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Category Archives: Long Term Disability ERISA and Private Disability Insurance Claims - Page 3

How Long Term Disability Carriers Will Use Functional Capacity Evaluations To Deny Your Claim

long term disability insurance claims

Long term disability carriers play hardball on claims and one of the ways they play hardball is to have you undergo a functional capacity evaluation. Why? If the long term disability carrier can show that you’re capable of engaging at least sedentary work, they will have legitimate grounds to deny your claim for disability benefits, notwithstanding what your physician has said about your restrictions and limitations.

long term disability insurance claims

What is a functional capacity evaluation?

It’s a 3 to 5 hour confidence evaluation used to determine your current ability, strength endurance, sensation, hand function and gross and fine motor coordination. They will evaluation the appropriateness of your physical limitations assigned by your physician and will test the consistency of your effort.

It is not uncommon to be performed by an insurance company and can be performed when the disability company thinks that your doctor is only relying on your subjective complaints.

What should I do if I am scheduled for a functional capacity evaluation?

You should immediately get out your policy and contact a long term disability attorney, such as Nancy Cavey, who has represented disability claimants in claims against UNUM Provident, MetLife, Cigna/________, Aetna, Lincoln Financial, Prudential and The Hartford. She’ll first determine whether the long term disability carrier has the right to a functional capacity evaluation. Many long term disability policies don’t provide the carrier with that right yet, improperly request the same.

If the carrier does have a right to a functional capacity evaluation you should be prepared for what will occur during the functional capacity evaluation including the questions that you’ll be asked, tests that you’ll be asked to perform and the hidden traps waiting for you in the functional capacity evaluation. Of course, the functional capacity evaluation should be videotaped. It might also be helpful to secure your own functional capacity evaluation or have an appointment with your physician the day of or the day after the functional capacity evaluation so your physician is in a position to rebut the findings of the functional capacity evaluation. Next, don’t let an improper functional capacity evaluation result in the denial of your long term disability claim.

Need Help With Your Long Term Disability Insurance Claim?

Long term disability attorney, Nancy Cavey, is familiar with the many methods disability insurance companies use to wrongfully deny or terminate legitimate long term disability insurance claims.

She’s helped hundreds of people secure their long term disability benefits and will 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 your free initial consultation so you can discuss your situation and get your questions answered today.

What Are The Five Reasons Disability Insurance Companies Wrongfully Deny Or Terminate Long Term Disability Benefits?

5 reasons long term disability

If you purchased your disability policy through your employer the policy is most likely governed by the ERISA statute. The Employer Retirement Income Security Action (ERISA) of 1994 is Federal legislation that has given a “get of jail free card” to disability insurance companies.

5 reasons long term disability

In most ERISA governed claims, courts will only overturn the insurance company’s decision if you can prove that denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil case and it allows insurance companies to “play hardball” on claims.

The most common reasons that long term disability carriers wrongfully deny or terminate benefits are:

1. Insufficient medical proof;
2. Reliance on functional capacity evaluations or independent medical evaluations;
3. Medical reviews by a nurse;
4. Peer reviews that rely on “independent physicians”; and
5. Transferable skills analysis.

1. Insufficient medical proof

Many long term disability policies require that you send proof that’s acceptable to the carrier for their review and consideration. Unfortunately, many long term disability carriers play ping pong and no matter how much you send them, it’s never enough.

2. Functional capacity evaluations or independent medical evaluations

Your policy probably provides that the carrier is entitled to an independent medical evaluation. If you are scheduled for an IME, you should immediately retain the services of an attorney to represent you to ensure that you are protected during the independent medical evaluation.

Some long term disability carriers will also schedule a functional capacity evaluation which is an evaluation to determine your physical capabilities. However, not all policies provide that the carrier has a right to a functional capacity evaluation!

Unfortunately, FCE providers are also in the pocket of the long term disability carriers and will routinely opine that you’re capable of engaging in at least sedentary work so the long term disability carrier can terminate your benefits.
3. Medical review by a nurse

Long term disability carriers have nurses on staff who will summarize your medical records and mysteriously, conclude that the medical records don’t support your diagnosis, disability or inability to return to your own occupation or that of any occupation.

4. Peer review by physicians

It’s tough for a physician these days. Many physician have supplemented their income by doing “paper reviews.” They’re hired by a peer review company for the purposes of reviewing medical records, which have been summarized by the nurse and determining (a) whether there is any objective basis of your diagnosis, (b) any objective basis for the restrictions and limitations assigned by your physician, and © give their opinion on your ability to work.

It’s rare to find a peer review physician who will give an honest opinion because, quite frankly, their income is dependent on giving the peer review company and often the long term disability carrier the ammunition to deny your claim for benefits.

5. Transferable skills analysis

Long term disability carriers also have in their employ vocational evaluators. These evaluators will often review the job description of your occupation and will either misclassify that application or opine that you’ve learned skills in that occupation that you could take to other occupations. That is called a transferable skills analysis.

Many times transferable skills analysis provide jobs that you can’t do because of non-exertional problems, such as pain or side effects of medication. Worse yet, transferable skills analysis will list jobs that you might be able to do, but simply don’t exist.

What you should do immediately

If you claim for long term disability benefits has been denied, contact long term disability attorney, Nancy Cavey, who represents clients throughout the United States. She’ll review your claim, prepare your appeal and, if necessary, file suit and represent you in Federal court.

She has litigated disability cases against every major disability insurance company in the United States and knows first hand the methods long term disability carriers will use to wrongfully deny or terminate legitimate claims.

Call today at 727-894-3188 for free initial consultation.

How Developing Your Exertional and Non-exertional Limitations Can Help You Win Your Long Term Disability Claim

non exertional limitations

Many long term disability carriers will deny policyholder’s claims on the basis that there isn’t an objective basis for any physical restrictions and limitations and/or there is no causal relationship between those restrictions and limitations and your inability to your own occupation or any occupation.

It’s crucial that you develop both the exertional and non-exertional limitations that affect your ability to your own or any occupation.

Exertional limitations for Long Term Disability Claims

Exertional limitations affect your ability to do the physical demands of the job. Most exertional limitations are strength related and they affect your ability to:

• Sit;
• Stand;

• Walk;
• Lift;
• Carry;
• Push; and
• Pull.

The long term disability carrier will use your exertional limitations to categorize your residual functional capacity using the Dictionary of Occupational Titles and Definitions for work levels:

• Sedentary;
• Light;
• Medium;
• Heavy; or
• Heavy work.

If your physician says that you are capable of doing sedentary work, the long term disability carrier will immediately deny your benefits.

If you can’t carry more than 10 pounds on a regular basis or never lift more than 20 pounds, you will have a residual functional capacity for light work. If you can do light work, you can do sedentary work. That means you’ll lose your claim for long term disability benefits.

Non-exertional limitations for Long Term Disability Claims

Many long term disability carriers ignore non-exertional limitations that affect your ability to do non-strength work related work activities.

Examples of non-exertional limitations include difficulty doing the following tasks:

• Manipulative restrictions and limitations.

If you have difficulty using your fingers or hands to manipulate, reach or handle objects, you `have manipulative restrictions and limitations that can limit your ability to engage in repetitive activities with your hands.

• Postural restrictions.

If your doctor has restricted your stooping, climbing, crawling or crouching, those postural restrictions and limitations can also erode your ability to do sedentary work.

• Visual and communicative restrictions.

If you have difficulty seeing, speaking or hearing as a result of your disabling medical condition, you’ll have visual and communicative restrictions that will limit your ability to do sedentary work.

• Psychological limitations.

You may have difficulty functioning because of nervousness, anxiety or depression. You may have difficulty paying attention and concentrating or understanding and remembering detailed instructions. These psychiatric restrictions and limitations can reduce your ability to do sedentary work.

Non-exertional limitations can also be caused by pain or side effects of medication. If you or a loved one needs help with a Long Term Disability claim, please don’t wait to contact us today. Often waiting to file for long term disability can prolong the process. Call 727-894-3188 today.

Your Plan for Long Term Disability Benefits and a Functional Capacity Evaluation

functional capacity evaluation disability

One of the best ways to establish your functional restrictions and limitations is a functional capacity evaluation. However, all to often, long term disability carriers use functional capacity evaluations as a basis to deny claims.

functional capacity evaluation disability

Many long term disability carriers will deny claims on the basis there is no objective basis for the physical restrictions and limitations assigned by your physician. The long term disability carrier will request a functional capacity evaluation to determine the validity of your subjective complaints and prove you can work.

What is a functional capacity evaluation?

A functional capacity evaluation is a 3 to 5 hour comprehensive evaluation used to determine your current physical ability to sit, stand, walk, lift and carry. Your mobility, strength, endurance, sensation, hand function and gross/fine motor coordination will also be evaluated. Part of the testing will determine your consistency of effort and, long term disability carriers can deny claims on the basis that you failed to give full effort during the course of the functional capacity evaluation.

Test for malingering During The Functional Capacity Evaluation

The functional capacity evaluator will perform a Waddell’s test. The Waddell’s test is a group of signs that are part of a physical examination and are divided into 5 groups:

1. Regional disturbance;
2. Distraction;
3. Simulation;
4. Tenderness; and
5. Overreaction.

For example, in the simulation test the evaluator will press down on your head. If you complain of back pain while the functional capacity examiner is pressing down on your neck, that’s a sign of a non-organic response. If you have 3 or more positive signs on the Waddell’s testing, it’s positive for symptom magnification. The long term disability carrier will accuse you of exaggerating your symptoms.

The functional capacity evaluator will also be looking for inappropriate description of symptoms which can include:

• Whole leg pain;
• Whole leg numbness;
• Whole leg giving out;
• Tailbone pain; and
• The failure of medical treatment and no pain free periods.

Psychometrics testing in the FCE

You may be given a battery of psychometric testing to assess your perceived pain and disability. The lack of consistent findings can suggest a non-organic influence that has more to do with illness behavior than physical disease. The testing can include:

• Ransford pain drawing;
• Numeric pain rating scale;
• McGill pain questionnaire;
• Dallas pain rating questionnaire;
• Waddell’s testing; and
• Oswestry pain questionnaire.

As a long term disability attorney, I seriously question whether the psychometric testing is a legitimate part of a functional capacity evaluation and would suggest that you refuse to take any psychometric testing. You should, fully, otherwise cooperate with the functional capacity evaluation.

Getting the long term disability benefits you deserve

If you’ve been scheduled for a functional capacity evaluation, you are, most likely, being set up for a claims denial.

You should first check your policy to see if whether or not the long term disability carrier even has the right to a functional capacity evaluation. If the policy doesn’t allow for the functional capacity evaluation, I would strongly recommend that before going you consult with a long term disability attorney and see if they agree with you. You shouldn’t subject yourself to testing that is not permitted under the long term disability policy.

If you’ve been scheduled for a functional capacity evaluation, it’s time to contact long term disability attorney, Nancy Cavey, who will help determine the best course of action for you.

Contact her today at 727-894-3188 for a no obligation consultation about your rights to long term disability benefits.

How Your Doctor Can Help You Win Your Long Term Disability Claim

Doctor Long Term Disability Claim

The long term disability carrier will send your doctor a physician disability form to complete which asks questions about your physical restrictions and limitations. Unfortunately, there is no routine form and many of the forms are designed so that your physician will ultimately opine that you’re capable of sedentary work. Why? The long term disability carrier wants to deny your claim.

Doctor Long Term Disability Claim

If the form that your doctor has been sent by the long term disability carrier simply doesn’t address all of your restrictions and limitations, have your doctor document on the form what, in fact, your restrictions and limitations are as a result of your medical condition.

The Definition of Disability

Before you have your physician complete the form, get out your policy and look at the definition of disability. Many times the definition of disability includes an inability to do the “material and substantial duties of your own occupation as performed in the national economy.” You will want to get a description of your occupational duties and provide that to your physician outlining for them the material and substantial duties of your occupation. You want to make sure that your doctor understands the standard of disability before completing the RFC forms.

Getting The Help You Need for Long Term Disability

Using a combination of exertional and non-exertional impairments can be crucial to winning your long term disability claim. You should contact an experienced long term disability attorney, such as Nancy Cavey to help develop the exertional and non-exertional impairments that can help win your claim.

It is crucial that you and your physician understand the standard of disability and the proof needed to get the benefits you need. Contact long term disability attorney, Nancy Cavey, who can help you get the benefits you need regardless of where you live in the United States. She has written to go to guide for Long Term Disability – Get it Here!

What Happens After Your ERISA Law Suit has been Filed?

You purchased a long term disability policy to provide you with peace of mind. But, when you least can afford it, your disability carrier has denied your benefits and has rejected your appeal.

Your next and only recourse is to higher a long term disability attorney to sue your long term disability carrier. Your attorney will file what is called a complaint which outlines the facts of your case and why you are entitled to benefits. There generally is no activity for 60 to 90 days after a claim is filed. Why? The complaint is filed and then served on a defendant who, in turn, has to “answer” the complaint within 20 days after the lawsuit is filed.

There “answer” is nothing more than the formal denial of the allegations of the complaint.

After the answer is filed, the court will issue a scheduling conference order directing the attorneys to confer about the scheduling of events in your case including, taking depositions, disclosing experts, filing motions, mediation, pretrial and trial.

The scheduling conference takes place about two to three months after the law suit is filed and establishes a time table for the parties to complete the discovery, conduct mediation and have a trial date.

Each court has there own local rules. These dates might vary depending on where you live. In any event, it may seem that nothing is happening until the scheduling conference. And, quite frankly, that’s incorrect. Many ERISA long term disability attorneys are drafting what’s called interrogatories and requests to produce which they can file as soon as the scheduling conference order is issued.

You can learn more about the ERISA mediation process by contacting ERISA disability attorney Nancy Cavey who can help you with your claim regardless of where you live in the United States.

Continuing Disability Statements and Your Rights to Long Term Disability Benefits: The Introduction

traps for disability statement

You may have received a phone call or letter from your long term disability carrier advising that they want to take “a continuing disability statement”, they may even come to your house to attempt to take the statement which I strongly discourage. The introductory part of the continuing disability statement will include:

1. The agreement that the interview site is an agreeable location
2. Identify who is present and their relationship, if any, to you
3. The day’s date and time
4. Your acknowledgement that the interview is going to be recorded and your agreement to the same
5. Questions as to whether you are under the influence of any alcohol or drugs
6. Question about your prescription medication that would impair your ability to provide a statement
7. Any diagnoses of any mental or physical condition that would prevent you from understand or answering questions
8. Your agreement that you can provide a clear and coherent interview
9. Identification by you of the medical conditions that currently prevent you from working.

There are number of traps in this introduction but first and foremost is your agreement to give a statement at your home. The disability representative will be taking notes about what your yard looks like, what the interior of your house looks like, your ability to move in or around our house, greeting the representative, how you sit or move or about throughout the interview and what assistive devices you may be using.

traps for disability statement

Another trap involves your failure to record the interview. Interviews are a two way street and many times you keeping your own recording is way to keep the long term disability carrier “honest”.

If you are taking prescription medication, be prepared to identify any side effects that you are having as a side effect of those medications that will interfere with your ability to give a statement. For example, some medications can make you tired, dizzy, or cause slowed cognition, or slurred speech and your certainly don’t want to be giving a statement if you are under the influence of those medications.

Describing your medical condition can be a trap in that there might be multiple medical condition each of which individually cause you to be disabled, or when combined, cause you to be disabled. Many long term disability recipients simply don’t understand the combined impact of multiple medical conditions or multiple medications on their ability to work.

You should be thoroughly prepared, even for the introduction of a disability statement.

You can learn more by ordering long term disability ERISA attorney Nancy Cavey’s book The Smart Long Term Disability Consumer Guide for Preparing for Your Statement and Field Visit.

Make Your Medical Records Work for You and Your Claim for Long Term Disability Benefits

medical records long term disability

When you apply for short or long term disability benefits, carriers will obtain your medical records and have your physician complete what’s called an Attending Physician’s Statement Form.

medical records long term disability

Make Your Medical Records Work for You

Those medical records and what your physician has to say about your restrictions and limitations can make or break your disability claim.

It’s crucial that your doctor document, with your assistance, your physical or psychiatric complaints, how those complaints impact on your ability to function and establish an objective basis for your doctor’s opinions about your restrictions and limitations.

Many times, disability carriers will deny disability claims on the basis that there is insufficient medical support in the medical records and that you are capable of working in either your occupation or any occupation.

What You Should do Before You File a Disability Claim

Before you apply for disability benefits, get a copy of your medical records and review them. Ask yourself whether there is an objective basis for your diagnosis, an objective basis for your restrictions and limitations, and a causal relationship between your inability to do your own occupation or any occupation and the medical evidence in your medical records.

If there isn’t, you need the assistance of disability attorney, Nancy Cavey, who can review your medical records and work with you and your physician to document the medical basis for your disability.

Disability attorney Nancy Cavey can assist you in your initial disability application regardless of where you live in the United States. Contact her today at 727.894.3188 for a complimentary 30 minute consultation. Don’t delay!

Approved Today, Denied Tomorrow Games Long Term Disability Carriers Play!

Long term disability carriers aren’t in the business of paying benefits! There real business is collecting premiums and investing.

The Transition in the Definition of Disability

An approval of your disability claim today doesn’t mean that they are going to continue to make payment of the benefits tomorrow.

It’s not uncommon for carriers to review files closely in the transition from short to long term disability, from long term disability, own occupation benefits, to long term disability, any occupation benefits, and after an award of Social Security Disability benefits.

Games Disability Insurance Carriers Play

Disability carriers will routinely ask you to fill out activity of daily living forms and harass your doctor with requests for Attending Physician’s Statement Forms to be completed.

Worse yet, if the long term disability carrier doesn’t like that your doctor says you are unable to work, they will pester your doctor asking for clarifications on restrictions and limitations until your doctor has finally had enough or, in conversation of the long term disability carrier, can see that you produce some form of sedentary employment.

You and your doctor need protection from the games the long term disability carriers routinely play in wrongfully delaying and denying benefits.

If you have purchased a long term disability policy through your employer as an individual, you should be prepared for the games that carriers play when you become disabled.

Irritable Bowel Syndrome and Your Rights to Long Term Disability Benefits

Irritable Bowel Syndrome long term disability

Long term disability carriers don’t make it easy for those who have Irritable Bowel Syndrome (IBS) to get the Long Term Disability Benefits they deserve.

Signs of Irritable Bowel Syndrome IBS are:Irritable Bowel Syndrome long term disability

1.) Abdominal pain,

2.) Bloating,

3.) Discomfort.

Other signs of IBS can include:

1.) Cramping in your abdomen,

2.) Diarrhea or constipation,

3.) Changes in how often you have bowel movements,

4.) Mucus in your stool.

Your colon has layers of muscles that tighten up and relax. That steady rhythm moves food and waste through your intestines. But, with IBS, the muscles in your colon do not contract like they should. Strong or weak contractions can cause cramping and bloating.

Your Rights to Long Term Disability benefits with Irritable Bowel Syndrome

The symptoms of pain, bloating, and discomfort can interfere with your ability to perform the essential duties of your occupation. It’s crucial those symptoms be developed in your medical records, if you want to be successful in your claim for Long Term Disability benefits.

Long Term Disability carriers do not always make it easy for IBS sufferers to get the disability benefits they deserve. Contact IBS Attorney Nancy Cavey, who can help you get the Long Term Disability benefits you deserve regardless of where you live in the United States. Call today for a complimentary consultation at 727-894-3188.