Are you a physician who has multiple specialties or businesses? If so, you must properly protect yourself in the event that you become disabled, because one of the common defenses to a long-term disability claim is the “dual occupation” defense. What is this defense?

The long-term disability insurance company will argue that you have two or more occupations at the time you claim to be disabled. Because you’re able to work full time in one of those occupations, a long-term disability carrier will argue that you are not entitled to ANY benefits.

Let me give you some examples.

In Giampa v. Trustmark Insurance Co., 73 F.Supp.2d 22 (D. Mass. 1999), Dr. Giampa, a chiropractor, spent 85% to 95% of his pre-injury time treating patients by conducting examinations and performing manipulations or chiropractic adjustments. He injured his back, which limited his ability to perform manipulations. He had spent incidental time managing his two other chiropractic facilities before his injury.

After his injury, Dr. Giampa devoted all of his time to administrative duties managing the other chiropractic facilities, which resulted in a dramatic increase in his income. He claimed long-term disability benefits, which were denied.

His disability insurance policy had both a total disability clause and a partial disability clause.

The Federal Court decided that the total disability clauses should not be read so literally that an insured persons ability to perform some business duty, no matter how small, would prevent the finding of total disability.

Another twist on the dual occupation issue involved a dentist who had retired and begun working in the real-estate field.  He became disabled and filed a claim asking for the payment of long-term disability benefits based on his inability to perform dentistry. The court found that regardless of whether he intended, even after the sale of his dental practice to resume dentistry, dentistry wasn’t his regular occupation at the time he became disabled. The un-controverted medical evidence show that he was unable to perform most of the substantial material duties of his regular occupation as a real estate developer. The clause in the disability policy defined total disability as the inability to perform some substantial and material duties of his regular occupation. The long term disability policy  did not unambiguously require that he be unable to perform all of the substantial maternil duties of his occupation.

Another example involves the policy of a general surgeon who had on the side, developed a second business doing cosmetic surgeries including vein striping. Needless to say, that was far less stressful and more remunerative than doing general surgery. Unfortunately, he became disabled and unable to perform general surgery. Was he entitled to long-term disability benefits?

The answer could be found in the terms of the disability policy. He had a policy that looked at the occupation he was engaged in at the time of his disability and also had a residual disability provision. The residual disability provision paid benefits even if he was working at another occupation.

The residual disability provision said that “residual disability must follow right after a period of total disability that lasts as long as the qualification period, if any.” Huh?

This would seem to say that one could never get residual disability benefits, unless there was some initial period of total disability. Another question would be whether you had to be totally disabled from work as both a general surgeon and as a cosmetic surgeon to get benefits?

Another paragraph says that “This (residual disability benefit) will begin on either the commencement date or the day after the total disability ends up later.”  You could argue that if he are unable to do general surgery, but the same day could do vein stripping, the doctor  would be entitled to residual disability benefits.

You have significant choices to make and you can inadvertently shoot yourself in the foot and screw up your eligibility for disability coverage by making the wrong decision

It is crucial that you consult with a qualified long-term disability/ERISA attorney before you file your disability application to avoid making crucial mistakes that can result in the complete denial of your claim and cost you residual disability benefits.

You must determine what your policy says about the criteria for being disabled, what occupation your policy covers, whether there is a residual claim, what percentage of your revenue comes from both occupations, how your disability impacts your ability to perform both occupations, and how you’re going to prove that disability. That determination should be made BEFORE you even file your long-term disability claim.

Nancy Cavey, a long-term disability/ERISA lawyer, can be a great resource to you before you apply for long-term disability benefits. Nancy Cavey will be able to review your policy, advise you as to the best course of action to preserve your benefits and maximize your disability income, and assist you in gathering the necessary documentation to prove your entitlement to disability benefits.

Finding a lawyer with long-term disability/ERISA experience who has a proven background in dealing with physicians committee will make the difference between obtaining your long-term disability benefits or being denied. The lawyer who helped you set up your practice, helped you write your will and helped you purchase your house does not have the experience handling disability/ERISA claims.

Contact Attorney Nancy Cavey, who represents physician’s  through out the United States for more information on the dual occupation defense and to get your free no obligation copy of “Robbed of Your Peace of Mind.”

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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The time to learn that you’ve picked the wrong disability insurance company isn’t when you’re sitting in a lawyer’s office. Unfortunately, there are many times I have to explain to my clients that they’ve picked the wrong disability insurance company.

There are many factors and variables that should be considered in picking out a disability insurance policy, which are discussed in Nancy Cavey’s book, Robbed of Your Peace of Mind, which is free of charge.

http://www.caveylaw.com/getDisabilitybook.cfm

This article focuses on choosing the right disability insurance company.

First, and foremost, you should purchase an individual disability policy which you pay for yourself with post-tax dollars.

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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Have you purchased an overhead disability insurance policy? When’s the last time you read it?

Most policies agree to “pay benefits to during a period of disability for covered overhead expenses which accrue while you are totally disabled after the elimination period.” These policies can define disability as the “inability to perform a substantial and material duties of your occupation.”

Overhead disability insurance policies also may pay benefits if you are partially disabled. “Partially” disabled can mean conditions where you are “unable to perform one or more substantial and material daily business duties” or are unable to do “usual daily business duties for as much time as you would normally take… to do them.”

An important provision in this policy was the definition of office expenses. “Covered overhead expenses” were defined as items of expense incurred by you, which are usual and customary in the operation of your business or profession. They must be generally accepted as tax-deductible business overhead expenses.”

There are lessons to be learned about these policies before you claim you are disabled and stop practicing.

In Uno v. Provident Life and Accident Insurance Company, Dr. Uno, a urologist, or became disabled and stopped practicing. He retired his medical license and canceled his medical malpractice insurance.  However, he continued to maintain his medical office, employing a part-time employee for the limited purpose of collecting accounts receivable, copying and mailing patient charts, paying bills and storing his financial and patient records.

Dr. Uno made a claim for benefits under the policy for expenses in maintaining is downsized medical practice. Provident ultimately denied his claim on the basis that is overhead expenses weren’t covered. Provident argued that Dr. Uno was essentially operating a collection agency

The trial court agreed saying that the office expenses were not incurred in the operation of his business or profession, reasoning that he had to be currently active in his urology practice.

The parties differed on whether the costs associated with continuing his business during his disability where items of expense incurred in the operation of his business or profession.

The appellate court found that the plain meaning of operation of the business in the context of an insurance policy included performing actions to continue the business, without regard to whether patients were still being treated. The court found that billing and collection efforts are normal activities that are part of a professional practice, and that the policy contemplated incurring expenses by disabled insurer over a long period of time.

The result would have been different if Dr. Uno had sold his practice or had entered into a stock purchase agreement over time. The court, most likely would’ve found that he was not conducting a business or profession after he sold his stock.

It is crucial that you secure the services of a experienced long-term disability/ERISA attorney to review both your disability and overhead expense disability insurance before you decide to stop practicing. You need to understand what long-term disability benefits your policy provides and what overhead disability coverage you have before making a crucial mistake that could destroy or limit your entitlement to benefits.

Nancy Cavey specializes in representing professionals, such as physicians, in the long term disability and overhead expense disability insurance claims. She has written extensively on the terms that you do not want to see in your long-term disability policy and pre-disability planning, including the 7 Tips for Long Term Disability Policy Holders Before Applying for 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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“Financial pre-planning does not end when you buy your Long Term Disability Policy,” says ERISA disability attorney Nancy Cavey. There are two considerations in determining how great your long-term disability benefits will be if you become disabled. Normally, your insurance policy provides that you’ll be paid a percentage of your salary if you become disabled.

There are two important considerations that will determine the amount of your long-term disability benefits. The first is whether or not your long-term disability benefits are taxable. This was discussed in a recent posting.

The second consideration is whether or not your long term disability policy has an offset provision that will reduce your benefits. What’s an offset? Some policies will provide that if you receive Social Security disability benefits (including dependent benefits for your children), workers compensation benefits, retirement disability benefits, or even a distribution from your 401(k), your long-term disability benefits will be reduced by the receipt of those benefits.

You will often find a minimum mandatory payment provision in your policy. What is that? This allows a long-term disability carrier to reduce your gross long-term disability benefits by “off settable” benefits.  This offset may be so great that you receive very little long-term disability benefits. This offset can also be greater than the gross amount of your long-term disability benefits. If that happens, many policies say that they’ll pay you a minimum amount of benefits. Perhaps as little as $100.

Do you know whether your long-term disability policy allows your gross disability benefit to be reduced?  Do you know if there is a minimum mandatory payment? You should find these things out now and not before you become disabled.

Many long-term disability policy holders are surprised to learn that their benefits can be reduced. Here’s another surprise!

After the long-term disability insurance company produces the gross amount of your benefits to practically nothing, they will then deny your client. Why? Long-term disability insurance carriers know that if there are little or no benefits left after offsets, it will be difficult for you to find an experienced and skilled long-term disability Attorney to fight for you and secure the benefits you are entitled.

Don’t let the long-term disability insurance company rob you of your peace of mind! Get a copy of your policy and read it. If you see offsets and minimum mandatory payments, your long-term disability policy may, in fact, be worthless in your time of need.

If you have any questions regarding your long-term disability policy, please contact experienced long-term disability/ERISA Tampa Bay attorney, 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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Are Long-Term Disability Benefits taxable?

It depends! If you’ve paid for your long-term disability policy with pretax dollars, your long-term disability benefits will be subject to taxation. Most people have long-term disability insurance coverage as part of a benefit package offered by their employer. Even if you pay part of the long-term disability insurance premium and your employer pays the rest, your long-term disability benefits will be taxable.

If you paid for your long-term disability benefits with after-tax dollars, your long-term disability benefits will not be subject to taxation.

Do you know if your long-term disability benefits are taxable? You should find out so that you have adequate long-term disability coverage. You don’t want to find out that you didn’t purchase the correct amount of long-term disability coverage after you become disabled.

If you have questions about the taxability of your long-term disability benefits, please contact Tampa Bay disability Attorney Nancy Cavey. Nancy has written the free must read book on Long Term Disability/ERISA  policies and the disability claims process.

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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If you are sick or injured and unable to work, you and your family are probably experiencing financial problems. Disability Income Insurance can replace, in part, a paycheck, so it is important to understand the disability  benefits you purchased. I would suggest that you get a copy of my book ““Robbed of Your Peace of Mind? Important Information on Long Term Disability Insurance Policies, the Claims Procedures and How to Win Your Long Term Disability Benefits” to learn about your disability policy.

Disability policies have common provisions. Plans have a specific period of time you have to be disabled before the disability benefit kicks in and you start receiving payments. There is also a maximum time limit you get paid before benefits stop. Think of it as a starting and ending point for your disability/ERISA benefits

Disability benefits plans generally only cover 2/3 of your gross income. However, there are offsets that can reduce your disability check by the receipt of Social Security, Workers’ Compensation benefit and 401K benefits. You could end up with a minimum payment of $100.00 after all reduction and deductions are made.

There are two types of disability insurance. Short term disability is just that- payment for a short period which can last six weeks to twenty-six weeks. Long term disability plans can last 2 years, 5 years, 10 years, and even in certain cases, can last you until you are 65.

Short-term disability usually can only be purchased on a group basis through your employer. Short-term disability benefits can start immediately after an injury or illnesses. Policies will typically pay after one or two weeks or being off of work.

Long term disability plans are more complicated than short-term disability plans. The waiting period for benefits can be one to six months or more, with an average waiting period of 90 days. Long-term disability plans have all sorts of limitations which I discuss in my book Robbed of Your Peace of Mind? Important Information on Long Term Disability Insurance Policies, the Claims Procedures and How to Win Your Long Term Disability Benefits”.  One of the most important is an “own occupation” policy. This “own occupation” policy says that if you cannot work in the job you were trained for (by schooling or experience) you are considered disabled and eligible to receive benefits. There are many other types of disability policies with different definitions of disability. Do you know what your policy says?

Do not let an disability insurance policy intimidate or confuse you. If you have any questions regarding short or long term disability policies contact experienced St. Petersburg Long Term Disability/ERISA Attorney, Nancy Cavey. Regardless of where you live, she can help!

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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UNUM’s 2008 Third Quarter Profits are in! UNUM reported a “net income of $108.00 million in the third quarter of 2008 compared to a net income of $187.00  million in the third quarter of 2007″. Mr. Thomas R. Watjen, president and CEO, commented in an article that he was “pleased with our operating results and the quality of our balance sheet . . .”

Well, his pleasure at UNUM’s profits is coming at the expense of UNUM LTD Policy Holder’s peace of mind.    UNUM is robbing their long term disability policy holders by denying  valid long term disability claims and offering buyouts of 15% – 35%. UNUM’s profits are, in part, generated out of their long term disability claims handling process.

To learn more about how long term disability insurance companies write policies that rob long-term disability applicants of their peace of mind go to Cavey law.com where you can order Nancy Cavey’s book “Robbed of Your Peace of  Mind”.

In my next blog post, I’ll report on the verdict recently entered by a federal jury in Boston finding that UNUM committed fraud in some long term disability cases by requiring long-term disability applicants to apply for Social Security benefits even though UNUM knew their long-term disability claimants weren’t eligible for Social Security 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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