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    Robbed of Your Peace of Mind? Your Guide to Long Term Disability Benefits

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

What Happens After your ERISA Lawsuit has been Filed?

erisa lawsuit

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 hire 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 erisa lawsuitdays 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.

Need Help With Your ERISA Lawsuit?

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.

The Initial Application for Short Term or Long Term Disability Benefits Can Make or Break Your Case

long term short term disability cases

Completing your initial application without consulting a disability attorney is a setup for failure. You should formulate a plan of attack for winning your long term disability claim before you willy nilly complete an initial disability application with hopes that your carrier will Fedex a disability check to you.long term short term disability cases

Applications often contain vague questions that are misleading or will bait you into submitting incomplete information. Worse yet, having an irregular disability policy you don’t even know the standard proof you need to establish to show that your disabled as a result of your medical condition.

You will also be asked to have your physician complete an Attending Physicians Statement, or APS form, which will also have vague and misleading questions. As part of the initial disability application process it’s crucial that you discuss with your physician filling out the disability forms and the standard of a disability. You may be surprised that your physician wont fill out the disability agreement form or even support your claim for disability benefits.

Short and long term disability application attorney Nancy Cavey helps place you in the best position to secure your social security disability benefits. By:

1. Reviewing your policy;

2. Reviewing your medical records;

3. Creating a plan of attack and strategy for submitting a winning short and long term disability application;

4. If necessary consulting with your physician and helping them understand how to properly fill out the short or long term disability application;

5. Help you prepare and accurate description of your occupation;

6. Help accurately and fully complete your disability application.

Questions About The Initial Application For Short Term or Long Term Benefits?

If you have questions regarding the initial application for short or long term disability benefits or how to appeal a claim that’s been denied, you should immediately consult with Nancy Cavey. A severe medical condition makes it impossible for you to work, Nancy Cavey can help you 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.

Tricks Long Term Disability Carriers Will Use to Deny Your Claim for Disability Benefits

long term disability carrier tricks

Many long term disability carriers will use a paper review of your file conducted by its internal medical personnel to determine whether or not there is:

1. An objective basis of your severe diagnosis.long term disability carrier tricks

2. An objective basis for the restriction of limitations that have been assigned.

3. A causal relationship between your diagnosis and or restrictions limitations in your inability to perform your own occupation.

It is not unusual for long term disability carrier’s medical personnel to determine your records do not indicate an inability to return to work.

Next weapon that long term disability carriers will use is a functional capacity evaluation to determine your restrictions and limitations. A long term disability carrier will select a bias FCE provider who will give the long term disability carrier exactly what they want- a reason to deny your claim either on the basis you didn’t fully cooperate with the FCE or that the restrictions and limitations indicate that you can engage in at least sedentary work.

It’s not uncommon for long term disability carriers to cherry pick the portions of the functional capacity evaluation to support their position to terminate benefits.

The third trick that long term disability carriers will use is to place you under video surveillance to justify a termination of the benefits. They’ll use it as a one two combination with your statement to show that you are exaggerating your complaints or functionality as compared to what is shown on the video tape.

Long term disability attorney Nancy Cavey will systematically attack long term disability carriers positions using their own evidence against them. She’ll also supplement your file with additional medical evidence to support your claim for disability benefits It is not unusual for long term disability appeal letter alone to be 65 pages long and, with additional medical and vocational support, to be hundreds of pages long.

If you suspect that your long term disability claim is being setup for a denial keep in mind those three tricks that long term disability carriers will use to justify their claims denial.

Long term disability carriers will go to any lengths to deny your benefits. Long term disability attorney Nancy Cavey handles long term disability claims throughout the United States and has represented claimants against every major long term disability carrier.

For a free consultation regarding your long term disability claim you can call 727.894.3188.

Do ERISA plans have to abide by Social Security Disability benefit award?

ERISA plans

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 ERISA plansassistance 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.

Why?

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.

Why Should I Appeal the Denial of my Disability Benefits?

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.

What is an ERISA Appeal?

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.

Chemotherapy, Breast Cancer, and Your Rights to Long Term Disability Benefits

breast cancer long term disability

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 breast cancer long term disabilitypatients 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

Doctors Earn Millions to Aid Long Term Disability Insurance Companies to Deny Claims

doctors long term disability

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 doctors long term disabilitybenefits. 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**

ERISA Mediations, Your Chance to Tell Your Story

medications ERISA disability

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 medications ERISA disabilitymake 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.

Long Term Disability Insurance Offsets

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.