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Denials of Long Term Disability Claims because of No Improvement in Your Medical Condition

Unfortunately it is not uncommon for Long Term Disability carriers to play games in Long Term Disability claims particularly when the policy definitions changes from own occupation to any occupation. Many times the Long Term Disability carrier will find that you are totally disabled from performing your occupation and pay Long Term Disability benefits but notify you that they will re-review your claim when your policy definition changes to “any occupation.” For example in Saffron vs. Wells Fargo & Company LTD Plan, 522f.3d863 (9th Circuit 2008), Mr. Saffron had an MRI in April of 2003 that should degenerative changes and remained...

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MD Guidelines and Your Long Term Disability Claim | Long Term Disability Lawyer Tampa

Did you know that there is a company called MD Guidelines, which is being advertised as an "essential tool for insurers who underwrite and manage disability and workers' compensation products"? MD Guidelines, has developed return to work guidelines through a "rigorous statistical analysis of over 2 million disability cases," and have been "reviewed by a panel of leading physicians to ensure recommendations that are fair, consistent and represent leading edge medical knowledge." Visit MD Guidelines. What they haven't told you is that a lot of these return to work guidelines are based solely on workers' compensation claims and not Long Term...

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The Material and Substantial Duties Game and Your Claim for Long Term Disability Benefits

Has your Long Term Disability benefit claim been denied because the Long Term Disability carrier says that you can return to the material and substantial duties of your own occupation? If so, you may have been set up by a Long Term Disability vocation rehabilitation counselor. More often that not, insurance company vocational evaluators don’t always know what your job was at the time that you became disabled and frequently don’t understand the material and substantial duties of your job, particularly as performed by your employer. If your Long Term Disability policy provides for the payment of Long Term Disability benefit based...

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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...

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Vacations and Your Long Term Disability Claim

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...

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

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,...

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

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...

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

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...

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Rebutting Potentially Damaging Surveillance Video and Your Long Term Disability Claim

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...

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The Many Mistakes Vocational Evaluators Use in Long Term Disability Cases

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...

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