Free Consumer Reports

  • Long Term Disability Guide

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

    View Details

  • Hiring a Great Long Term Disability Attorney

    The Key To Hiring The Right Long Term Disability Attorney

    View Details

  • #

    The Smart Long Term Disability Guide For Preparing Your Statement and Field Visit

    View Details

  • Social Security Disability Guide

    Your Rights To Social Security Disability Benefits - Your Guide to Getting Benefits Now

    View Details

Tag Archives: Long Term Disability carriers

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Further, the long term disability companies will cite to an outdated study in the Journal of Rheumatology of 1996 called the “FMS Consensus Report.” The outdated report concludes that “only a minority of FMS patients are unable to work.”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

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.

UNUM’s Use of “Independent Medical Examiners” | UNUM Disability Claim Lawyer Florida

What: UNUM Article by Jane Lundy

In an interesting article by Jane Lundy on October 28, 2009, Jane outlines the gains that Long Term Disability carriers, such a UNUM play, by using “independent examiners.” Independent doesn’t means independent, it means a doctor who, for whatever a reason, needs to make money to supplement their income and becomes a hired gun for Long Term Disability insurance companies like UNUM.

If you are being scheduled for an Independent Medical Evaluation in your Long Term Disability claim, you need to immediately call and experienced Long Term Disability and ERISA attorney who can assist you in understanding the “independent medical” process and help you protect yourself from bogus independent medical evaluations.

Hartford Insurance Company Rehabilitation Counselors Denying Long Term Disability Claims

Did you know that it is not uncommon for Long Term Disability carriers, such as Hartford to reward their outside rehabilitation vendors for helping deny Long Term Disability claims?

Hartford has a rehabilitation supplier performance reviews on their Long Term Disability cases and part of that review actually requires the rehabilitation counselor to tell Hartford how much money they have saved Hartford by rendering an opinion that a person can return to work.

I wouldn’t be surprised that there is some form of reward system as part of the performance reviews that rewards vocational rehabilitation counselors and others for assisting in claims closures.

If you’ve received a claim’s denial letter from Hartford or other Long Term Disability carriers, and an opinion that their vocational rehabilitation counselor says that you are capable of working, you have potentially been set up by a rehabilitation provider who is putting their financial interest before yours. You need to immediately contact Long Term Disability/ERISA Hartford Denied attorney Nancy Cavey for assistance in appealing your Long Term Disability claim’s denial. Contact us today to help with your Hartford Claim.

The Truth About Long Term Disability Carriers Attending Physician Forms

All long term disability carriers will have your physician complete what called an attending physician form. Unfortunately there is no uniform forms. ETNA, for example, asked doctors to comment on activities of daily living driving, lifting, pulling and pushing.

In Helms vs. Gerald Dynamics Corp, 2007 US.app.Lexus 4534 (11th Circuit February 7th, 2007) in a published decision, the 11th circuit held that ETNA “unreasonably construed what qualified as restrictions and limitations”, ignoring the opinions of the treating physician which established the extensive restrictions and limitations and which were greater than ETNA’s own attending physician form.

Initially, ETNA concluded that the claimant had “difficulty driving and needed to lay down occasionally,” but then when on “conclude in the very next line that Helms had failed to submit any restrictions and limitations”.

The court held that ETNA claims handling was contrary to the “undisputed evidence”. If ETNA is using an attending physician form to deny your claim for benefits, contact ETNA denied long term disability attorney Nancy Cavey.

Doctor’s Paid to Help Long Term Disability Carriers with Their Claim’s Denials

The Long Term Disability insurance company has an army of doctors to write disability reports saying that you are capable of working at least a sedentary position and these opinions carry more weight in court than even the opinion of a treating physician.

Long Term Disability peer review doctors aren’t required to see you. They simply review the medical records sent to them by the Long Term Disability insurance company and render an opinion about your level of physical functioning.

If the peer review doctor, who can be paid millions over years, writes that you are capable of at least working in a sedentary capacity you lose your Long Term Disability benefits. Doctors such as psychiatrist, Steven Gerson, are well known in the disability world for writing favorable report after favorable report for Long Term Disability insurance companies.

If you’ve received a denial letter from you Long Term Disability carrier on the basis of a peer review report, you need assistance with your Long Term Disability claim immediately. Remember you only have 180 days in which to file an appeal or the insurance company wins. Don’t let the Long Term Disability carrier and peer review doctors rob you of your peace of mind.

Common Myths: What the long term disability companies don’t want you to know about your disability claim.

Long term disability carriers spend a lot of money advertising on the TV. I am sure you have seen advertisements for Liberty Mutual, The Hartford, CIGNA and other carriers claiming how they will be there for you in your time of need when you are unable to work. These insurance companies have used the media to spread a number of myths about disability insurance coverage. Why? To collect your premium! Long Term Disability carriers are in the business of collecting premiums not paying benefits.

Then, in your time of need they betray your trust, they send you correspondence asking you to have doctors complete forms and you fill out activities of daily living forms. When they don’t like the way they are filled out, they will harass your doctor to fill them out differently so that your doctor will finally give up and say you can work. OR better yet, they will send an investigator to your house to take a statement from you and put surveillance on you for the purposes of labeling you a liar.

Call Barb, at Cavey and Barrett, to set your pre-appointment consultation to learn the truth about disability law, call 727-894-3188.

How Your Doctor Can Destroy Your Long Term Disability Claim | LTD Attorney

What: Doctors and Your Long Term Disability Claim

Unfortunately, some treating physicians are uncooperative and don’t want to get involved in Long Term Disability claims. Because they choose not to get involved, Long Term Disability carriers, like UNUM, will interpret the doctor’s failure to get involved to mean that you have no restrictions and limitation and are not entitled to Long Term Disability benefits. Even if your doctor states that he only treats you and hasn’t evaluated your restrictions and limitations, the carrier will misconstrue that comment.

If your treating doctor is unwilling to help you with your Long Term Disability claim you, unfortunately, have a difficult decision to make. You may have to change doctors and find one that would be willing to deal with all the paperwork that the Long Term Disability Insurance company provides.

If you need assistance with your Long Term Disability claim or guidance on how to proceed contact Long Term Disability ERISA claim attorney Nancy Cavey who can help you develop the necessary medical and vocational evidence to support your claim.

Learn About Fibromyalgia | Fibromyalgia Disability Claims

Fibromyalgia is a syndrome that describes symptoms that are characterized by complaints of wide spread pain, decreased pain threshold, non-restorative sleep, fatigue, stiffness, mood disturbances, irritable bowel syndrome, and headaches.

The American College of Rheumatology established criteria for the classification of Fibromyalgia. There are two criteria, these are:

1. At least a 3 month history of wide spread history on both sides of the body at locations both above and below the waist in the skeletal axis.

2. Pain palpitation for at least 11 of 18 designated tender points, which are found on both side of the body.
There is no definite laboratory or a diagnostic test that can confirm the presence of this disease and as a result it is largely based on self-reported symptoms.

The Long Term Disability carriers hate fibromyalgia claims because of these self-reported symptoms and generally don’t recognize that fibromyalgia patients are unable to work.

Long Term Disability carriers by policy generally treat fibromyalgia syndrome claims with an assumption that is reasonable to conclude that you are able to perform sedentary or light work. In other words, there is a built in biased that Long Term Disability carriers have with every Fibromyalgia case and that is that you can perform sedentary or light work.

If you are able to either by definition, you are not entitled to Long Term Disability benefits.

At Cavey and Barrett, we believe that it is important to develop the physical requirements of your job and show by objective medical evidence such as functional capacity evaluations that you are unable to perform sedentary or light work. We believe that fibromyalgia claims are best developed in conjunction with your treating physician, a functional capacity evaluation and a vocational evaluator who has experience in handling fibromyalgia claims.

If you are a fibromyalgia syndrome sufferer who is thinking about filing a claim for Long Term Disability benefits, Nancy Cavey, fibromyalgia Long Term Disability benefits denied attorney, can help you make sure that you have the necessary medical and vocational evidence to fight a Long Term Disability carrier’s presumption that you can do sedentary or light work.

Prudential Insurance Company Ordered Response to Long Term Disability Request for Claims Guidelines

Long Term Disability carriers hide behind many defenses one of which is that you are not entitled to learn the basis of the denial or analyze the nature of the information the Long Term Disability carrier considered in making the decision.

In a recent case of Grams v. American Medical Industries under Prudential Insurance Company, my good friend and colleague, Claudeth Henry, fought the Prudential Insurance Company on these discovery issues and won!

The court has ruled that Ms. Grams is entitled to analyze how Prudential reached this decision to deny benefits and analyzed the nature of the information that Prudential considered.

If there is a conflict of interest, the administrator decision does not automatically prevail in the 11th Circuit, and instead the court has to continue its inquiry to determine the self-interest of the claim’s administrator.

While the court pointed out that the existence of a conflict of interest doesn’t necessarily permit fraud discovery, it doesn’t allow the discovery to focus on evidence related to Long Term Disability carrier Prudential Insurance Company self interest in denying claim’s benefits.

In Ms. Grams case, Prudential Insurance Company determined the eligibility for benefits and paid the benefits.

We will see if Prudential Insurance Company abides by the court’s decision and produces this material.
If your claim for Long Term Disability or ERISA benefits has been denied and you are filing an appeal you need to consult an experienced Long Term Disability attorney immediately. You only have 180 days to submit to the Long Term Disability carrier the evidence that supports your claim. Delay can even result in denial! You can contact Pinellas and Hillsborough County Long Term Disability attorney Nancy Cavey by phone at 727-894-3188 or Contact Us Now online.