Practice Areas

FREE Books

Florida's First Responder Heart/Lung Benefits: What You Need to Know

Your Wage and Hour Rights -Information Your Employer Never Wanted You to Hear.

Your Rights to Social Security Disability Benefits - Information the Social Security Administration Rarely Tells Your About Your Claim.

Robbed of Your Peace of Mind? Important Information on Long Term Disability Insurance Policies, The Claims Process, and How to Win Your Long Term Disabality Benefits.

Latest News

Library

Cavey Barrett Blog

Florida First Responders and Their Rights to Workers' Compensation Benefits

8/6/2008
Nancy
Comments (0)

Risks Factors Don' t Mattter Any More In Florida First Responder Claims

In a block buster decision on July 21, 2008, the First DistrictCourt of Appeals ruled munciipalities can't try to overcome the Florida First Responder's Presumption by arguing that other risk factors overcome the presumption.

Florida Statute 112.18 says that First Responders who have heart attacks with no apparent nonoccupational cause are entitled to Florida workers compensation benefits.

To get the benefit of the presumption you must show that you pass a preemployment physical and your employer can't overcome that presumption. Municipalities typically try to overcome the presumption by showing evidence of pre-existing conditions and other personal risk factors, such as a family history of heart disease.

The Court found that there's a difference between risk factors and causation. The only way to overcome the presumption is to show a specific cause of the claimant's heart disease that isn't occupationally based.

This ruling in Punsky v. Clay County Sheriff's Office takes away one of the primary defenses I see raised to valid Florida First Responder Claims.

Labels: Florida First Responder Claims. Florida First Responder's Presumption Florida Statute 112.18 Punsky v.Clay County Sheriff's Office

5/9/2008
Nancy
Comments (0)

New First Responder Peripheral Vascular Disease Decision Extends Presumption

On May 8, 2008 The First District Court of Appeal clarified its decision in Butler v. Jacksonville. Mr. Butler was a firefigher who had hypertension which caused peripheral vascular disease (PVD). The First District held that Butler was entitled to presumption that his PVD as caused by his occupation as a firefighter. The Court also found Mr. Butler was permanently totally disabled as a result of the PVD. His hypertension was not per se disabling.

This is a great case that can be used to argue that any medical condition that flows from a presumed condition is also a covered presumptive condition extending the reach of the presumption!

Take a look at http://opinions.1dca.org/written/opinions2008/05-08-08/06-5918.pdf

Labels:

Long Term Disability ERISA and Private Disability Insurance Claims

5/29/2008
Nancy
Comments (0)

Protect Yourself from Surveillance By the Long Term Disability Carrier

Is there a strange van down the street? Are you being followed? Are you getting calls and when you answer, the person on the other line hangs up?

If is is happening to you, the long term disability carrier just might have surveillance on you to see if you are doing something you said in your activity of daily living forms you could not do! Or they just might be checking up on you.

How can you protect yourself? Simple! Call the police and report this activity everytime it happens.

If you are driving in your car and being followed either drive to the police station or use you cell phone call 911. Give the 911 operator your location, the make, model and color of the other vehicle (and there can be more than one), and your vehicle description. Carefully follow the instructions the 911 operator gives you.

Unfortunately,you can't tell if it is a carjacker or insurance company surveillance. Don't play games with your safety!

Labels: disability insurance surveillance protect yourself from surveillance surveillance by insurance company

5/29/2008
Nancy
Comments (1)

Has Hartford Targeted Your Long Term Disability Claim For Termination

Unfortunately, it seems that some long term disability carriers are targeting certain long term disability cases for denial.

Hartford has a GRP division that buys long term disability claims from other carriers and then targets the claims for denial.

Based on what I am seeing in my practice, Hartford is also trying to target claims on the psychiatric limitation of benefits clauses that limit the payment of long term disability benefits for psychiatric conditions to two years. Hartford will have a physician review the case and determine that, while the person has physical problems, the real problem is psychiatric. That physician or Hartford will then try to get the treating physicain to sign off by saying that your disability is really " psychiatric." Bingo, your long term disability benefits are terminated.

Any, in yet another situation, Hartford is terminating benefits after a Social Security award results in a significant reduction in long term disability benefits. They try to have it both ways by reducing your long term disability benefits and then terminate benefits on the basis you are no longer disabled.

Don't be a victim of Hartford's games. If you have been denied benefits or had your long term disability benefits terminated, please contact an experienced ERISA or disability attorney.

Nancy Cavey can be reached at 727-894-3188.

Labels: disability attorney ERISA attorney Hartford Hartford termination after award of social security Nancy Cavey termination of LTD by Hartford

5/5/2008
Nancy
Comments (0)

Cancer is Top Cause of UNUM's Disability Claims

Unum has issued an annual review of the leading causes of the 400,000 short and long term disability claims it got in 2007.

According to the review, the leading cause of short term disabilty claims is a normal pregnancy which caused 21% percent of the disability claims. That is understandable! 10% of the claims where due to non- back related injuries, 7% due to digestive or intestinal disease and 6% were due to back injuries.

The leading cause of long term disability claims, based on a disability database that tracks 25 million covered individuals and 178,000 employer policies, for 2007 was cancer at 12.2% followed by complications of pregnancy at 12.1% and back injuries at 11%.

UNUM has done a study into the factors that cause mssed time from work during cancer treatment and successful return to work after treatment. UNUM is encouraging employers to support workers diagnosed with cancer duirng treatment and to assist in return to work. http://www.medicalnewstoday.com/articles/106231.php

Labels:

5/4/2008
Nancy
Comments (0)

New York Insurance Comissioner Says UNUM is Complying with Claims Handling Agreement

The New York Insurance Commissioner has just announced that, in his opinion, UNUM is complying with the 2004 Multistate Agreement that UNUM entered into after being sued by a number of State Attorney Generals for their claims handling of long term disability cases.

Click on the link http://www.ins.state.ny.us/press/2008/p0805011.htm

Labels: UNUM Settlement, claims handling, NY Commissioner of Insurance report on UNUM, long term disability

4/28/2008
Nancy
Comments (0)

Must a Long Term Disability Carrier Give You Medical Reports They Rely on To Deny Your Claim?

The ERISA statute, 29 U.S.C. 1133(2) says that a person asking for payment of long term disability benefits should be given "full and fair review .. of the decision denying the claim." You also must be given "all documents, records, and other information relevant to the claimant's claim for benefis for a review to qualify as a full and fair review."

Doesn't that sound reasonable? Reality is different!

Ms Glazer, who had myofascial pain, fibomyalgia, cervical spodylosis and radiclopathy, was cut off by Reliance, based on the report of a notorious "peer review" doctor who always opines "there is no medical evidence" to support a continuing claim for disability benefits.

Ms. Glazer wanted, like you would want, to see the "peer review" report Reliance had produced while it was reviewing the initial denial of benefits. Reliance said "no!"

The 11th Circuit Court of Appeals has agreed with Reliance! The Court has ruled, in a circular fashion , that a "relevant document" is not relevant until Reliance relied on it to deny Ms. Glazer's claim. Only AFTER, Reliance relied on the peer review report and denied Ms. Glazer's claim, would Reliance have to produce the damining report of its peer review physician.

The 11th Circuit justified this by holding that if Reliance produced the peer review report (which it got for the sole purpose of denying Ms. Glazer's claim) earlier it would "create an unnecessary cycle of submission, review, resubmission, and re-review."

I don't disagree but let's remember that Reliance started this review for the sole purpose of terminating Ms. Glazer's benefits. There was nothing fair about the process and letting Reliance hide this report during the review of the initial denial forces claimants like Ms. Glazer to try to "put the horse back in the barn."

You can look at Glazer v. Reliance Standard Life Insurance Company at http://www.ca11.uscourts.gov/opinions/ops/200615855.pdf

Labels:

4/27/2008
Nancy
Comments (0)

What is ERISA and Why Should You Care?

Your employer may have offered you a long term disability policy as part of your benefit package. Did you accept and begin paying premiums? If so, and if you are not employed by a church or a municipality, your claim is probably covered under the Empoyee Retirement Income Security Act (ERISA).

The ERISA Act was passed by Congress in 1974 to address teamster union corruption. Remember Jimmy Hoffa who used teamster dues to fund his criminal enterprise?

Congress wanted to pass a simple (not), comprehensive (not) and uniform (never) application of law for health, life, disability and pension benefits plans. The ideas was to reduce litigation by having a uniform system that protected beneficiaires such as yourself while reducing premiums.

The reality is that ERISA, which impacts your health, life, disability insurance policies, and even your private penion or 401 K plan, has failed miserably at meeting those goals.

ERISA has become a complicated regulatory maze that has only benefited administrators of ERISA plans and the insurance companies that offer these policies. ERISA has been used to deny people, like you, the benefits you paid for and the benefits you deserve.

ERISA specifically prohibits you from making any state law claims. Many state insurance laws provide consumer protection provisions such as prohibiting "discrectionary clauses" in policies.

ERISA usually presumes the claims administrator was right in making the decision to deny or limit your benefits. You, must show the claims administrator was "arbitrary and capricious" in denying your claim if you are going to win.

This is true even if the claims administrator who is making the decision to pay also pays the benefits. Talk about a conflict of interest!

Even if you proved you have been robbed, all you get are the benefits you asked for to begin with. You can't sue for compensatory damages or punative damages. You can't even ask that the claims administrator who wronfully denied your benefits be punished.

Even the court in Florence Nightingale Nursing Service v. Blue Cross Blue Shield, 832 F. Supp. 1456, 1457 (N.D.Al. 1993) called ERISA, "Everything Ridiculous Imagined Since Adam."

The United States Supreme Court heard oral argument on April 23, 2008 on the question of what deference a claims administrator should be given in an ERISA plan. This decision will have monumental impact on ERISA cases in the future.

Labels:

4/5/2008
Nancy
Comments (0)

Long Term Disability Carriers Clog Up The Social Secuirty System

2.5 Million American apply for Social Security disability benefits every year and it takes, on average a whopping 288 days, to get a decision on because of the backlog. The reality is that in the Tampa/St. Petersburg area the delay is almost 2 years.

What contributes to that delay? In an awesome article, the New York Times author, Mary Williams Walsch, exposed for the public what ERISA/LTD and Social Secuirty lawyers and their clients deal with every day. The Social Security Disability system is being clogged by long term diablility carriers, such as UNUM, Cigna, Liberty, who require any policy holder claiming long term disability benefits to apply for Social Security. And when a policy holder is denied, the long term disability carriers insist the policy holder appeal and appeal again!

The typical long term disability policy requires a policy holder to apply for Social Security Disability benefits. This improves the disability carrier's profit margin. If you refuse to apply, the long term disabiity carrier simply stops paying benefits until you apply or appeal. Sometimes, the long term disability carrier just reduces the long term disability payment by what you would have gotten in Social Security. This reduces the long term disability carrier's reserves and smaller reserves means bigger profits for the long carrier. So they pay less and can use their premium dollars for investment.

It gets worse. If you do get Social Security benefits, the long term disability wants thier money back from you lump sum retroactive Social Secuirty and reduce your monthly benefits! Then, many long term disability carriers have the gall to turn around after an award of Social Security benefits and tell their policy holder "They no longer qualify for LTD benefits.

Whistleblowers are claiming that since almost 18% of the long term disability applicants are ultimately denied Social Security, the long term disability carrier could screen those cases not likely to get Social security and not force their policy holder to apply and appeal.

Unloading unqualified Social Security applicants on the Social Security Administration's (SSA) doorstep is fraudulent and a waste of American tax dollars. Please read www.nytimes.com/2008/04/01/business/01disabled.

Labels:

Social Security Disability (SSD)

5/12/2008
Nancy
Comments (0)

Immune System Disoders Listing Updated by Social Security

Are you applying for Social Security disability benefits because you have an immune system disorder?

The Social Security Administration has published changes to the Immune System Disorder listings which will become effective June 16, 2008. Immune disorders that are covered in this listing include autoimmune disorders, HIV infection, systemic lupus erythematosus (SLE), scleroderma, connective tissue disorder, polymyositis, dermamyositis, inflammatory arthritis and a new listing for Sjogren's syndrome found at Listing 14.10.

You can view these changes at www.gpoaccess.gov/fr/index.html.

I will be commenting on the Immune System Disorders listings and changes in upcoming blog posts at our blog on Social Security Disability found at
http://socialsecuritydisabilitybenefitslawblog.com.

Labels:

5/3/2008
Nancy
Comments (0)

Social Security Is To Give GREAT Weight to VA Disability Ratings

If you are applying for Social Security Disability Benefits and that condition has been rated by the VA, the Social Security Administration must give GREAT weight to the VA disability rating

In McCartey v. Massanari, 298 F.3d 1072 (9th Cir. 2002), the claimant had been found by the VA to be permanently totally disabled and unable to "secure and follow a substantially gainful occupation due to disability." http://altlaw.org/v1/cases/1122239

The court reversed the ALJ rejection of the VA findings. If your disabiling condition has been rated by the VA, make sure you send Social Security a copy of the VA ratings decision. It could make all the difference in your case.

Labels: Social security disability benefits, VA ratings decision, VA findings

4/26/2008
Nancy
Comments (0)

Asksing for An On the Record Decision

Do you know that we rountinely ask for what is called an "on the record decision"?

Just before the hearing we get your updated medical reports, have residual funtional capacity forms completed by your doctor and write a detailed letter to the Administrative Law Judge about your case.

That letter outlines the 5 step sequential evaluation process and how the evidence in your file establishes that you should be awarded your Social Security Disability Benefits without having a hearing. This works in some cases and benefits are granted without the need for you to go to trial.

We have just gotten a notice from the Social Security Adminsitration indicating they are creating something called an "Adult Fully Favorable Draft Decision" form which is 2 pages long. We are to enclose the decision form with our cover letter starting in July 2008. Hopefully, this might speed up the process at the hearings level.

Labels:

4/26/2008
Nancy
Comments (0)

The VA Doctors's Duty to Respond to Medical Information in Your Social Security Case

It is not uncommon for a Veteran who is applying for Social Security Disability benefits to ask his VA doctor to complete Residual Funcational Capacity forms in support of the Social Security Claim. Unfortunately, VA doctors would say "No!"

VHA Directive 2007-024 now requires VA medical providers to complete SSA forms and SSA requests for a "Medical Source Statement".

If your VA doctor refuses and says they are not authorized to provide information, go to http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1593.

Run off the Directive and give it to the uncooperative provider. This should solve the problem and allow you to get the necessary SSA forms completed and get a completed Medical Source Statement.

Labels:

4/26/2008
Nancy
Comments (0)

Social Security Benefits For " Wounded Warriors"

The Social Security Administration has created a "wounded warrirors" website at www.ssa.gov/woundedwarriors.

The site explains what types of Social Security Benefits a military service member who became disabled while on active military service on or after October 1, 2001 might be eligible for, how to apply, how to speed up the decision and benefits for familly members.

The site also has links to a publication "Disability Benefits for Wounded Warriors" which is a must read.

Labels:

4/5/2008
Nancy
Comments (0)

Clogged Social Security System

Kenneth Nibali, former top Social Security Adminstrator of the Social Security disabilty system, is the plaintiff's expert in a whistleblower's suit that has just been filed in Federal Court in Boston. In a must read article in the New York Times on April 1, 2008, Mr. Nibali pointed out that long term disability carriers like Cigna and UNUM, are making their policy holders who are disabled apply for Social Securty disability, even if the claim does not meet the standard for Social Security disabilit benefits. That is fraud!

As a result, it is estimated that over 450,000 applications filed by long term disability policy holders - 18% of the 2.5 million Social Security disability applications filed annually - are not entitled to Social Security Disability benefits. That bogs the Social Security system down causing a delay for legitimate claims.

It also costs the Social Security Administration $4,759.00 to process a case through the first 3 levels of claim review to a hearing in front of an Administrative Law Judge.

While most ERISA policies require a disabled policy holder to apply for Social Security, long term disability carriers do have a reasonably good idea which cases are not going to meet Social Security disability standards. They could weed these cases out and not force denied policy holders to appeal and appeal their Social Security denials.

Weeding out these cases would help reduce the huge backlog that exists and would save millions and millions of our taxpayer money. Money that could be used to streamline the Social Security disability process and hire staff to process Social Security disability claims.

Wouldn't it be a novel idea if long term disability carriers, who force a policy holder to apply for Social Security over and over, repay the Social Security system the $4,759.00 it costs to process the case through a Social Security hearing in front of the Administrative Law Judge if the Judge denies the claim.

Think of it as a user's fee the long term disability carrier would pay for clogging the system with baseless claims!

Labels:

General

6/6/2008
Nancy
Comments (0)

Shocking News - 140,000 Unexpected Requests for Social Security Hearings

Sharon Barrett, a St. Petersburg Social Security Attorney and my law partner, has just called from Miami where she is attending the National Organization of Social Security Claims Representatives (NOSSCR) conference.

One of the speakers Lisa DeSoto, Social Security's Deputy Commissioner for the Office of Disability Adjudication and Review, announced at the Social Security Administration received 140,000 more requests were a hearing before the Administrative law judge this year than expected.

The Social Security Administration has a plan to eliminate the huge hearing backlog which has resulted in 17,000 approvals of Social Security disability benefits at the reconsideration stage, 14,974 senior attorney decisions and 60,000 more administrative law judge's dispositions this year.

However, we knew this plan would not result in addressing the 28,623 cases in which Social Security disability applicants have been waiting 900 days for a hearing and other backlogs.

The 140,000 unexpected requests for hearing will just increase that backlog!

You can order our free book on the Social Security disability application process at caveylaw.com

Labels: Lisa DeSoto, Social Security's Deputy Commissioner for the Office of Disability Adjudication and Review Sharon Barrett Social Security disability application process St. Petersburg Social Security Attorney

2/10/2008
Nancy
Comments (0)

Back Log of Social Security Cases and Proposed Rules to Limit Evidence

There are 8.7 million disabled workers collecting Social Security Disabilty Benefits and over 3 million people apply for Social Security Disability Benefits each year! Only 33 percent of the initial applications are approved and only 700,000 appeal the denial to the Administrative Law Judges. Roughly 1 million people give up! Of the 700,000 who appeal the average wait from the filing of the initial application to a decision from the Administrative Law Judge is 500 days!

Under proposed Social Security Rules, the disability appeals process would adopt strict deadlines and rules of evidence. The Administrative Law Judge would give 75 days notice of hearing and require the applicant to submit all evidence supporting their claim for benefits withiin 5 days of the hearing. No post hearing evidence would be allowed as is now permitted.

While, on the face of it, these proposals sound reasonable, the proposed rules would discourage unreprsented cllaimants. Nancy Shor, executive Director of the National Organizations of Social Security Representatives (NOSSCR) was quoted in an interview with Alex Wayne, House Democrats Oppose Proposed Social Security Claims Policy, http://cqpolitics.com, as saying the new rules would discourage the "unrepresented claimant- from appealing a denial of benefits.. about a third of those who appeal do not hire lawyers."

Rather than hire staff and Administrative Law Judges to deal with the back log of 750,00 cases, which is the largest in our history, the proposed rule would hinder an applicants ability to submit evidence. As a result, denials will only increase. This proposed rule underscores the need for all applicants to have representation in the social security disability claims process.

Labels:

9/14/2007
Larry
Comments (0)

Real Life

Historically, businesses have taken advantage of their workers. In a system or business design where employees are reduced to commodities or just plain numbers, the only thing typically concerning the business owners is profits. When profits are the sole desire, people get lost in the mix.

At my old job, I would receive a salary based on 40 hours a week of work. However, presumably like many others, I would sometimes work 50, even 60 hours a week. I didn't think anything of it because I just wanted to do my job and make everything run smoothly. I didn't know Florida's Wage Laws.

Many businesses are required to pay some of their employees overtime, but they do not. There are many ways for businesses to avoid doing this as I have learned this personally.

I am so glad there are lawyers in the Tampa Area that are fighting for the average worker's rights.

You guys rock!!

Larry

Contact Us Today - Free Consultation

Cavey & Barrett
821 16th Street North
St. Petersburg, FL 33734-7539

Phone: (727) 894-3188
Fax: (727) 821-2751

The Law Offices of
Cavey and Barrett

821 16th Street North
Post Office Box 7539
St. Petersburg, FL 33734

Workers' Compensation
727-894-3188

Long Term Disability
727-897-9053

Social Security Disability
727-897-9117

Fax: 727-821-2751

Practice Areas

Cavey Law Blog

FREE Books

Latest News

Library

Cavey Barrett Blog

Risks Factors Don' t Mattter Any More In Florida First Responder Claims

New First Responder Peripheral Vascular Disease Decision Extends Presumption

Protect Yourself from Surveillance By the Long Term Disability Carrier

Has Hartford Targeted Your Long Term Disability Claim For Termination

Cancer is Top Cause of UNUM's Disability Claims

New York Insurance Comissioner Says UNUM is Complying with Claims Handling Agreement

Must a Long Term Disability Carrier Give You Medical Reports They Rely on To Deny Your Claim?

What is ERISA and Why Should You Care?

Long Term Disability Carriers Clog Up The Social Secuirty System

Immune System Disoders Listing Updated by Social Security

Social Security Is To Give GREAT Weight to VA Disability Ratings

Asksing for An On the Record Decision

The VA Doctors's Duty to Respond to Medical Information in Your Social Security Case

Social Security Benefits For " Wounded Warriors"

Clogged Social Security System

Shocking News - 140,000 Unexpected Requests for Social Security Hearings

Back Log of Social Security Cases and Proposed Rules to Limit Evidence

Real Life

Contact Us Today - Free Consultation

FAQs