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Own Occupation Claim for Long Term Disability Benefits and Fibromyalgia

Your Long Term Disability policy may provide that you are entitled to disability benefits if you are unable to engage in your own occupation. It is important that you first understand how the Long Term Disability carrier defines “own occupation.” The Long Term Disability carrier may define your “own occupation” as the occupation you are performing for your employer, the occupation as it is performed in the local economy or the occupation as it is performed in the national economy. Note that we are not talking about a new way to do your job or how the job is performed...

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Fibromyalgia and Your Long Term Disability Claim Part 1

Introduction and the Three Things Every Fibromyalgia Disability Applicant Should Know There are three things the Long Term Disability carrier looks for in every Fibromyalgia Long Term Disability claim: 1.     Objective evidence of the diagnosis of Fibromyalgia 2.     Objective evidence that Fibromyalgia is causing physical restrictions and limitations that result in you being disabled. 3.     A causal relationship between your diagnosis and disability and your inability to work. The Long Term Disability carriers know that there are many people with Fibromyalgia that are able to work and unfortunately, they evaluate Fibromyalgia claims through that mindset. Is Your Fibromyalgia Condition Covered in Your Long Term Disability policy? One...

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Sleep Apnea and the MS Patient’s Claim for Long Term Disability Benefits

If you suffer from MS and are having difficulty with your long term disability claim, Nancy Cavey, experienced long term disability MS attorney, suggests that part of the problem you might be having is your failure to fully explain all the problems that you have as a result of your MS. This can include difficulty walking, balance and coordination. However, obstructive sleep apnea is a common sleep disorder among people with MS. Many people with MS, also have bladder problems which means that there are in and out of bed frequently. They may also have restless limp syndrome, or periodic limb...

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Lupus and Benlysda: Short and Long Term Disability

If you are a short term or long term disability recipient who suffers from Lupus, there is new drug, Benlysta, specifically designed to treat lupus. It is expected to receive FDA approval this year but it is very expensive. Local Rheumatologist, Dr. Michael Burnette of the Tampa Medical Group has been working with Benlysta as part of the clinical trial for the last five years. In a recent article in St. Petersburg Times on April 29th, 2010, he explained that Benlysda works by "suppressing the part of the immune system associated with Lupus". Research by GlaxoSmithKline has found that Benlysta can...

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Dr. Amy Hopkins and Your Long Term Disability Claim

In a blockbuster article, “Doctors Paid to Aid Insurers in Disability Claims Denial,” Daily Journal staff writer Evan George exposed Dr. Amy Hopkins for what she is. Dr. Hopkins is routinely hired by Long Term Disability carriers to do peer review analysis of Long Term Disability claims. Dr. Hopkins is an occupational medicine specialist who has been paid “$493,832 for file reviews from 2001 to 2004 from just one company.” Her opinions have been challenged in lawsuits repeatedly. In 2004 a Federal Judge in Pennsylvania described Dr. Hopkins approach to disability claims as a “pick and choose approach” that “ignored evidence...

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Dr. Mahwar and Your Long Term Disability Claim

Have you ever heard of Dr. Suresh Mahwar, an internist in Freemont, California? If you are a Long Term Disability claimant, beware because he moonlights by reviewing disability claims for a company called “University Disability Consortium” who is hired by Long Term Disability carriers to provide peer reviewed medical reports. Long Term Disability carriers do this because they need a “legitimate” reason to deny your claim. They routinely will pick organizations such as University Disability Consortium to hire doctors like Dr. Mahwar who rarely disagrees with the Long Term Disability carrier’s decision to deny benefits. In an article by Evan George,...

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UNUM Forces Long Term Disability Applicant to Return to Work and Then Denies Claim

Can you imagine waiting 13 years to get disability benefits? That’s what happened to Johnny McAulley who was insured under a disability policy purchased through his employer Socretes Holdings and later under a conversion policy. UNUM denied coverage to Mr. McAulley on the basis that he untimely exercised his rights to convert his group Long Term Disability policy to an individual policy. UNUM argued that Mr. McAulley should be denied 13 years of disability benefits because he had “tried to return to work.” In Johnny McAulley v. First UNUM Life Insurance Company the trial court “ruled earlier this week that Mr....

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Claims Denials Based On a Misunderstanding of My Job Description

If you are Long Term Disability policy holder in what is called the own occupation stage, the Long Term Disability carrier will get information from your employer about your job description and job duties, if your policy requires the Long Term Disability carrier to use the description of your job is as preformed in the national economy, the Long Term Disability carrier will go to the book call the Dictionary of Occupational Titles and get the job duties as the position is preformed in the national economy. Unfortunately, Long Term Disability denied attorney Nancy Cavey often finds that the Long Term...

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Functional Capacity Evaluation and Chronic Fatigue Syndrome Long Term Disability Recipients

If you are a suffer of Chronic Fatigue Syndrome or Fibromyalgia and have been scheduled for a Functional Capacity Evaluation, beware! You are being set up for a claims termination. Long Term Disability carriers hate Chronic Fatigue or Fibromyalgia claims because they feel that these are conditions based on “subjective complaints.” It is not uncommon in these cases for the Long Term Disability carrier to routinely have you fill out Activities of Daily Living Forms, look at what your physicians say about your Activities of Daily Living and use extensive surveillance to try and catch you doing something that is inconsistent...

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Has Your Long Term Disability Carrier Asked to Undergo a Functional Capacity Evaluation?

If you are a Long Term Disability applicant and your Long Term Disability carrier has asked for you to undergo a functional capacity evaluation you are being set up! It is not uncommon for Long Term Disability carriers to use Functional Capacity Evaluations to challenge your doctor’s opinions or your statements about your ability to function. While most Long Term Disability carriers have the right to such an evaluation, you should know that Long Term Disability carriers, such as CIGNA will routinely send instructions to the FCE provider about how to fill in the forms, how to interpret the data and...

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