Your Disability Claim Denied Due to Nurses Review! | Tampa Long Term Disability Attorney

Reading a Long Term Disability denial letter can be like reading a bad novel. Nancy Cavey, an expert Long Term Disability attorney based in the Tampa Bay area, will commonly see many mistakes made by Long Term Disability carriers when reviewing denial letters. One the most common involves those claim’s denials based on a medical review by an in house nurse.

Now this will take several forms. Nurses will review medical records and render opinions about your functional capacity. They have no expertise do they? A review preformed by a nurse violates the ERISA regulations. 29cfr section 2560.502-1(h)(3)(i) provides that medical judgments have to be made by “healthcare professionals with the appropriate training and experience in the field of medicine involved in the medical judgment.”

Here in Florida, the District Court in Levinson v. Reliance Standard Life Insurance Company 2000wl193623(S.d.fla.) January 5, 2000, have held that a medical review by a nurse is an inappropriate basis for claim’s denial.

The next mistake that Long Term Disability attorney Nancy Cavey sees is when the nurse summary is given to the in house physician for review. It is not uncommon to see the in house physician or even an outside medical reviewer adopt the opinion of the nurse reviewer. You can always tell that the in house physician or outside medical reviewer has adopted the opinion of the nurse when there was just a summary or without documentation of any additional medical records for review. That is the grounds for argument, if the Long Term Disability carrier has denied your rights for a full and fair review.

If your Long Term Disability claim has been denied as a result of a nurse review, contact Tampa Bay based Florida disability attorney, Nancy Cavey.

Return to Work Guidelines and Your Claim for Long Term Disability Benefits

The Reed Group, third party administrator of Long Term Disability claims, has developed a product called MD Guidelines, which they are marketing to insurers who underwrite and manage disability products. What is it? MD Guidelines allegedly has been developed through statistical analysis of over 2 million disability cases and have allegedly been clinically reviewed by a panel of leading physicians to ensure that their recommendations are “fair, consistent and represent leading edge medical knowledge.” If you take a look at these guidelines, I am sure you will find that a number of these physicians are in fact well known, peer review physicians used in Long Term Disability cases to deny Long Term Disability claims.

Companies like Reed Group are selling and using MD Guidelines as a tool to wrongfully deny Long Term Disability applicants their benefits by pointing to the guidelines as a reason why you should be able to return to work and are no longer disabled.

As well, a lot of these “return to work” durations are based solely on workers’ compensation claims and not Long Term Disability claims. That would make you question the methodology wouldn’t it?

If your Long Term Disability claim is being handled by Reed Group or you think they may be using return to work guidelines in evaluating your claim, contact Reed Group denied Long Term Disability claim attorney Nancy Cavey. Nancy has written the easy to read consumer guide 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, which sells on Amazon.com for $19.95, but you can receive your free, no obligation, copy at www.caveylaw.com or by calling 727-894-3188.

Protect yourself and understand the games that Long Term Disability carriers and third party administrators like Reed Group will play in your Long Term Disability claim.

Vocational Mistakes Long Term Disability Carriers Use to Deny Your Long Term Disability Benefits | Sarasota Long Term Disability Benefit Lawyer

Long Term Disability carriers will routinely use a vocational assessment to determine your residual functional capacity  and the skills, interests, aptitudes you have so that they can determine whether you are capable of going back to your past work or other work available in the national economy.

One of the many errors that Long Term Disability carrier’s vocational evaluators will use is to cherry pick your doctors report about your physical and mental impairments. They will pick out those restrictions and limitations, which indicate that you are capable of sedentary work.

They will also fail to consider important medical or vocational information. It is not uncommon for Long Term Disability applicants who have cardiac conditions to have problems with stress or Long Term Disability applicants who are suffering from Fibromyalgia to have problems with chronic fatigue and concentration.

Unfortunately Long Term Disability vocational rehabilitation counselors routinely ignore this important information and will render a vocational opinion that you are capable of some form of employment. The result- your claim has been denied or your benefits stopped.

If a Long Term Disability carrier has assigned a vocational rehabilitation provider to evaluate you, or your claim has been denied based off a vocational opinion, you need an experienced Long Term Disability attorney who can help rebut the vocational evaluators opinion. Sarasota, Manatee, Hillsborough, Pinellas County Long Term Disability denied attorney Nancy Cavey is experienced in developing the proper medical and vocational evidence to rebut the Long Term Disability carrier’s vocational opinion.

Your Long Term Disability carrier’s selective review of your medical evidence Cherry picking your medical records on your Florida denied disability benefits

Nancy Cavey, Long Term Disability denied attorney, often finds that Long Term Disability carriers have “cherry picked” medical records in justifying its claim’s denial. The claim’s administrator often doesn’t accurately and completely summarize your medical evidence but rather includes only portions of the medical records that supports their claim’s denial.

The 11th Circuit, which deals with Long Term Disability claims in Florida, Georgia and Alabama has recognized that the failure to renew relevant medical evidence in support of a claim is arbitrary and capricious and could be grounds for a claims reversal. Oliver v. Coca Cola Company, 497f3d.1181, 1199 (11th Circuit 2007).

If your medical records have been cherry picked and your Long Term Disability claim denied in Florida | St. Petersburg, contact Long Term Disability claim denial attorney, Nancy Cavey.

Long Term Disability Traps and Tricks

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If you have a questions or concerns give us a call at 727-894-3188 or contact us at www.caveylaw.com.

Long Term Disability Unfair Language 7

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If you have any questions, or if you’d like to learn more, contact us at www.caveylaw.com or give us a call at 727-894-3188.

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