most ERISA governed cases, the Federal court must defer to the long term disability decision so long as there is a “rational basis” or a “reasoned explanation for the decision.”

The Federal court will only overturn the insurance company’s denial, if you can show the denial is “arbitrary and capricious.” Even if you’ve been accepted as being disabled by the Social Security Administration, the long term disability carrier isn’t bound by that determination. The discretionary clause in the disability insurance company is their “get out of jail free card.”

When you file a lawsuit the best you can hope for is to recover the past due benefits that you are owned and have your monthly disability check reinstated. Unfortunately, there are no bad faith or punitive damages and attorney fees are rarely awarded. Most cases settle for 10% to 50% of the past and future value of your benefits.

What you should do today

Let’s be frank. Long term disability insurance claims are complicated. There are short deadlines and the appeal is your trial. There are a number of legal issues in many appeals including limitations, benefits due to mental illness or self reported conditions, exclusions for pre-existing conditions and even arguments about overpayments or reduction of benefits.

You would owe it to yourself to get help with your long term disability claim, appeal or lawsuit regardless of whether or not your long term disability policy is a group sponsored long term disability plan or an individual disability income policy.

Contact long term disability attorney, Nancy Cavey, who has helped hundreds of people with the long term disability insurance. She’ll personally consult with you, review your claim, prepare your appeal, and if necessary, file suit and represent you in court.

Call today at 727-894-3188 for a free no obligation consultation or to order a copy of her book, “Everything You Need to Know About Your Long Term Disability Claim.”