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Why isn’t an Award of Social Security Disability Benefits Acceptable to prove that I am Disabled Under My Long Term Disability Policy?

The problem with disability under the Social Security program does not imply that you are disabled under your Long Term Disability policy, why? The Social Security Administration uses a five step sequential evaluation including listed impairments and an age/education grouping which was designed to manage the high number Social Security Disability claims. The Social Security program does not have any time limits on how long the benefits are paid regardless the cause of the disability, while your Social Security claim may be re-reviewed every 3 years, which much different than an ERISA claim. An ERISA Long Term Disability policy is a contract...

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My Long Term Disability Claim was denied because I Can Be a Video Surveillance Monitor: What Does That Have to Do With My Claim?

Long Term Disability policies normally say that after the payment of two years of benefits, you must prove that you are unable to do the material and substantial duties of any occupation by which you are experienced as a result of your age, education and transferable skills. One the most common tricks is for Long Term Disability carriers to pick jobs like video surveillance monitors and justify their denial based on the existence of a job like video surveillance monitors or even day guard monitor. In Moore v. American United States Life Insurance Company, 150 cal.app 3d 610, 630, the California court...

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Closely Reading Guidelines and Your Claim for Long Term Disability Benefits

Closely read, “return to work guidelines.” Long Term Disability carriers will routinely use these to deny Long Term Disability claims. What are the guidelines? Quite frankly, these guidelines are at best estimated return to work dates created by a former Long Term Disability medical claims consultant, obviously you can tell that any of these guidelines will provide for an early return to work and are not favorable to Long Term Disability claims applicants. Recently, Nancy Cavey, Orlando Long Term Disability attorney, came across a letter directed a treating physician asking the doctor to address the claimants ability to return to work...

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Have Predictions by Your Doctor of Improvement Led to the Long Term Disability Carrier Denying Your Benefits?

Long Term Disability insurance companies, including UNUM, have a habit of selectively reviewing medical records looking for statements to take out of context to justify a claims denial. For example in Pelchat v. UNUM Life Insurance Company of America, 2003 US District Lexis 8095 (N.D. March 2003), the Long Term Disability policy holders physician initially released her to return to work with restrictions but “shortly thereafter determined that she remained disabled.” The district court held that that was not sufficient ground to terminate the benefits and that “UNUM's reliance on Dr. Fishers release to work statement that neglected his latest prognosis...

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Your Doctor Tells You to Avoid Stress But Long Term Disability Carrier Denied Your Claim on the Basis that You Can Work: What Should You Do?

In case of Watson v. UNUM Provident, 185.fsupp.2d579 (N.D. 2002), the Long Term Disability claimant had heart disease and had suffered from cardiac arrest. His treating physician said that he was “at risk for sudden death on the job.” UNUM denied the Long Term Disability benefits and Watson appealed. According to the court “UNUM argument of a objective dispassionate review as the work for the available medical records in source of information that may support his adverse determination and to review more record evidence that might support the continuation of benefits.” Long Term Disability carriers have to consider stress as a factor...

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What Does the Phrase Regular Occupation Mean in My Long Term Disability Policy?

Many Long Term Disability policies say that you if are unable to perform your regular occupation you may be entitled to Long Term Disability benefits. But what does regular occupation mean? Regular occupation means the occupation you are in at the time that you became disabled. In Dionida v. Reliance Standard Life Insurance 50.fsupp2d.934 (N.D. CA 1999), the court held that regular occupation means “a position of the same general character as the insurers previous job, or similar duties and training requirements.” The court noted that it could be determined by “a vocational evaluation performed comparing the character of duties and...

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Is there a Good Book on Long Term Disability Policies for Florida Long Term Disability Policies Holders that You Would Recommend?

Nancy Cavey, a Long Term Disability ERISA lawyer who practices in Florida, has written two free consumer guides. Robbed of Your Peace of Mind and The Smart Long Term Disability Consumer Guide For Preparing For Your Statement and Field Visit, to help you understand terms you don’t want to see in your insurance policy and the games that Long Term Disability carriers play in denying your claim. ...

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Disability Attorney Nancy Cavey Helps Long Term Disability Insurance Claimants Understand Their Long Term Disability Claims Process

Disability insurance companies like to collect premiums but fight hard to protect their cash reserves, denying claims. Unfortunately it is not uncommon for Long Term Disability insurance companies to deny or delay a claim, which can lead to financial disasters for Long Term Disability policyholders. It is important that you understand the Long Term Disability claims process before you file a claim for Long Term Disability benefits. Disability insurance attorney Nancy Cavey suggests that before you file your Long Term Disability claim that you do the following: 1. Find your policy 2. Read the...

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Fibromyalgia and Your Long Term Disability Claim

Long Term Disability carriers, like UNUM Life Insurance Company of America, frustrate those with fibromyalgia. Fibromyalgia is in some way a self reported disease which relies on a circuit board of symptoms and a physical examination that shows tender parts of your body on examination; http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/fibromyalgia.asp. It is important that you look at your Long Term Disability policy to determine whether or not there are any kinds of limitations on self reported conditions or a specific exclusion for Fibromyalgia. There also may be a limit for the payment of benefits for self-reported conditions of Fibromyalgia with a maximum of 24 months...

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Do I really need a private disability insurance policy if I have a policy through work?

Yes! Many disability insurance policies provided by your employer only cover you with 60% of your salary with a maximum of $5,000 to $10,000 in benefits. These benefits can be taxable and subject to various reductions. As a result, you’ll get less than 60% of your salary. More importantly, group policies are governed under the ERISA law and most ERISA Long Term Disability carriers take an adversarial approach to paying group disability claims. Can you and your family survive on 60% or less of your current income? Probably not. I suggest that you buy a supplemental private disability insurance policy. Protecting yourself...

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