No, the United States Supreme Court in MetLife vs. Glen, 554 US 105 (208), was troubled when MetLife encouraged Mr. Glen to apply for Social Security Disability benefits, reduced his long term disability benefits by the receipt of the Social Security benefits and then ignored the Social Security finding entirely in denying the long term disability benefits.
Many ERISA plans require claims to apply for Social Security Disability benefits and they even provide legal assistance to provide those benefits. Since the Glen decision, many long term disability insurance companies have been careful to reconcile the Social Security determination with their ultimate ERISA plan denial. In other words, they simply can’t ignore the decision but they are not bound by it.
The Social Security Administration has unique rules and procedures in making Social Security rules and determinations. As a result, courts do not view an award of Social Security benefits as the equivalent of disability on a ERISA disability policy.
As a result, ERISA long term disability insurance companies are now required to make a distinction between a Social Security Disability benefit decision and their denial. If they don’t, that can be grounds for appealing a denial of long term disability benefits.
If you have been awarded Social Security Disability benefits, and your carrier doesn’t discuss those benefits in it’s denial decision, you should contact disability attorney Nancy Cavey who can get the long term disability benefits that you deserve regardless of where you live in the United States.
You purchased a long term disability policy to provide you and your family peace of mind. Unfortunately, long term disability carriers are not in the business of paying disability benefits to their policy holders. They would rather collect the premium. So, what happens after you have submitted your claim and you have been denied? There are two reasons why you should appeal the denial of your disability benefits. Why?
1. Your appeal is your last chance to submit evidence of your disability.
You can actually get a copy of your file from your disability carrier which will help you determine the real reasons why your plan got denied. It isn’t uncommon for claim’s to be denied on the following basis: 1. No objective basis for diagnosis; 2. No objective basis of your restrictions and limitations; 3. No casual relationship between the diagnosis or restrictions and your inability to do your own or any occupation.
There is no trial in an ERISA case and, as a result, the court will decide your case entirely based on what was in the insurance companies claim file at the time of your last appeal.
That’s why it’s important that you secure the services of an experienced long term disability attorney.
Screwing up your appeal by handling it yourself only screws up the appeal but potentially screws up your lawsuit. There are many things that can and should be done to develop the medical and vocational evidence. This can include:
- Undergoing a functional capacity evaluation;
- Vocational evaluations;
- Statement from your physician addressing the reasons why your claim was denied;
- Statements of family, friends and even your employer.
2. If you fail to timely submit an appeal, you may be barred from suing your insurance company. This sounds weird but if you have fail to timely appeal the denial, the long term disability carrier may say that you fail to “exhaust your administrative remedies”. That appeal is your administrative remedy and if you do not use it, you can’t get back and fix it once the appeal deadline has passed. So, appealing the denial of benefits in time only gives you a chance to get your benefits reinstated but preserves your right to sue the disability insurance company.
To learn more about appealing the wrongful denial of your disability claim, contact long term disability attorney Nancy Cavey who can help you regardless of where you live in the United States.
If you’ve purchased a long term disability insurance policy through your employer, it, most likely, is governed by the ERISA law. ERISA is a pro insurance federal law which requires that you submit an ERISA appeal if your claim has been denied. Generally speaking, an ERISA appeal is your only opportunity to submit additional information in support of a denied claim.
Simply writing a letter saying that your appealing the decision or sending a letter from your physician saying that you are disabled wont win your appeal. It is crucial that the appeal addresses the myriad of reasons that long term disability carriers are using to deny your claim. Most long term disability applicants whose claims are denied don’t even know that they can request a copy of the entire claims file, by law, before submitting their appeal. Long term disability claims denial attorney Nancy Cavey obtains your disability file and then carefully uses it to determine the reasons that the long term disability carrier is using to justify your claims denial and the evidence which they believe supports their claim’s denial.
She then works closely with you and your treating physicians to ensure that every one of the reasons that your claim has been denied is addressed. Her appeal letters are “shock and awe” packages that consist of an written appeal letter and hundreds of pages of supporting documents.
Those documents can include statements from you, your physicians, vocational evaluations, functional capacity evaluations, medical literature and research.
If an ERISA lawsuit has to be filed, a federal judge will decide whether or not your disability insurance company unreasonably denied your benefits based only on the information contained in the ERISA appeal record.
The term “unreasonably denied” is a term of art in the ERISA world. Most long term disability policies have a clause in the disability policy that requires the federal judge to give deference to the insurance companies decision regardless of how arbitrary and unreasonable it may seem. The scales of justice are not equal in an ERISA disability case. That’s why it is important that you have an attorney who will relentlessly pursue your disability benefits.
If you have questions about how to appeal a claim that’s been denied, you should contact long term disability attorney Nancy Cavey. Unfortunately, ERISA disability insurance carriers don’t make it easy for the disabled to get the benefits they’ve purchased. If your unable to work and you’ve been denied your long term disability benefits, contact Nancy Cavey today who can help you cut through the red tape fight for your benefits, no matter where you live in the United States contact her today at 727.894.3188.
Dr. Jim, of the Moffit Cancer Center, has recently published an analysis of how Chemotherapy effects cognitive functioning in Breast Cancer survivors in the Journal of Clinical Oncology. It’s not uncommon that patients that are undergoing Chemotherapy for Breast Cancer experience some kind of cognitive impairment and Dr. Jim’s studies indicate that the cognitive impairment persists even through the end of treatment.
The long term effects of chemotherapy include difficulty finding words and lapses in visual spatial abilities. In some groups of patients, changes in both the brain structure and function.
If you have been diagnosed with breast cancer or have cognitive problems as a result of the chemotherapy, and you have purchased a private disability policy or have been provided a group disability policy through your employer, you may be entitled to long term disability benefits.
Unfortunately, the long term disability carriers’ don’t always make it easy to get the disability benefits that you deserve and will deny disability benefits of breast cancer survivors who have cognitive problems as a result of their chemotherapy. If your claim has been denied, don’t give up! You can learn more about your rights to long term disability benefits by contacting Tampa Bay breast cancer long term disability attorney Nancy Cavey, who can help you win the long term disability benefits that you deserve. Call today at 727.894.3188 for an appointment.
Cited from: Long Term Effects of Chemo on the Cognitive Function of Cancer Patients, Heather Jim, PhD, Gary Roden, MD, Tim Ahles, PhD
You bought a long term disability policy to provide you and your family peace of mind if you became disabled. Every year, millions of Americans file for long term disability as a result of illness or injury. Unfortunately, long term disability carriers are in the business of collecting premiums and not paying benefits. One of the ways that they legally deny long term disability claims is by hiring medical doctors to write reports about whether there is an objective basis for the diagnosis, objective basis of any restrictions and limitations, whether they are capable of working in at least a sedentary capacity.
Under the ERISA law, the opinions of the insurance company hired doctors’ carry more weight because the ERISA disability policies have a magic “discretionary” clause in the policy. That discretionary clause is a get out of jail free card for disability insurance companies. Companies are free to deny any disability claim so long as they have a reason. And, who supplies them with the reason, doctors. Physicians like a psychiatrist Dr. Steven Gerson, who, according to court records has made over $1 million in 4 years reviewing disability files and rendering unfavorable opinions to disability insurance companies.
How does this work? When you file a claim for disability benefits, your disability insurance company will send your file to a medical review company who has employed a cadre of doctors from different medical specialties. These firms, set up a review, collect millions of dollars a year for their services and coach their doctors never to use the word “disabled” in their reports.
These physicians, rarely, if ever, examine patients and base their opinions on limited medical review.
If your long term disability claim has been denied as a result of a “peer review” or a “independent medical evaluation” don’t give up! Long term disability carriers don’t always make it easy for those who are disabled to get the disability benefits that they deserve. You will have 180 days from the day of the denial letter in which to file an appeal letter challenging the long term disability carriers’ denial. You can learn more about your rights to long term disability benefits and how you can appeal your claim’s denial by contacting ERISA long term disability attorney Nancy Cavey who can help you get the benefits that you deserve, regardless of where you live in the United States. **Cite to Evan George, Dailyjournal.com, Doctors’ Paid to Aid Insurers in Disability Claim’s Denial ADD LINK**
If you have purchased your disability policy through your employer and have become disabled, your claim will be governed by the ERISA law. ERISA law is unlike any law in the United States and, quite frankly, it isn’t a fair law. Many ERISA disability policies have a provision in the policy that grants discretion to them to make the claims decision. That discretionary clause unbalances the scale of justice because a Federal Judge must give deference to the decision of the long term disability carrier.
It is, quite frankly, difficult to win an ERISA case in court. Your day in court is no more than having a judge determine, based on a review at the administrative record, whether a disability carriers decision was wrong, and if so, whether or not there was a reasonable basis for their decision. You can’t even testify!
As a result, most ERISA long term disability claims end up selling 10 to 40% of the past and future value of benefits.
The Federal Law requires that every ERISA long term disability claim be mediated. That means that you and your lawyer will have an opportunity to meet with the long term disability carriers’ claims representative and their attorney. A neutral third party, called a mediator, will preside over the mediation. The mediator has no authority to make a decision and must simply report to the court that the parties were present. Nonetheless, mediation can result in a settlement of your case.
The basic principle of mediation is to allow you to tell your story. Although that information isn’t admissible in court, it will let you feel as if you have been heard and that you are not just a file.
Client’s in ERISA cases have been wronged and are entitled to the benefits that they deserve. Unfortunately, the ERISA law simply makes it difficult to get the benefits they deserve or even the full value of their benefits.
Mediation is a way of finding a solution to your long term disability claim. If your long term disability claim has been denied, make sure that you appeal within 180 days. To learn more about your rights to long term disability benefits, contact long term disability attorney Nancy Cavey.
Did you know that most long term disability insurance policies have a provision in their policy called Social Security Disability offset? You may find this in a definite section under “other income”. Your disability policy will require you, by the terms of the contract, to apply for Social Security Disability benefits. The insurance company forces you to apply for Social Security Disability benefits so that they can reduce the amount of your long term disability benefits by the receipt of your Social Security Disability benefits. It’s enough to make you wonder why they have made you purchase a long term disability policies. Many insurance companies will offer you a Social Security Disability representative, who may or may not be an attorney. So long term disability and Social Security Disability attorney Nancy Cavey suggests that you say no, no thank you to that offer. You need a Social Security Disability and long term disability attorney who can work with you to get you the maximum benefits that you are entitled to by law.
You have the right to choose who represents you at your Social Security Disability claim. Better yet, most long term disability insurance companies will “forgive” your Social Security Disability attorney’s fee and as a result you get better representation for both your Social Security Disability case at no cost to you. Choosing the right lawyer to help you get the Social Security and long term disability benefits that you deserve is crucial and the reality is that there are very few attorneys in the United States that do both long term disability and Social Security Disability litigation. That’s why you may want to contact Tampa Bay Social Security Disability Long term disability attorney Nancy Cavey who can help you with your claims no matter where you live in the state of Florida. Contact her today for a free no obligation consultation at 727.894.3188.
Arthritis can be a disabling condition that prevents you from working. If your doctor has told you are unable to work, long term disability benefits may be available to offset lost wages.
Did you know there are five tips to reduce your risk of arthritis: 1. Exercise; 2. Don’t push your body past its limits; 3. Watch your weight; 4. Stand up straight; 5. Take a Vitamin D. While family history plays a role in your risk of developing arthritis, the chances of developing many types of arthritis, including osteoarthritis and rheumatoid arthritis increases the older you get. While you can’t control this factors you can take steps outlined to protect your joints and reduce your risk of arthritis.
Long term disability benefits maybe available to you if you purchase a disability plan from a private insurer or have coverage through your employer. Unfortunately, long term disability carriers don’t make it easy for those who are disabled as a result of arthritis to get the benefits they deserve.
If you have question regarding your eligibility for long term benefits as a result of osteoarthritis or rheumatoid arthritis or how to appeal a claim that’s been denied, you should immediately speak with long term disability attorney Nancy Cavey, who can help you cut through the red tape and help you fight for your benefits no matter where you live in the United States contact her today at 727.894.3188.
You can purchase a long term disability policy that will pay a percentage of your income when you cannot work due to health reasons. Some employers offer long term disability benefits to their employees which will be covered under the Employer Retirement Income Security Act (ERISA) while others purchase policies on their own.
If you can afford it, you are far better off to purchase your own individual disability policy because if you need to file a claim to collect those benefits, you have more legal rights with a private disability insurance policy.
When do Long Term Disability Policies Pay Benefits?
Most long term disability policies will pay a percentage of your income when you cannot work due to health reasons. Generally, you must be out of work three to six months before the long term disability benefits will kick in.
But, beware, some long term disability policies will actually limit the length of time that you can get your long term disability benefits. So, for example, if you suffer from fibromyalgia, a psychiatric condition, or even soft tissue muscular skeletal problems, your policy may limit the payment of those benefits to just 24 months.
You should understand your benefit package so that you can provide you and your family with peace of mind if you become disabled.
You can learn more about the disability provisions that you don’t want to see in your disability policy by ordering a copy Robbed of Your Peace of Mind.
You may have a false sense of financial security if you only have a group long term disability insurance policy. Individual disability policy attorney Nancy Cavey suggests that you supplement your group coverage with an individual disability policy so that you can have financial peace of mind.
Did you know that:
1. Most employer sponsored group plans provide a benefit of 60% of your base salary up to a maximum monthly amount.
2. An individual disability policy can protect the portion of your income not covered by a group plan and will generally cover 80-90% of your total compensation, including bonuses and commissions.
3. If your employer pays a premium for the group coverage, you’ll have to pay taxes on any group benefits your receive. Benefits from an individual disability policy aren’t taxable as long as you paid full premiums with after tax dollars.
4. If you suffer total disability, neither you or your employer can contribute to a 401K since you wont have any earned income credit however, some individual disability policies will insure continued retirement contributions if you purchased a rider.
5. If you change employers, you won’t be able to carry your group insurance to your new employer. An individual disability policy is yours, policy you own and it protects you regardless of where you work.
6. Your group coverage can be changed or even terminated by the insurance company. Worse yet your insurance premiums can be raised. An individual disability policy can’t be changed and canceled by insurance company. Premiums can’t be changed before the age 65.
If you have questions regarding your eligibility for long term disability benefits or how to appeal a claim that’s been denied, contact individual disability attorney Nancy Cavey.
Unfortunately, many group disability carriers don’t make it easy for the disabled to get access to the benefits they deserve. If you have a medical condition that makes it impossible for you to work and you’ve been denied your benefits, Nancy Cavey can cut through the red tape and fight for your benefits no matter where you live in the United States contact her today at 727.894.3188.