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Law Enforcement Agencies Don’t Have To Tell First Responders About The Statutory Presumption

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The 1st District Court of Appeal recently ruled that there is no requirement that an Employer/Carrier provide injured law enforcement officers information regarding the statutory presumption.Officer Guevara was employed by the City of North Bay Village and was placed on light duty on March 15, 2007 after a physical revealed his blood pressure was elevated. His supervisor completed a Notice of Injury and the City of North Bay Village, through Florida Municipal Insurance Trust/Florida League of Cities, sent Officer Guevara an initial claim packet which included an informational brochure approved by the Department of Financial Services.The packet did not enclose...

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How To Deal With Erisa Disability Insurers Claims And Reimbursement For Social Security Overpayments

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Many Long Term Disability plans provide that the policy holder must properly refund any lump sum retroactive Social Security Disability payment and send the overpayment amount within 30 days of the receipt of the notice from the Long Term Disability carrier. If you fail to make reimbursement, many carriers will claim reimbursement of the overpayment of disability benefits that occur due to your receipt of Social Security benefits pursuant to 29 U.S. Code Section 1132(a)(3).In Great - West Life and Annuity Insurance Company v. Knudson, 534 U.S. 204(2002), United States Supreme Court addressed a carriers’ right to enforce a reimbursement...

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Unemployment Benefits And Your Rights To Social Security Disability Benefits

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The receipt of Unemployment Insurance benefits does not prevent you from getting Social Security Disability benefits.In Cleveland v. Policy Management Systems Corp. 526 U.S. 795 (1999), the United States Supreme Court held, in a unanimous decision, that a claim for Social Security Disability benefits is consistent with a claim for relief under the Americans with Disabilities Act (ADA), even though there must be an ability to work in order to obtain relief under the ADA.The United States Supreme Court held that under the presumptions embodied in the 5-Step Sequential Evaluation process, a person can qualify for Social Security Disability benefits...

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How Do Long Term Disability Carriers Use Position Statements To Deny Fibromyalgia Claims?

long term disability carriers position

Many long term disability carriers are in the business of collecting premiums and not paying benefits to fibromyalgia policy holders. Many long term disability carriers will deny fibromyalgia claims on the basis that fibromyalgia is largely based on self reported symptoms and that there isn’t any objective evidence of restrictions and limitations.It’s not uncommon to see a denial letter language that describes fibromyalgia syndrome as a functional somatic syndrome. The denial language will say that FMS sufferers symptoms are “exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient’s...

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Musculoskeletal Connective Tissue Disorders Are The Leading Cause Of Social Security Disability Awards

Malignant Neoplastic Diseases

According to the Social Security annual statistical report on the Social Security program benefits were awarded to 960,260 disabled workers in 2012.The most common impairment was musculoskeletal system and connective tissue diseases which represented 35.4% of all disability awards. Mental disorders comprised 18%, circulatory system 10.6%, neoplasms 9.5%, nervous system and sensory organs 8.0% and all other impairments 18.5%.The Social Security Administration doesn’t always make it easy for those who are disabled to get the Social Security disability benefits that they deserve.If you suffer from a herniated disk or failed back surgery, you may be eligible for Social Security Disability...

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Surviving Spouse Social Security Benefits For Same Sex Couples

social security disability same sex couple

The Social Security Administration (SSA) issued rules on December 16, 2003 authorizing the processing and payment of some surviving spouse lump sum death benefits for same sex married couples.SSA has also begun to process claims for the spouses of retired workers, if the couple is married and domiciled in a state that recognizes same sex marriages.There is the question of what happens if the couple was married in the state that recognizes same sex marriage but the wage earner lived in a state that didn’t recognize same sex marriage. We’ll keep you advised once the Social Security Administration addresses this...

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

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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...

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How Can I Obtain A Copy Of My Disability Documents?

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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...

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Why The Definition Of Disability In Your Long Term Disability Policy Is So Important

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Long term disability carriers don’t make it easy for those who have disability policies get the benefits that they deserve. There are many important provisions in your disability policy including the definition of disability, duties and regular occupation. You should read your policy closely before you apply for disability benefits so you understand these crucial terms.The definition of disabilityThe definition of disability will determine the scope of the coverage provided by your disability carrier. Normally, the policy provides for disability payments if you’re unable to engage in your “own occupation” which is usually the first 24 months of disability. After...

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Help! My Claim For Long Term Disability Benefits Has Been Denied

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If your disability benefits are covered under a group disability policy through your employer, your claim is probably governed by the ERISA statute. If your claim has been denied, the ERISA statute provides that you must file a claim within 180 days of the denial or you won’t be able to file. If you don’t file it timely and then try to file a lawsuit, the disability carrier will claim that you haven’t “exhausted” your remedies.Filing multiple appealsMany long term disability policies will also provide for a second level appeal to allow you to once again challenge the disability carrier’s...

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