Probably not!

Your employer may be self-funded for short term disability benefits. That means your employer is paying disability benefits out of its own pocket. Self funded employers normally will pay 13 to 26 weeks of short term disability benefits, and then turn your claim over to a long-term disability insurance company. If the monies coming out of their pocket, they may not be so anxious to pay you disability benefits. However, I have seen self-funded employers override the decision of short-term disability carrier and pay benefits out of their own assets.

Other employers have provided you with a short-term and/or long-term disability policy. If you are covered under the disability policy, the policy will be administered by the insurance company or by a third party administrator. Your employer is not involved in the claims handling or decision-making process.

Your employer provided you with a long-term and/or short term disability policy in the event you became unable to perform your job. Some employers will wash their hands of you since you are disposable. Some employers will give the disability insurance company incorrect information about your job duties or work performance in an effort to avoid claims for discrimination or other employment related claims. Other employers will try to have you quit on the wrong day thereby destroying your disability claim

The disability carrier will be asking you and your employer about your job. It is important that you get a copy of your job description and compare that description to what you actually did in your job. I always have my clients write out the description of their job duties and get a copy of the formal job description so we can compare the same.

It may be necessary to get a letter from your employer at some point regarding your inability to do your job or the difficulties that you had doing your job after you became disabled. Your employer may not be willing to give you such a letter but one of your co-employees might be able to do so. If and when you need such a letter will be up to you and your experienced disability attorney.

At the Law offices of Cavey and Barrett, we secure letters or affidavits from your employer or co-employees about the nature of your job, how you performed your job duties before you became disabled, how your job may of been changed as a result of your disability, and what problems you had performing your job after you became disabled. This information must be tailored to your specific circumstances.

If human resources is giving you a hard time, that may hurt your chances to get disability benefits and is yet, just another reason, why you need an experienced disability attorney to assist you in the disability claims process. If you would like to speak with an attorney, you can contact Nancy Cavey by clicking here or by calling 727.894.3188.

Learn More About: Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

Well, that depends on what the summary plan description or disability policy says about when and how you file a claim for disability benefits.

I think that as soon as your physician says that you are disabled, and you agree you’re unable to work, you should file a claim for disability benefits. When should you file the claim?

There is no easy answer to that question, because, again, a summary plan description or policy may tell you when you have to file for disability benefits. If you don’t file your claim for disability benefits at the right time, the disability carrier may say that they don’t owe you any disability benefits, because you screwed up.

I always suggest that the claim for disability benefits be filed in writing on the day you last worked. Get the disability forms from your employer or the disability carrier, complete them, keep a copy and give one to your employer, and send the other copy to the disability carrier certified mail, return receipt requested.

If you don’t have the forms, write out a note that says you are claiming disability benefits, and the date on which you claim you become disabled. Attach to your disability note any supporting medical documentation of your inability to work. Give your material to your employer and asked for a receipt. Send it to the disability carrier certified mail.

The ERISA regulations require that your request for disability benefits comply with the disability plans procedures and rules set forth in the summary plan description for policy. Even if these procedures are burdensome or unreasonable!! You need to try to comply with the rules.

And, by all means keep a copy!

Now start counting the days until you get a response!

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

Learn More About: Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

Congratulations! You’ve gotten the summary plan description which is just what it says – a summary of the plan. Let’s hope you got the policy.

Sometimes we find that there is a difference between what’s in the plan and what’s in the policy. For the sake of this posting, I will just talk about what’s in the disability policy.

Remember when I said there was no uniform disability policy in the United States. There are, however, some basic things I look for when I review a disability policy.

1. Is there a provision that requires you to have a policy for certain length of time before you can claim entitlement to disability benefits? If so, how long is it?

2. Is there a provision that excludes certain physical or mental conditions from coverage? If so, what’s excluded?

3. Is there a provision that limits coverage for certain physical or mental conditions? If so, what are those provisions, and how long is the coverage?

4. What is the definition of disability? Does the definition require objective proof of your disability?

5. What is the elimination period or the time you must be disabled before you are entitled to receive benefits?

6. How does your plan define occupation? Is it your occupation? Your occupation as performed for your employer? Your occupation as performed in the national economy? The Dictionary of Occupational Title definition of your job?

7. What is the claims process? When do you have to put the disability carrier on notice of your claim? How many appeals can you file? How long does the disability carrier have in which to make a decision?

8. How much are your benefits? Is there a set off against your disability benefits that will reduce your long-term disability benefits? Does that set off include Social Security benefits, your children’s Social Security benefits? Workers’ compensation or pension benefits?

9. Is there a limitation in the policy on when you must file suit?

10. What is the track record for this disability insurance carrier denying claims? Settling claims? Litigating claims?

Without knowing the answers to these questions, you are setting yourself up for a denial of your disability claim.

Nancy Cavey’s book, “Robbed Of Your Peace of Mind“, is a must read if you’re going to have any chance to avoid making mistakes, even before you file a disability claim.

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

Learn More About: Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

You really do want to have a copy of the summary plan description (SPD) and your disability insurance policy before you even think about filing a disability claim.

So how do you get it? You should have been given a summary plan description when you signed up for your benefits. It may even be online.

Look at the summary plan description and see if it has the name of the plan administrator. If the plan administrator is identified, send a letter certified mail return receipt requested, asking for a copy of your policy and any amendments or changes made to the policy since you signed up.

If you can’t figure out who the plan administrator is, ask your human resources department. If they can’t give you an answer, send a written request to your employer certified mail, return receipt requested, asking for the name of the plan administrator, disability insurance company and a copy of any policy they might have.

Under the ERISA statute, the failure to provide a summary plan descriptions in a timely manner can result in a fine, under ERISA, of $110.00 per day. Unfortunately, that penalties is only awarded under certain circumstances, and by a judge.

If you can’t get a copy of a summary plan description or policy that is your first warning sign that problems lie ahead. You should obtain the assistance of an attorney to get the summary plan description and policy. Your attorney can file a lawsuit asking for enforcement of ERISA and the imposition of penalties.

Disability insurance companies who don’t play nice when asked to provide basic information aren’t going to play nice when it comes to deciding if you’re entitled to disability benefits. Take warning!

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

Learn More About: Frequently Asked Questions about Short and Long Term Di,Uncategorized | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

ERISA is a federal statute. If you disability plan and policy is covered under ERISA, there are no state law claims.

Unfortunately, there is a game in federal courts called “What is the standard of review?”

The first question that the federal court assigned to your case will ask is not ” Is the disabled policy holder entitled to the disability benefits they paid for?”

No! The federal court asks whether or not they should wear blinders when they review your case. What do I mean?

I am sure that you are familiar with the burden of proof in a criminal matter. The state has to prove that the defendant is guilty beyond a shadow of a doubt. In civil litigation, the plaintiff has to prove their case by a preponderance of the evidence. One party has more evidence and is more persuasive than the other.

Unfortunately, preponderance of the evidence is not the standard for success in the federal court. The United States is divided into11 appellate districts and each district has their own standard of review. What a mess!

United States Supreme Court has recently heard a case called Glenn v. MetLife to try to decide whether or not there should be a uniform standard of review and, if so, what it should be. Depending on how the Court rules, this case could make it easier for you to win your case or easier for the disability insurance companies to legally deny your disability benefits.

ERISA law changes on a daily basis and you should have an attorney who is skilled in this area of law. Many lawyers just think ERISA case is just another contract dispute. Not so! We will see what the Supreme Court rules.

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

Learn More About: Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

Do you remember Jimmy Hoffa? Jimmy Hoffa stole money from the Teamsters so Congress decided to enact federal legislation to protect pension funds. This legislation also regulated other employee benefits such as group health, group life, pension and disability policies. This law is called the Employee Retirement Income Security Act of 1974 or ERISA.

It’s complicated, complex, and always changing. Most lawyers don’t like this kind of law and its been nicknamed “Everything Ridiculous Invented Since Adam.”

The purpose of ERISA is to “protect… the interests of participants in employee benefit plans… by establishing standards of conduct, responsibility, and obligation for fiduciaries of employee benefit plans, and by providing for appropriate remedies… ready access to federal courts.” ERISA Section 2 (b). This federal statute preempts or chromes state law for the most part.

The reality is, of course, completely different. The Department of Labor rarely enforces the applicable regulations and disability carrier’s wrongfully deny claims. People, such as yourself are forced to file federal lawsuits to get their benefits.

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

Learn More About: Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

You have many questions about your Short and Long Term Disability benefits. There is no uniform long term disability policy in the United States. Every policy is different. The answers provided to frequently asked questions are general in nature. If you would like a full explanation concerning your specific problem, consult an experienced long-term disability attorney.

Please feel free to order your free, no obligation, copy of Attorney Nancy Cavey’s book

“Robbed of your peace of mind? Important information on long-term disability insurance policies, the claims process and how to win your long-term disability benefits”

You can order a copy on the home page of this blog or by going to www.caveylaw.com.

Ms. Cavey can be reached at 727 -894-3188 for a free, no obligation, phone consultation. She handles long-term disability cases nationwide.

Frequently asked questions include:

What is ERISA?

What impact does ERISA have on my claim?

What if I asked for my plan or other documents and I can’t get them?

Okay, I got the plan. Now what does it say?

How do I file a claim?

Will my employer help me with my disability claim?

What does my doctor have to do to help me with my claim?

Are there certain medical conditions excluded from my policy?

What is the definition of disability?

How does the carrier define my occupation?

How much will my benefits be if I get approved?

Are my benefits subject to taxation?

How long will it take for an initial decision?

What if I get a notice of denial letter?

What is the disability claims appeals process?

What seven clauses you don’t want to see in your long-term disability policy?

What are the common mistakes I can make in trying to handle my own disability case?

What happens if my benefits are denied?

What is a Standard of Review and why do I care?

When should I get a disability attorney?

What type of legal services do I need?

I have a limited income. How do I pay for lawyer?

When can we sue the long-term disability carrier?

If there are other questions you’d like answered, use the comment function and send me an e-mail about your questions. I can either answer them online publicly, or we can communicate privately. Don’t be shy about asking questions!

My father became disabled when I was in middle school. He, like you, wanted to be prepared in the event that he became disabled and could not support his family. He purchased a long-term disability policy through USF&G. I remember the monthly trips he made to his doctor, asking for the appropriate long-term disability forms to be completed service benefits would continue. I remember my mother’s fear that the long-term disability benefits will be suspended.

I understand your fears and the unanswered questions you have. I have been there. So, don’t be shy about asking questions, as the purpose of this blog is to help educate you about the ERISA and short term/long-term disability process. I hope you find this information useful.

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

Learn More About: Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post