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Tag Archives: Long Term Disability carriers

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.

Employers Hand Over Their Legal Responsibilities to Disabled Employees

Unfortunately, an overwhelming majority of employers look for somebody or some organization to hand over their legal responsibilities too. Instead of taking responsibility for managing their lost time cases, return to work issues or employees on short term disability, many employers find groups like  “Custom Disability Solutions” and “The Regroup” who offer services to make it easy for employers to evade their responsibility.

Leed Management Administration Services, in my opinion, work with human resources departments by providing alleged guidelines and analytics to help employers manage their short and long-term disability need claims.

Organizations like The Regroup have developed pinnacle models that attempt to predict return to work periods for medical conditions. Interestingly enough, these guidelines often conflict with return to work criteria and factors recognized by organizations such as the American Academy of Orthopedics.

In trusting return to work and short term/long term disability management, quite frankly, does not make, in my view, good business sense. Employers should learn to administer leave on a consistent and focused manner and make sure that they thoroughly understand the Family Medical Leave Act: The Integration of Family Medical Leave which works with Long Term Disability carriers coverage so that they can partner with their employees in designing return to work criteria to meet the specific individual needs of the employer and their employees.

At Cavey and Barrett, Nancy Cavey, an experienced Workers’ Compensation, Social Security and Long Term Disability attorney has worked for many years with both employers and employees in the managing of disability claims.

She brings her expertise into the handling of claimant and defense insurance matters in representing individuals who have short term and long-term disability claims.

She will assist short and long term disability applicants in understanding and making choices about your entitlement to benefits and the best path creating a favorable outcome for you and your employer.

For a free, no obligation, consultation, at a $450 value, contact the Law Offices of Cavey and Barrett at 727-894-3188.

Join countless other short and long-term disability recipients in obtaining your benefits!


Long Term Disability Carrier’s Use of PSY BAR

Unfortunately, long-term disability carriers routinely use companies such as PSY BAR to review long-term disability/ERISA claims involving psychiatric conditions.

I recently reviewed PSY BAR’s website and noted that they offer online courses to adjusters and IME doctors.

One of the courses, “Psychological and Psychiatric Assessment of Individuals for Disability Insurers,” actually teaches “independent medical doctors” what the long-term disability insurance company’s expectations are and how to meet those expectations in an ethical manner.

Interestingly enough, this course identifies what PSY BAR believes to be “common IME errors:”

“ERROR NO. 1 – Confusing the needs of the disability carrier with other kinds of coverage including medical, workers’ compensation, and Social Security.”

ERROR NO. 2 – Confusing diagnosis with limitations in functioning.

ERROR NO. 3 – Confusing symptoms with limitations in functioning.

ERROR NO. 4 – Assuming the role of a treating doctor.

ERROR NO. 5 – Interpreting measures of personality and mood as measures of functional capability.

ERROR NO. 6 – Making conclusions about functional problems caused by physical illness.”

I am sure that long-term disability carriers are looking for reasons to deny claims involving psychiatric conditions and will look for these errors in your treating physician’s records.

If you have any questions regarding your long-term disability claim or need assistance, contact experienced long-term disability/ERISA disability attorney Nancy Cavey, who is based in Florida.

Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.