Quite frankly, if the a long-term disability or ERISA carrier calls and asks to take your statement or arrange a field visit you are in trouble! Call Nancy Cavey, an experienced long-term disability/ERISA disability Attorney, before you make mistakes in your statement or field visit by the long term disability/ERISA investigator.

In my experience, disability claims are denied generally for three reasons:

1. No objective evidence of your diagnosis;

2. No objective evidence of your disability;

3. No evidence of causal relationship between your disability and your inability to engage in your own occupation or any occupation.

The long-term disability or ERISA carrier wants to take your statement or arrange, a field visit because they question what your doctor says about your restrictions and limitations and what you are reporting on your Activities of Daily Living forms that you are asked to complete.

They also question your reported disability and your inability to engage in your own occupation or any occupation.

Unfortunately, by the time the long-term disability or ERISA carrier asks to take your statement or have a field visit with you they probably have done surveillance on you. They want to interview you and have you describe your activities. Once you’ve done so, they’ll have you sign a statement about your activities. As soon as you sign the statement, they spring surveillance on you and then ask you to comment on the surveillance. They want you to acknowledge the difference between the statement you just gave and  what is shown on the film.

The long-term disability/ERISA carrier will then take that information to your treating physicians and ask them to sign off on a letter that says you’re capable of of least sedentary work.

They have sprung a trap on you for the purposes of painting you a malingerer or fraud with the sole purpose of terminating your benefits.

It is my strong recommendation that if you are asked to give a statement or if the carrier wants to have a field visit that you need to immediately retain an experienced long-term disability/ERISA attorney, like Nancy Cavey.

You need to be prepared! You need to have someone with you to make sure that the questions, you are asked are not open-ended questions. You need to have someone with you to make sure that your answers are accurate. You need to have a statement and field visit done in a neutral location.

I never let a statement or field visit be done at my client’s home. I often see statement summaries with questions and comments about how your yard and house look. You will be, innocently, asked about how you keep up with your house or yard work. They would use that information to draw conclusions about your inability to work.

You should have an experienced long-term disability/ERISA attorney, like Nancy Cavey, prepare you for your statement and field visit.

In the following blog postings, I will go through the questions that you will most likely be asked in a statement or field visit. This should help you prepare for and avoid making mistakes that can jeopardize or even destroy your case.

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

Posted June 02nd 2008 to Preparing for Your Statement and Field Visits By The C | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

You fought long and hard to get the long-term disability benefits you deserve. What the insurance company is already setting you up for is the termination of your long-term disability benefits.

Unfortunately, it is not uncommon for long-term disability carriers to target high-paying cases or cases where the definition of disability will soon change for termination.

The long-term disability carrier isn’t going to call you up and say “Away we go!” No, they will probably send you a vague letter saying they’re going to be doing a review of your case. They are not fooling and this is not fluffy letter.

So, what are they going to do?

First, they are going to contact your doctor to try to get a statement that will be used to terminate your benefits. They will try to get your doctor to say that you can work, that you can work in some accommodate position, that your diagnosis is only based on your complaints to the doctor, that their peer review doctor (who has never seen you) says you can do this activity or that activity and won’t they just agree, that they have surveillance on it and you’re doing lots of things are not supposed to be doing so won’t your doctor agree you can work, etc.

One of the first things that I do as your attorney is to revoke all medical authorizations you signed. Why? Because they will talk to your doctor without my knowledge! They will allegedly have conversations with  your doctor and send a letter that “summarizes” the conversation. More often than not, there’s never been a conversation or they twisted what your doctor who said… Then I have the pleasure of going back to your doctor and trying to undo the unfavorable “what we discussed” letter that your physician signed.

They will also send the infamous letter to your doctor that says “If you don’t comment or disagree with what our doctor says, we’re going to presume you agree with what our doctor said.” I try to avoid this by revoking the medical authorization. If they want to have a real truthful conversation, I’ll be present and it will be recorded!

Insurance companies will also do a background check on you to find out what you own, what bank account you have, and your credit information. I think they do this just find out whether you are living on a limited means and can sustain your lifestyle through their continued denials.

One of the tools in the disability carrier’s insurance bag is surveillance which will be the subject of another posting. Be careful of calls to your home. If you get calls, and the caller hangs up that’s a sure sign of  surveillance. If there’s a strange vehicle down the street, there is surveillance. If there’s an investigator asking your neighbors questions about your activities, there is surveillance.

Don’t put up with it — call the police every time you suspect you are being surveyed.

Another favorite is to schedule you for a functional capacity evaluation by a doctor the disability carrier has selected. Immediately retain an experienced disability attorney as there are things that can be done to either stop the evaluation or make sure that you are protected during the evaluation process. The disability insurance companies hire the same folks for the same results – denial.

Lastly, there is the home interview which will be the subject of a comprehensive posting. Simply put, don’t let them in your house. You don’t have rats in your house — don’t let an investigator in. And, by all means, don’t talk to the claims adjuster. They’re taking notes about what you say you “can” and “cannot” do — they’re not calling to have a social conversation.

An experienced long-term disability/ERISA attorney like Nancy Cavey can help you through this process.

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

Posted June 01st 2008 to Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

You can only file a lawsuit under ERISA after you have exhausted your administrative remedies. This is called “exhausation”. There is a joke among ERISA attorneys that it really means the “exhaustion of your client” and not exhausting all of your appeals.

You should not file a lawsuit unless you are represented. I will be frank with you. You are going to have a hard time finding an experienced ERISA/LTD attorney to take your case at this stage since you can not add anything to the record. Cases are won or are set up for a win in Federal court based on what is put in your record during the claims denial appeal process.

A Federal lawsuit starts with preparing a complaint and filing the summons and complaint in United States District Court. The filing fee is $350 and Nancy Cavey advances the filing costs.

The suit is served and in the defendant, who is the carrier or the self-funded ERISA plan, has 20 days to file an answer and any counterclaims.

The counterclaims can include a claim for the repayment of disability benefits for an overpayment. Disability plans have offset provisions that let the disability carrier reduce the amount of your disability benefits based on what you receive from Social Security, workers compensation or other sources.

Your lawyer will file the answer to any counterclaim.

Every United States District Court has its own rules about how the lawsuit will be handled. In the middle District of Florida, we are required to have a case management conference soon after the answer is filed so that we can sit down and agree on a schedule for discovery, mediation, the filing of motions, and trial.

The Florida District courts require that ERISA cases have a settlement conference known as mediation.

The insurance company attorney will send me a copy of the disability carriers file which is called the “administrative record” and I will check to see if it has the same things that were sent to me during the appeal process. Don’t be surprised if there are different things in the file the defense attorney sends me.

At our firm, Cavey and Barrett, we routinely schedule a designated representative deposition of the adjuster so that we can learn the basis of the denial and establish the necessary standard of review.

If we are unable to settle the case, the court requires us to prepare a Motion for Summary Judgment. A federal judge will decide your case based on what is in the record. There are no trials! You will not get the opportunity to testify in front of the judge or a jury. Your doctors won’t get the opportunity to explain your condition and how it prevents you from working.

The federal judge will issue an order ruling on your right to benefits or lights and your case back to the insurance company because your case is not “ripe” for review.

Either party can appeal the judge’s decision to the United States Circuit Court for the Federal Circuit in which the district is located. For example, appeals from the district courts of Alabama, Georgia, and Florida go to the 11th circuit in Atlanta, Georgia.

If you win, the court will order the insurance company to pay you back benefits that are due, and sometimes, attorneys fees and costs.

The decision to file a lawsuit is a difficult one and one that you should consult with an experienced long term/ERISA attorney about – and, preferably, during the appeal process and not when it’s time to file a lawsuit!

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

Posted June 01st 2008 to Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

There are as many different fee arrangements as there are ERISA attorneys.

Some attorneys will require a flat fee for investigations and then take your case on a contingent fee basis. Contingent fee basis means that you are not required to pay any money up front and the lawyer only gets paid a fee based on what they recover for you.

Some attorneys will require you to pay for retainer up front and then bill you hourly deducting the hourly charge from the retainer.

The Law Firm of Cavey and Barrett has a flexible fee schedule designed to meet your specific financial situation. We are also flexible about advancing costs.

Our attorney’s fee contracts are in writing and explain our fees and costs in detail.

If you would like to see a copy of our basic fee agreement, contact Nancy Cavey by clicking here or by calling 727.894.3188.

Posted June 01st 2008 to Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

If the Federal District Court denies your case, an appeal can be taken to the United States Circuit Court for the Federal Circuit where the District Court is located. For example, appeals from district courts in Florida, Georgia and Alabama are taken to the 11th circuit Court of Appeals which is located in Atlanta, Georgia.

And appeal is just that – an appeal. You don’t get a trial.

Te Federal Circuit Court looks at the record and the District Court’s decision. It is difficult to prevail on appeal because the ERSIA deck is stacked against you. The standard of review on appeal makes it difficult but not impossible to prevail.

Please remember that appeals are expensive and can take between one to two years.

The lawyers file what are called briefs which is summarized the facts, the law, and why the court was wrong. More often than not, the Appellate Court makes a decision without argument by the attorneys. They make a decision based on the record and the briefs.

Sometimes there is an oral argument. The attorneys will travel to the federal circuit court and have 15 minutes per side to argue their case in front of a panel of judges. You don’t know who’s on the panel until several days before the oral argument. It’s difficult to predict what the court will do without knowing who’s on the panel.

The Court normally renders a decision within 60 days of the oral argument.

That decision can be appealed to the United States Supreme Court if certain requirements are met and, of course, the Court decides to hear your case. Very, very few cases get to the Supreme Court each year involving ERISA cases.

It is better to try to avoid this by making sure you retain an experienced ERSIA disability Attorney, such as Nancy Cavey, to prepare your long term/ERISA claim denial appeal properly.

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

Posted June 01st 2008 to Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

The appeals process is the most important step in the long term disability or ERISA case for several reasons:

1. Appeals are generally required before you can file a lawsuit;

2. If you don’t file your appeal timely, you have lost your case.

3. It is your last opportunity to submit material because once suit is filed it is next to impossible to add material regardless of how important it might be.

4. It is your only opportunity to see what the carrier has in your file and for you  to make your  argument  with supporting materials about why the denial is wrong.

This is a complex legal, medical, and vocational process and you should not, regardless of your education or work experience, handle it yourself.

Hiring an experienced long term disability ERISA attorney such as Nancy Cavey will improve your chances of a successful appeal.

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

Posted June 01st 2008 to Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post

You’ve gotten the dreaded Notice of Denial letter and you are shattered. You can’t believe the long term carrier/ERISA carrier has denied your claim. You think that if you just give them the information they are asking  for they will just pay your claim.

That is very unlikely and wishful thinking on your part.

You will have 180 days following the receipt of the notice of denial to letter to submit your appeal. You should do the following:

1. Consult with an experienced long-term disability/ERISA attorney.

2. Keep the envelope the notice of denial letter came in. Sometimes letters are dated differently than actually mailed and this can make a difference if the plan administrator or carrier refuses to give you additional time to appeal.

3. Write a letter to an administrator asking for a copy of your summary plan description and policy.

4. Write a letter to the disability insurance company asking for a copy of your file cover to cover with adjusting notes, medical records by peer-reviewed doctors that have looked at your file, surveillance reports and any material the carrier has relied on in denying your case. Send the letter certified mail return receipt requested.

5.Review what you get from the carrier. Compare a policy terms to your denial letter and see if they are citing the right policy provisions. Look at the job description they used. Look at the peer review physician reports. Look at the vocational reports.

6. Figure out the real reason they denied your claim and how you’re going to get evidence to rebut the disability carrier’s reasoning.

7. Whatever evidence you get make sure that it specifically addresses the basis of the denial.

8. Submit your appeal letter with your supporting documentation to the own term disability care within 180 days sending certified mail return receipt requested.

While I have outlined the steps you should take, those steps are more complex.

This will be your ONLY chance to get it right. Don’t mess it up. There are no “do-overs.”

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

Posted June 01st 2008 to Frequently Asked Questions about Short and Long Term Di | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post