FAQ – How Long Will It Take to Get An Initial Decision on my Disability Claim? | Hudson Long Term Disability Lawyer

You have sent in your claim for disability benefits and are now waiting to hear whether your claim has been accepted for whether it will be denied. How long will it take to get the initial decision on your disability claim?

Once the claim is received, a plan has 45 days under the ERISA regulations to make a decision. If more time is needed, a plan can notify you in writing asking you for an extension of 30 days. However, the plan must ask for this extension before the end of the 45 day time and can only ask for that extension because of “matters beyond the administrator’s control.”

And, guess what? The plan can ask for a second 30 day extension.  The plan has to ask for that second extension during the first 30 day extension.

So, we start out with a 45 day base waiting period that can be extended for 60 days for a total of 105 days.

But that period can be extended if the disability carrier sends you a request for information. That stops the clock!

If you want to start the clock again, you need to promptly provide the information that has been requested and send it certified mail. If the disability carrier asks for more information after you’ve sent in your claim, that’s another signal you need to retain an experienced disability attorney like Nancy Cavey.

The short-term or long-term disability carrier is looking for something specific and if you don’t give it to them is likely your claim will be denied. You probably won’t have a clue as to what it is they’re looking for unless you understand the policy terms and your medical records.

If you don’t have the information lto et the disability carrier know in writing sent by certified mail, return the receipt requested. If you are trying to get the information, notify them of any problem you are having and let them know what you’re doing to get this information.

Better yet, retain and experienced disability attorney. This process is full of pitfalls. Don’t be lulled into thinking you can give the disability carrier what they want and they will happily send you a disability check. Disability carriers are in the business of collecting premium and not necessarily in the business of paying disability benefits.

If you have any questions, please give us a call at 727.894.3188 or contact us online by clicking here.

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FAQ – Are My Disability Benefits Subject to Taxation? | St. Pete Beach Long Term Disability Attorney

The basic answer to this question depends on how you paid for your policy. The general rule is that if you paid for your policy with pretax dollars, you are disability benefits are taxable.

Conversely, if your benefits were paid with after-tax dollars, then you’re disability benefits are not taxable.

So, if you pay or your employer pay for your disability policy as part of an employee benefit package, your disability benefits are taxable. You will probably be sent something from a disability insurance company to show the total amount of your benefits, which you will have to use in your tax-preparation.

If you have any questions, please give us a call at 727.894.3188 or contact us online by clicking here.

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FAQ – How much will my Disability benefits be if I get approved? | Indian Rocks Beach Long Term Disability Lawyer

Disability insurance policies normally pay a percentage of your salary. I said “normally.”

Most disability insurance policies do not include overtime or commissions in what is called a base monthly earnings or BME. The starting point for calculating your disability benefits is your base salary.

This is always an issue in disability policies owned by physicians, attorneys, accountants, architects and stockbrokers. These professions may be paid on a bonus basis, partnership earnings, consulting income, sales of property owned by the partners or other salary arrangements.

I have been involved in litigations involving the sole question of how to calculate the base monthly earnings when professionals became disabled. You must know the answer to this question before you decide when to apply for disability benefits and how your benefits are going to be calculated.

I have seen professionals think that certain monies were included in their base monthly earnings only to find out after the fact those earnings were excluded. What a financial disaster!

It’s important to know whether you increased your disability coverage over time or whether your disability insurance company will allow you to increase your disability coverage while you’re disabled. The issue of residual disability benefits will be the subject of another posting.

You should also know whether there is a cost-of-living adjustment that will increase the amount of your disability benefits the longer you are disabled.

Of course, the most important question is, what’s the maximum disability benefits you purchased?

The most dreaded question is whether your disability benefits can be reduced by other benefits paid to you such as Social Security disability benefits, workers’ compensation, or pension benefits. Some policies have a minimum mandatory payment, which means they have to provide you a limited fixed amount of benefits.

For example, you may have a disability policy that pays $2000 in benefits per month. You are eligible for Social Security disability, workers’ compensation or other benefits of $2500 per month. Your policy may say that they can deduct all those monies from your disability benefits. The policy may say that they have to pay you a minimum payment of $100 per month after all those other monies are deducted from your disability benefits.

You better know this before you stop working and apply for disability benefits.

These are the kinds of disability insurance issues at Nancy Cavey will discuss with you. If you like to contact her, please click here or call 727.894.3188.

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FAQ – How Does The Disability Carrier Define My Occupation? | Lakeland Long Term Disability Attorney

“I’m disabled! Can’t the long-term disability carrier see that based on my medical records? Why do I care how the disability carrier defines by occupation? This is about my job not my occupation. I just want to be paid my disability benefits!”

I hear those complaints frequently. I have to explain that the second most important definition in your long-term disability policy is how your disability carrier defines “occupation”. Not “job”

It is the standard by which your disability is measured.

And, it might be defined as your regular occupation, your occupation as performed for your employer, your occupation as performed in the regional economy, your occupation as performed in the national economy, or your occupation as defined by the Dictionary of Occupational Titles.

Or, is it the job you are doing while you are disabled but before you stopped working?

If you are going to have your doctor comment on on your ability to work, you are asking the wrong question. Your doctor will need to comment on your physical restrictions and limitations by having the right definition of occupation. You can destroy your claim by having your doctor use the wrong definition of occupation.

If you have any questions, please give us a call at 727.894.3188 or contact us online by clicking here.

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FAQ – What is the definition of disability? | Tampa Long Term Disability Lawyer

I have two teenagers, and when I asked them a question the answer always seems to be “it depends!” Doesn’t that just drive you nuts?

Sorry, I’m going to drive you nuts in answering this question.

You would think the insurance companies who are in the business of writing disability policies could come up with a simple definition of disability. Think again …

Let’s start with wikipedia’s definition of disability:

“A disability is a condition or function judged to be significantly impaired relative to the usual standard of an individual or their group. …”

Okay, let’s look at your disability policy. How does your policy with its fancy cover define “disabled?” You might language that says “disability” means: “the inability to perform the material and substantial duties of your regular occupation due to your sickness or injury, and if you have a 20% or more loss in your indexed earnings to do that sickness or injury.”

You need to go searching for a definition of ” material and substantial”, “regular occupation”, ” sickness or injury” and “indexed earnings”.

Your employer told you, when you bought the policy, that you were buying a disability policy that would pay you disability benefits when you are unable to work. That’s not what this policy says.

Do you know the definition of “disabled” is in your policy? Do you think you need to know what “material and substantial” means and how it applies in your case? Do you think you need to know what “your regular occupation” is as defined by the policy? By the way, did you change your job to continue to work despite your disability? Is that your regular job, or is it the job you are doing at the time you became disabled?

Do you think you require the assistance of a skilled disability benefits attorney? This is a complex area of law that most attorneys simply do not understand. Personal injury attorneys think this is like a personal injury claim or contract dispute over coverage. They can be as uninformed as you.

If you don’t know what the definition of disability is in your policy, you will find it very difficult to meet the appropriate standard and receive the long term disability benefits that you are entitled to as a result of your disabling medical condition. It depends on whether you want to try to represent yourself or whether you want to find an experienced long-term disability attorney, such as Nancy Cavey, to represent you. If you would like help with your case, contact Nancy by clicking here or by calling 727.894.3188.

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FAQ – Are there certain medical conditions excluded from my policy? | St. Petersburg Long Term DIsability Attorney

YES! I am not being flip — you really do need to read your summary plan description and policy.

There may be conditions that are excluded from short-term and/or long term disability coverage. If you have one of those excluded conditions and are disabled, you are, unfortunately, not entitled to disability benefits. You may well be entitled to Social Security disability benefits. But you are not entitled to disability benefits.

There are some conditions, such as soft tissue conditions like strains or sprains or what are considered self-reported conditions, by chronic pain, that are limited to two years of benefits. There may be specific restrictions on disability coverage for conditions like fibromyalgia, herniated discs, or psychiatric problems.

It pays to read your summary plan description and policy before you stop working so you know whether or not you’re disabling condition is covered or whether there are limits on how long disability benefits will be paid. You need to know this information to make crucial employment and disability decisions. What you do can also impact your continuing group insurance benefits. The mistakes can be made by not knowing what medical conditions are excluded or are limited by the terms of your disability policy

If you have any questions, please give us a call at 727.894.3188 or contact us online by clicking here.

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FAQ – What does my doctor have to do to help me with my claim? | Tampa Long Term Disability Lawyer

Just because your doctor says your disabled doesn’t make it so. And just because your doctor says your disabled, doesn’t mean that the disability carrier is going to agree.

The disability insurance carrier is looking for objective evidence from your doctor about your  diagnosis and objective evidence of your disability. Your history of complaints and symptoms, your findings on examination, and the results of objective medical testing are important to establish an objective basis for your diagnosis.

There must be objective evidence of your functional restrictions to establish that you are, in fact, disabled.  Your doctor is going to be asked to complete forms commenting on your ability to sit, stand, bend, lift, walk or other physical activity. It is important that those forms are completed accurately and are consistent with what you are telling your doctor about your physical abilities.

Don’t pay your doctor to give his statement that you’re disabled. Pay your doctor, if necessary, to complete the disability form. It’s not your doctor’s role to say that you are disabled.

In fact, the Supreme Court has ruled that your long-term disability carrier doesn’t have to believe the opinion of your treating doctors. We use other ways to bolster the opinions of your doctor.

We have given many seminars to doctors about how to properly fill out the disability forms. At Cavey and Barrett, we meet with your physician during the disability claims process to make sure that your diagnosis and disability have been objectively established. Nancy Cavey will take a statement or even a videotape your doctor discussing your diagnosis and disability.

We even arrange for functional capacity evaluations to objectively test your physical capabilities and to verify your restrictions and limitations.

Nancy Cavey makes sure that the doctor provides the right kind of information to the the disability carrier to support your claim for disability benefits.

If you have any questions, please give us a call at 727.894.3188 or contact us online by clicking here.

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