14 April

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

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...

18 March

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

Posted by Nancy Cavey

in Long Term Disability

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...

11 March

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How Can I Obtain A Copy Of My Disability Documents?

Posted by Nancy Cavey

in Long Term Disability

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...

13 February

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What Is Erisa And Why Should I Care That My Long Term Disability Carrier Might Be Governed By Erisa?

Posted by Nancy Cavey

in Long Term Disability

erisa lawyer disability tampa st petersburg

What you need to know about the claim forms ERISA is shorthand for the Employer Retirement Income Security Act of 1994. It’s Federal legislation that governs how insurance companies handle disability claims and it gives disability carriers a “get out of jail free card.” In most ERISA governed claims, a court can only overturn the long term disability carrier’s decision if you prove that the denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil court and it’s the “get out of jail free card” that disability insurance companies, like UNUM Provident, MetLife, Cigna/LINA, Aetna, Lincoln Financial, Prudential...

05 February

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How Long Term Disability Carriers Will Use Functional Capacity Evaluations To Deny Your Claim

Posted by Nancy Cavey

in Long Term Disability

Long term disability carriers play hardball on claims and one of the ways they play hardball is to have you undergo a functional capacity evaluation. Why? If the long term disability carrier can show that you’re capable of engaging at least sedentary work, they will have legitimate grounds to deny your claim for disability benefits, notwithstanding what your physician has said about your restrictions and limitations. What is a functional capacity evaluation? It’s a 3 to 5 hour confidence evaluation used to determine your current ability, strength endurance, sensation, hand function and gross and fine motor coordination. They will evaluation the appropriateness...

03 February

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What Are The Five Reasons Disability Insurance Companies Wrongfully Deny Or Terminate Long Term Disability Benefits?

Posted by Nancy Cavey

in Long Term Disability

If you purchased your disability policy through your employer the policy is most likely governed by the ERISA statute. The Employer Retirement Income Security Action (ERISA) of 1994 is Federal legislation that has given a “get of jail free card” to disability insurance companies. In most ERISA governed claims, courts will only overturn the insurance company’s decision if you can prove that denial was “arbitrary and capricious.” That’s the highest burden of proof in a civil case and it allows insurance companies to “play hardball” on claims. The most common reasons that long term disability carriers wrongfully deny or terminate benefits are: 1....

17 December

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Your Plan for Long Term Disability Benefits and a Functional Capacity Evaluation

Posted by Nancy Cavey

in Long Term Disability

functional capacity evaluation disability

One of the best ways to establish your functional restrictions and limitations is a functional capacity evaluation. However, all to often, long term disability carriers use functional capacity evaluations as a basis to deny claims. Many long term disability carriers will deny claims on the basis there is no objective basis for the physical restrictions and limitations assigned by your physician. The long term disability carrier will request a functional capacity evaluation to determine the validity of your subjective complaints and prove you can work. What is a functional capacity evaluation? A functional capacity evaluation is a 3 to 5 hour comprehensive evaluation...

16 December

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How Your Doctor Can Help You Win Your Long Term Disability Claim

Posted by Nancy Cavey

in Long Term Disability

The long term disability carrier will send your doctor a physician disability form to complete which asks questions about your physical restrictions and limitations. Unfortunately, there is no routine form and many of the forms are designed so that your physician will ultimately opine that you’re capable of sedentary work. Why? The long term disability carrier wants to deny your claim. If the form that your doctor has been sent by the long term disability carrier simply doesn’t address all of your restrictions and limitations, have your doctor document on the form what, in fact, your restrictions and limitations...

23 September

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What Happens After Your ERISA Law Suit has been Filed?

Posted by Nancy Cavey

in Long Term Disability

You purchased a long term disability policy to provide you with peace of mind. But, when you least can afford it, your disability carrier has denied your benefits and has rejected your appeal. Your next and only recourse is to higher a long term disability attorney to sue your long term disability carrier. Your attorney will file what is called a complaint which outlines the facts of your case and why you are entitled to benefits. There generally is no activity for 60 to 90 days after a claim is filed. Why? The complaint is filed and then served on a...

20 September

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Continuing Disability Statements and Your Rights to Long Term Disability Benefits: The Introduction

Posted by Nancy Cavey

in Long Term Disability

You may have received a phone call or letter from your long term disability carrier advising that they want to take “a continuing disability statement”, they may even come to your house to attempt to take the statement which I strongly discourage. The introductory part of the continuing disability statement will include: 1. The agreement that the interview site is an agreeable location 2. Identify who is present and their relationship, if any, to you 3. The day’s date and time 4. Your acknowledgement that the interview is going to be recorded and your agreement to the same 5. Questions as to whether you are...