17 September

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The Two Reasons Why You Need To Appeal The Denial Of Your Erisa Disability Claims

appeal denial of ERISA disability claims

If you have an ERISA disability policy and your claim has been denied there are two reasons why you should appeal the denial of your disability benefits within 180 days of the date of the denial. What Are The Two Reasons I Should Appeal My Denial of My ERISA Disability Claim? 1. The ERISA law requires a policy holder to “exhaust” their administrative remedies before filing a lawsuit. Your appeal is considered your “administrative remedy.” If you fail to timely appeal the insurance company may say that you can’t sue because you failed to exhaust your administrative remedies. Appealing preserves your right...

26 February

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Do I Have To Cooperate During A Functional Capacity Evaluation In A Long Term Disability Claim?

Posted by Nancy Cavey

in Long Term Disability

FCE and IME disability long term disability

Disability policies generally require policy holders who apply for disability benefits to undergo an Independent Medical Evaluation or even a Functional Capacity Evaluation. If your policy allows for these and you’ve been requested to undergo such an examination, you have the duty to cooperate. What Happens if you Refuse to Perform Tasks Requested or Don’t try Hard Enough During the FCE? Your claim can potentially be denied for “lack of cooperation.” In the case of Ortega-Candelaria v. Johnson & Johnson, 2014 WL 2696725 (1st Cir. June 16, 2014), Mr. Ortega-Candelaria applied for disability benefits and was asked to undergo a Functional Capacity...

27 January

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Am I Entitled To Attorneys Fees At The Expense Of The Disability Carrier If They Paid Benefits After A Lawsuit Is Filed?

Posted by Nancy Cavey

in Long Term Disability

attorney fees long term disability carrier

If you purchased your disability policy through your employer, your policy is covered under the ERISA law. The disability carrier has the discretion to pay your benefits and, many times, will improperly deny legitimate disability claims. Sometimes filing a lawsuit is what it takes to get your benefits granted. What about Attorneys Fees? In ERISA cases, a court may, in its discretion, award attorneys fees if the parties achieve “some degree of success on the merits.” Is the Mere Filing of a Lawsuit After a Plaintiff Files an ERISA-governed Disability Benefit Claim Sufficient to win an Award of Attorneys Fees? It depends on where...

20 January

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What Every LTD Policy Holder Needs To Know About Overpayment Of Benefits

Posted by Nancy Cavey

in Long Term Disability

Many long term disability policies have a policy provision that reduces the amount of long term disability benefits by “other income.” If a long term disability carrier begins making disability payments, they will offer the policy holder the option to: 1. Reduce the amount of disability benefits by an estimated amount of deductible benefits, or 2. Allow the policy holder to elect to receive full payments, without reduction, in exchange for an agreement to notify the carrier of the receipt of other income benefits and to repay any overpayment incurred, as a result of receiving other benefits. What Happens When the Policy Holder...

12 January

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What Is Overpayment Of Long Term Disability Benefits?

Posted by Nancy Cavey

in Long Term Disability

overpayment long term disability benefits

Many long term disability policies will deduct from your disability benefits any money you might receive for: • Social Security Disability benefits, • Dependent benefits, • Workers’ Compensation, or • Proceeds of a third party settlement arising out of an accident. Many policies will provide the policy holder to either receive the full amount of benefits and agree to reimburse the carrier, if and when they receive any “other income” benefits. The amount that is owed back to the insurance and disability carrier is known as an “overpayment.” What are My Options to Avoid Creating an Overpayment? Alternatively, disability insurance companies can offer you the option to...

08 January

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Why Every Long Term Disability Policy Holder Should Hire Their Own Social Security Disability Attorney To Assist Them In Getting Social Security Disability Benefits

Posted by Nancy Cavey

in Long Term Disability

hiring a social security lawyer LTD claim

Most long term disability policies will pay full long term disability benefits, but subtract from those benefits other income benefits, such as Social Security Disability benefits. The Games the Representative Company Plays with Long Term Disability Often, the disability insurance company will recommend that you use a service they endorse to help you get the Social Security Disability benefits. While these companies will claim that they represent you, and not the long term disability carrier, the reality is that often these representative companies develop your social Security claim based on medical conditions that only have a limited payment period under the terms...

06 January

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The Four Reasons Long-Term Care Insurance Gets Overlooked In The Estate Planning Process

Posted by Nancy Cavey

in Long Term Disability

One of the most commonly overlooked areas in estate planning is deciding whether you should purchase long-term care insurance. Four Reasons Why Long-Term Care Insurance Gets Forgotten Long-term care insurance is the only way to prepare for the future and protect assets that you might want to pass on to your relatives or loved ones. It can also protect you from being a burden on your family! Did you know that over 60% of people over the age of 65 need some kind of long-term care in their life? Medicare simply doesn’t cover many of the long-term care services that are required. It’s important...

14 July

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Group Health Insurance Benefits For Those On Long Term Disability Insurance

Posted by Nancy Cavey

in Long Term Disability

group health insurance long term disability attorney

When you became disabled you, unfortunately, most likely lost your job and your group insurance benefits. The lack of health insurance can have a devastating impact on your medical and financial future. Websites for help with insurance Did you know that there are a number of websites that can help you find an affordable insurance program? These include the following: • Heathcare.gov: The official site for the Health Insurance Marketplace (a.k.a. Obamacare); • FinancialHelpforHealth.org: A new site from the Robert Wood Johnson Foundation to help consumers learn about credits and subsidies for health insurance; • AARP.org: Solid information on both Medicare and the Health Insurance...

30 June

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Discretionary Clauses And Your Long Term Disability Claim

Posted by Nancy Cavey

in Long Term Disability

Discretionary Clauses long term disability claims

Get out your long term disability policy and look for something called the “Discretionary Clause”. It’s a clause that lets the long term disability carrier make the decision and requires that the court defer to its decision. It’s what I call a “get out of jail free card.” Fortunately, there are some states that prohibit discretionary clauses in long term disability policies. These states include: California; Colorado; Illinois; Michigan; and Washington. You can determine whether the discretionary clause is applicable to you by looking at your disability policy and what state your policy was issued. What other terms don’t you want to see in your long term disability...

24 June

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Making The Decision To Hire An Attorney To Get Your Long Term Disability Benefits If Your Claim Has Been Denied

Posted by Nancy Cavey

in Long Term Disability

You bought your long term disability policy to provide you and your family peace of mind if you were unable to work. You’ve even made the difficult decision to apply for disability benefits knowing that your physician and employer have supported your claim. Yet, you’ve gotten a denial from the long term disability carrier. No matter how angry or upset you are, don’t walk away from your long term disability claim. As a disability attorney, I know that very few people look forward to protracted litigation but there are times in life when the only right course of action is...