28 October

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Long Term Disability Denials Based On Vocational Opinions

In determining whether you are entitled to Long Term Disability benefits, the Long Term Disability carrier must determine whether or not your diagnosis and disability prevent you from doing your own occupation during the first twenty four months of your disability and any occupation thereafter. Long Term Disability carriers routinely use vocational rehabilitation counselors to review disability claims to determine whether or not you can do your former work or any work in the national economy. Unfortunately, vocational rehabilitation counselors hired by the Long Term Disability carriers make a number of mistakes. First, they will use the Residual Functional Capacity forms...

28 October

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Vacations and Your Long Term Disability Claim

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Many times I am asked by my Long Term Disability clients whether or not they can take a vacation and whether or not they may be risking denial of their Long Term Disability claim. As we know, Long Term Disability insurance companies aggressively use surveillance in both cases they are evaluating and Long Term Disability claims that have been accepted. They may try to contact you or send you forms for you to complete. If you don't return them or can't be found, Long Term Disability carriers are going to start aggressively looking at your Long Term Disability claim. Nancy...

28 October

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Why Long Term Disability Carriers Decisions Should Not Be Given Deference in Denying a Long Term Disability Claim

Posted by Nancy Cavey

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The Saffron vs. Wells Fargo & Company LTD Plan 209 US District Lexis 84152 (C.D.CAL. September 15, 2009), is one of my favorite cases. As a Long Term Disability attorney that deals with MetLife decisions denying claims, the Saffron case provided an interesting road map for determining whether or not MetLife should be given any deference in their denial decision. While this is a California case and not binding on the district courts in the 11th Circuit there are some interesting things to consider. The Saffron court noted that the district court could consider: 1. Whether MetLife ignored Ms. Saffron’s complaints of pain,...

28 October

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Sedgwick James Sues Unhappy Disability Policy Holder Because of Maintaining a Web Blog

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Can you believe this? Robert Delsman who was employed by GTE, sought Long Term Disability benefits under a MetLife GE plan. He was very unhappy with Sedgwick’s handling of his claim and began expressing his views through a web blog and post card mailing campaign called “operations going postcard.” Sedgwick and their chief executive and chief operating officer were not amused by Delsman’s complaints about wrongful denial of benefits to claimants and accused Sedgwick’s and its “minons” of being “Sedg Dogs.” Delsman also launched “operation going postcard” to “educate the consuming public” regarding the business practices of Sedgwick and one side...

28 October

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Long Term Disability Denials Based on Your Failure to Show Medical Improvement

Posted by Nancy Cavey

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Many Long Term Disability policies, such as Reliance Standard, require a showing of continued eligibility and they can ask for periodic updates to make sure that you continue to be eligible for Long Term Disability benefits. The three common reasons that Long Term Disability claims are denied or suspended is that the Long Term Disability applicant can’t: Show objective evidence of diagnosis Show objective evidence of disability Show objective evidence of the disability impact in your ability to do the material duties of your occupation Long Term Disability carriers will suspend the payment of disability benefits in part, based on what you put on your...

28 October

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Rebutting Potentially Damaging Surveillance Video and Your Long Term Disability Claim

Posted by Nancy Cavey

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Long Term Disability carrier’s like to collect premiums but don’t like to pay Long Term Disability benefits. One of the tools that they use to justify denial of Long Term Disability claims is surveillance. Many times, Nancy Cavey, Tampa Bay Long Term Disability attorney, finds that the Long Term Disability carrier does not submit all of the surveillance reports to their peer review independent medical examiner or even your treating physician for review and comment. If your claim has been denied as a result of video surveillance, Long Term Disability claim lawyer Nancy Cavey can secure a copy of your file including...

28 October

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The Many Mistakes Vocational Evaluators Use in Long Term Disability Cases

Posted by Nancy Cavey

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Long Term Disability carriers routinely use vocational evaluators to determine whether or not you can return to your former job or there is a job that exists in the national economy. Vocational rehabilitation counselors eager to please the Long Term Disability insurance company, make a number of errors in reaching a favorable Long Term Disability insurance opinion. These mistakes include: 1. Failing to understand the extent of your medical condition and the restrictions and limitations that you may have as a result of depression, fatigue, pace, concentration. 2. The opinions of functional capacity evaluators who determine the true extent of your physical restrictions...

28 October

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Dealing with the Insurance Carrier: Your Medical Records and Your Long Term Disability Claim

Posted by Nancy Cavey

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When you apply for Long Term Disability Benefits, your Long Term Disability carrier will ask for your medical records. However, the Long Term Disability carrier will not tell you what medical records are the most important in your disability claim. There are three types of medical records each of which can result in a denial of your Long Term Disability claim, or an approval. 1. Chart Notes When you go to see your physician, a nurse or assistant will take information regarding your complaints, symptoms, medications and perhaps the difficulty of how you are functioning. Chart notes are important because Long Term Disability...

28 October

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Long Term Disability Carriers Team Approach to Denying Your Long Term Disability Claim

Posted by Nancy Cavey

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Have you ever wondered how the Long Term Disability carrier goes about evaluating a Long Term Disability claim? They allegedly have “professional disability management teams.” These can consist of a “disability claims managers, disability management services and Social Security assistants.” What is a disability claims manager? That’s a person who is supposed to work with a disability claims management team that consists of their medical directors, clinical experts, Social Security specialists and other staff, who will evaluate your entitlement to benefits and quite frankly, how they will deny your benefits or reduce their exposure. Disability management services do that by developing “relationships...

28 October

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Long Term Disability Insurance Company Peer Review Scams

Posted by Nancy Cavey

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Long Term Disability carriers only need a reason to deny your disability benefits and, the way they get that reason is to send your file to a handpicked peer review doctor. They will use firms that are set up all over the United States who have recruited doctors to review your medical records and write a report. Guess who’s making the money! First, it’s the peer review or company who hires these peer review doctors and ostensibly, trains them. They are trained to never use the work “disabled” and to always determine that the claimant is capable of working in...

Author: Nancy Cavey