18 March

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Are There Disability Plans That Are Not Governed By The Erisa Statute?

The Employer Retirement Income Security Act of 1974 governs employee welfare benefit plans, including disability insurance plans. ERISA is not a plaintiff friendly statute and, fortunately, there are plans that are not governed by ERISA. These include plans by: • Churches; • Government; • Entities; • Plans maintained for the purposes of complying with Workers’ Compensation; and • Plans maintained outside the United States for the benefit of persons for non-resident aliens. The great news is that if you’re employed by a government agency such as state or a local government, your long term disability benefits are not governed by the ERISA statute. You can learn more about...

11 March

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How Can I Obtain A Copy Of My Disability Documents?

Posted by Nancy Cavey

in Long Term Disability

Your employer should be able to provide you with a copy of the summary plan of description (SPD) which provides you with a description of the benefits that you may be entitled to as a result of disability, the definition of disability and how to make a claim for benefits. You can also request relevant documents from the plan under a 29CFR Section 2560.503-1(N)(8) if your benefits have been denied. Long term disability carriers are required to provide you with a copy of documents to: • Rely on in making the benefit determination; • Submit, proceed or generate in the course of making...

13 February

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What Is Erisa And Why Should I Care That My Long Term Disability Carrier Might Be Governed By Erisa?

Posted by Nancy Cavey

in Long Term Disability

erisa lawyer disability tampa st petersburg

What you need to know about the claim forms ERISA is shorthand for the Employer Retirement Income Security Act of 1994. It’s Federal legislation that governs how insurance companies handle disability claims and it gives disability carriers a “get out of jail free card.” In most ERISA governed claims, a court can only overturn the long term disability carrier’s decision if you prove that the denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil court and it’s the “get out of jail free card” that disability insurance companies, like UNUM Provident, MetLife, Cigna/LINA, Aetna, Lincoln Financial, Prudential...

05 February

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How Long Term Disability Carriers Will Use Functional Capacity Evaluations To Deny Your Claim

Posted by Nancy Cavey

in Long Term Disability

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. 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...

03 February

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What Are The Five Reasons Disability Insurance Companies Wrongfully Deny Or Terminate Long Term Disability Benefits?

Posted by Nancy Cavey

in Long Term Disability

If you purchased your disability policy through your employer the policy is most likely governed by the ERISA statute. The Employer Retirement Income Security Action (ERISA) of 1994 is Federal legislation that has given a “get of jail free card” to disability insurance companies. In most ERISA governed claims, courts will only overturn the insurance company’s decision if you can prove that denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil case and it allows insurance companies to “play hardball” on claims. The most common reasons that long term disability carriers wrongfully deny or terminate benefits are: 1....

17 December

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Your Plan for Long Term Disability Benefits and a Functional Capacity Evaluation

Posted by Nancy Cavey

in Long Term Disability

functional capacity evaluation disability

One of the best ways to establish your functional restrictions and limitations is a functional capacity evaluation. However, all to often, long term disability carriers use functional capacity evaluations as a basis to deny claims. Many long term disability carriers will deny claims on the basis there is no objective basis for the physical restrictions and limitations assigned by your physician. The long term disability carrier will request a functional capacity evaluation to determine the validity of your subjective complaints and prove you can work. What is a functional capacity evaluation? A functional capacity evaluation is a 3 to 5 hour comprehensive evaluation...

16 December

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How Your Doctor Can Help You Win Your Long Term Disability Claim

Posted by Nancy Cavey

in Long Term Disability

The long term disability carrier will send your doctor a physician disability form to complete which asks questions about your physical restrictions and limitations. Unfortunately, there is no routine form and many of the forms are designed so that your physician will ultimately opine that you’re capable of sedentary work. Why? The long term disability carrier wants to deny your claim. If the form that your doctor has been sent by the long term disability carrier simply doesn’t address all of your restrictions and limitations, have your doctor document on the form what, in fact, your restrictions and limitations...

03 December

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Long Term Disability Claims For Leukemia

Posted by Nancy Cavey

in Diseases

Leukemia is a form of cancer of the bone marrow that can cause fatigue, weakness and bone pain. If you have a long term disability policy through your employer or you purchased one on your own, you may be entitled to long term disability benefits if your physician has told you that you are unable to work. Acute Leukemia There are over 10,000 cases of acute leukemia (acute myelocytic leukemia or AML) diagnosed yearly in the United States. One third of the patients have a mutation of the FLT3 gene which produces abnormal enzymes that drive the production of leukemic cells. Experimental...

22 October

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What is the difference between Social Security’s definition and a long term disability definition of disability?

Posted by Nancy Cavey

in FAQs

The Social Security Administration uses a five step sequential evaluation, the five step sequential evaluation asks whether or not you have engaged in gainful activity, whether you have a severe impairment, meet a listing, whether you can return to the work that you did in the past and whether you are capable of performing other work in the national economy based on your age, education and transferable skills. On the other hand, each long term disability policy has their own definition of disability that generally the definition is the inability to engage in the material and substantial duties of your occupation. The...

Author: Nancy Cavey