27 October

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Long Term Disability Claim Denial Because “You May Be Able to Perform Your Past Prior Work or Other Work”

Unfortunately, Long Term Disability insurance companies deny claims for all sorts of reasons, however, Nancy Cavey, ERISA Long Term Disability denied lawyer, often sees denial letters which contain the language that your claim was denied because “there is no evidence that demonstrates that a Long Term Disability applicant can perform at a certain exertional level and remains able to perform your past, prior work or other work as proposed.” What does that mean? Long Term Disability carriers routinely will determine, based on a review of your medical records, or an analysis of your medical records by an in house nurse...

27 October

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Is There a Statute of Limitations in ERISA Cases?

Posted by Nancy Cavey

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ERISA doesn’t provide for a statue of limitations for suites under section 502(a)(1)(b) to recover benefits. The federal court looks at the most closely analogous statute of limitations, unless the Long Term Disability contract has a specific limitations. In otherwords, the ERISA plan is nothing more than a contract. Under Florida Law, if the policy language can be given more than one interpretation the insurance policy is consider to be confusing and ambiguous. There has to be interpretability in favor of the policy holder. So here’s a test? Lets say your Long Term Disability policy says that: no legal action of any...

27 October

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Outrageous Conduct by LINA and CIGNA in Denying Claims for Long Term Disability Benefits

Posted by Nancy Cavey

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Unfortunately, it is not uncommon for Long Term Disability carriers to have their adjuster, nurse case reviewer, or their medical reviewer call your treating physician and attempt to get them to say that you are able to work. More often than not, Long Term Disability insurance companies, such as LINA/CIGNA’s medical reviewer will distort or misrepresent what your treating physicians had to say. As a result, Fort Myers, Naples, Sarasota Long Term Disability attorney Nancy Cavey routinely revokes the releases her Long Term Disability clients sign to give the Long Term Disability insurance companies such as CIGNA, the ability to speak...

27 October

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Signing a Medical Release in Your Long Term Disability Claim

Posted by Nancy Cavey

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It is not uncommon that Long Term Disability carriers will ask that you sign medical releases letting them get your medical records. Unfortunately, all too often, this medical authorization is too broad. It will allow them to contact other insurance companies, the Medical Information Bureau, Disability Income Records System and Health Claims Index. These are databases of information shared by insurance companies and they will secure your records in an effort to deny your claim for disability benefits. At The Law Offices of Nancy L. Cavey we object to these over-broad releases and crack them, so they only allow the insurance...

27 October

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Dr. Gerson and Your Long Term Disability Claim

Posted by Nancy Cavey

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Dr. Gerson is a well-known psychiatrist in the Long Term Disability world who makes millions doing part time reviews for companies like UDC. Dr. Gerson MO is clear, as revealed in an article “Doctors Paid to Aid Insurers in Disability Claim’s Denial” by Evan George. Mr. George noted that Prudential Claims uses Dr. Gerson to perform medical reviews as an independent contractor. According a Prudential Claims worker, Dr. Gerson tells them how to successfully deny claims including that of a woman with a brain tumor. Dr. Gerson will suggest surveillance and/or having neuropsychological examination among other tests. The Long Term Disability carrier...

27 October

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Multiple Sclerosis and Your Long Term Disability Claim

Posted by Nancy Cavey

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In Multiple Sclerosis there are a number of mobility challenges you may experience because of weakness, spasticity and balance problems. Weakness is often accompanied by a stiff and heavy feeling in your legs. This weakness and spasticity in your trunk and legs can reduce your balance. It’s important that your medical records and physical therapy notes document the problems that you are having with weakness, spasticity, and balance problems, as those are important parts of your functionality....

27 October

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How Can the Surveillance Company Positively Identify the Long Term Disability Claimant?

Posted by Nancy Cavey

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Long Term Disability carriers spend a lot of money to get pictures of Long Term Disability applicants or recipients so that they can ultimately deny Long Term Disability benefits. They have to make sure they have the right person! How do they do that? The Long Term Disability carrier may provide the surveillance company with a picture of you. The surveillance company will then attempt to match your photo and do at least six other things: 1. Overhear you state your name to someone. 2. Overhear someone else call you by name and you acknowledging your name being called. 3. Exiting a residence...

27 October

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How Long Will You Be Surveyed?

Posted by Nancy Cavey

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Surveillance cases are normally scheduled for a ten hour work day, 6am to 4pm. Most Long Term Disability carriers require investigators to check in with police or law enforcement on a daily basis. Upon arrival, investigators normally take a time shot of your resident for at least 30 seconds. If it’s a gated community they’ll try to make special arrangements to gain access to your community on the pretext doing “work.” Thereafter, most Long Term Disability carriers require that the investigator take time shots of 15 seconds at the beginning of every hour and a final time shot of thirty seconds at...

27 October

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Depositions and Discovery in Wrongfully Denied Long Term Disability Claim

Posted by Nancy Cavey

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The ability to take depositions in the long term disability cases is, unfortunately, limited. That allows of insurance companies like LINA to hide the conflict of interest in its reasons for denying disability benefits. For example, Medhav-Harahwaj is a repeat offender. Ms. Harahwaj has never seen a long term disability claim that she could pay. Fortunately, the court agreed that in Alleen V Lina Ms. Harahwaj could be deposed on topics including LINA’s internal growth procedures, or if LINA took steps to promote accuracy in its claim’s administration, the actual review of the claim filed, whether LINA had a history of large...

25 October

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How Long Term Disability Carriers Ignore Pain in Determining Own Occupation Eligibility

Posted by Nancy Cavey

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Many Long Term Disability carriers use the Dictionary of Occupational Titles, they search and stretch definitions of “sedentary” and “light,” close to the relevant plan definition. Additionally, carriers like Standard also ignore side effects of medication, sometimes concluding that you can discontinue the medication and be able to work. A Long Term Disability plan’s administrator abuses its discretion when it fails to consider how the side-effects of clients’ medication impacts the client’s ability to perform their own occupation. See Draby vs. Bell South Telecom, Inc, (89F3d, 755, 741 11th Circuit 1996). Some carriers even reject claims of side effects of medication because of...