Cost of Living Adjustments and Your Long Term Disability Claim

Long Term Disability Claims and Cost of Living AdjustmentsYour Long Term Disability policy might have a provision so that your disability benefits can be increased by a cost of living adjustment. However, fact remains that the rate of benefits can be hard to figure out simply because the Long Term Disability carrier doesn’t write the policy very clearly.

Some will use a cost of living adjustment based on the consumer price index. Even more confusing, they will sometimes attempt attack the COLA based on a fixed amount like 4% or the most recently determined annual percentage increase and the consumer price index. Trying to calculate this can give you a headache! If your Long Term Disability policy has a cost of living adjustment in it and you don’t believe you’ve been paid properly, contact Long Term Disability COLA increase law firm Cavey and Barrett for assistance in determining the correct amount of benefits that you are due and owed. Use the form on the right side of this page to contact us.  Let us help you today.

Has Your Long Term Disability Claim Been Denied When the Carrier Used the Wrong Expert for Your Medical Condition?

Long Term Disability carriers will routinely have a Long Term Disability claim reviewed by a panel of hired gun medical reviewers. We see these same reviewers time and time again.

One of the most common mistakes Long Term disability carriers make is to use the wrong medical expert for the medical condition that is being claimed. Now that sounds dumb doesn’t it?

The Florida federal regulations, which governs ERISA claim’s handling requires that the Long Term Disability carrier consult with a health care professional that has “appropriate training and experience in the field of medicine involved in the medical judgment,” 29 c.f.r. section 2560.503-1 (h)(iii).

Unfortunately, it’s not uncommon for Long Term Disability carrier’s who are evaluating Fibromyalgia or chronic fatigue cases to use physicians who have no expertise in those areas.

Nancy Cavey, Florida Long Term Disability Denied lawyer, checks the medical and professional background of any health care professional used by the Long Term Disability carrier in a claim’s denial to ensure that the carrier, in fact, used the right expert for your medical condition.

If you believe that the Long Term Disability carrier has denied your claim by using the wrong expert for your medical condition immediately contact Tampa Bay Long Term Disability Attorney Nancy Cavey.

Fibromyalgia Long Term Disability Claims Denied with out Physical Examination | Florida Disability Lawyer

Many times Nancy Cavey, Florida disability denied lawyer, often sees Long Term Disability carriers deny Fibromyalgia claims without having a physical examination.

Many Long Term Disability policies give the carrier the right to have you examined by a physician of your choice. More often than not, Long Term Disability carriers deny you disability without having that examination. When that occurs in Fibromyalgia cases, Nancy Cavey always reminds the Long Term Disability carrier that the evaluation of Fibromyalgia requires personal examination, in a case with Bellsouth Telecommunications, Inc., 89f3D775(758-59) (11th Circuit 1996).

We also remind the Long Term Disability carrier that “evaluating disability without personal examination of the individual… is medical sophistry at best” Spencer O/B/O Spencer v. Hecker 765f2D1090 (1094) (11th Circuit 1985).

More often than not the Long Term Disability carrier will use a peer reviewed doctor to review your medical records. Nancy Cavey, Long Term Disability denied lawyer often finds that these peer reviewed physicians will arbitrarily conclude that our clients symptoms are “out of proportion of physical findings.” That’s a credibility determination, reaching such a conclusion without the benefit of physical examination to support that finding is not evident of a deliberate or prudent decision and making.

Although independent exams are not required, they are, in my opinion significant in cases where a plan administrator is operating under a conflict of interest or rejects the treating physicians opinion. Hughes v. Prudential Life Insurance Company, 2005wl8399245 (W.D3VA, April 12 2005).

At Cavey and Barrett, we always argue that the failure to get an independent medical examination in align with peer reviewed doctors is a significant factor and raises questions about the inaccuracy of the benefits denial and grounds for claims reversal.

If your Long Term Disability claim has been denied, your symptoms “out of the proportions of the physical findings,” contact Nancy Cavey, your Long Term Disability denied expert.

Mistake 10 – Restrictions and Limitations – Use of your hands | St. Petersburg Long Term Disability Lawyer

Long Disability Carrier’s Activity of Daily Living form may ask you questions about the use of your hands.  These questions are particularly important if you are seeking disability benefits on the basis of such conditions as carpal tunnel syndrome. You can make crucial mistakes in completing your long-term disability forms!

You will be asked, “What is your dominant hand?”

The Activity of Daily Living Form that has been sent to you by the long-term disability carrier has all sorts of questions about what you can and cannot do. The ERISA carrier isn’t really interested about how your disability impacts you every day of your life. They are interested in your answers for the purpose of denying your claim.

If you are claiming disability based on problems with the use of your hands, you will  be asked whether or not you have the full use of your hands and fingers, have problems when you try to open a jar, button a shirt, unlock the door, write, type, or hold a coffee cup.

Think carefully before you answer these questions – think about how you use your hands from the time you get up in the morning until you go to bed at night. What can you do? What can you do with difficulty? How long does it take you to do something requiring dexterity? Do you have to stop or start the activity? What symptoms does it cause? Do you have to use splints or braces? Do you have difficulty with the use of your hands when you bend, twist, or reach with your hands?

And, of course, make sure you explain who filled out this Activities of Daily Living Form!

Take the time to properly think through these answers before you complete the form. If you have any questions about completing the Activities of Daily Living form, consult an experienced long-term disability Attorney like Nancy Cavey.

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 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 – 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 ERISA? | Sarasota Long Term Disability Lawyer

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.

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