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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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Your Psychiatric Exams, Fibromyalgia and Chronic Fatigue Claims

Long Term Disability carriers may accept the diagnosis of chronic fatigue and Fibromyalgia yet deny a claim on the basis that you are employable.It is not uncommon for Long Term Disability Insurance companies to have an “independent paper review” by a physician who has been hired by the carrier. More often than not this paper review, or even an independent medical evaluation physician who has been hired to evaluate, will conclude that you meet the diagnostic requirements requiring fatigue. However, they will claim that despite having the physical and psychiatric limitations normally seen in Chronic Fatigue Syndrome case, you still...

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Games Played by the Long Term Disability Carriers in Chronic Fatigue and Fibromyalgia Claims

If you have been diagnosed with Chronic Fatigue Fibromyalgia and are receiving Long Term Disability benefits during your own occupation stage, be prepared to have your claim to be challenged and/or denied when the definition of disability changes from “own occupation” to “any occupation.” You will most likely receive a letter from your Long Term Disability carrier indicating that they are going to be reviewing your claim. What that means is that you are being set up for a claim’s denial.They will be contacting your doctor to determine your restrictions and limitations, they will schedule a functional capacity evaluation, place...

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Long Term Disability Claims and Chronic Fatigue Syndrome: Are You Really Disabled?

Chronic Fatigue Syndrome disability lawyer Nancy Cavey knows that a mere diagnosis of Chronic Fatigue Syndrome does not guarantee that you will get your Long Term Disability benefits.A Long Term Disability carrier who is evaluating a claim based on Chronic Fatigue Syndrome will look to see whether or not you have an impairment that makes you unable to perform the material and substantial duties of your own occupation.It is not uncommon for Long Term Disability carriers to acknowledge the diagnosis of Chronic Fatigue Syndrome that have a peer reviewed physician or independent medical review physician determine that you are still...

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