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.

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