by Cody AllisonWhat is the ERISA “Safe Harbor” Provision And Why Should I Care?
Below is an explanation of the “safe harbor” provision under ERISA. As you will learn in dealing with your claim, there are all sorts of wrinkles in the law as it may apply to your policy or your situation. This is why it is important to consult with a professional when you are thinking of making a claim. Contact us — we’re here to help!
The ERISA “safe harbor” provision is covered under 29 C.F.R. 2510.3-1(j).
If a long-term disability plan, or other employee insurance policy, is excluded from ERISA coverage if it meets the criteria under this provision. The criteria include:
1) The employer makes no monetary contribution to the policy;
2) Employee participation in the policy is completely voluntary;
3) The Employer’s only function, without endorsing the policy, is to allow the insurer to publicize the policy to employees, and collect the premiums through payroll deduction;
4) The only consideration the Employer receives is in the form of an administrative fee for the payroll deduction function.
A policy must meet all four (4) criteria in order to be exempted from ERISA coverage. If these criteria are found to exist, the plan can be exempted under ERISA. Why should Employees / Claimants care if their plan can be exempted under the safe harbor provision of ERISA? The answer is because ERISA favors the Employer/inurance company. When attempting to enforce the payment provisions under the policy, it is to the advantage of the Employee / Claimant if the policy can be exempted from ERISA coverage, thus, the Employee / Claimant can argue coverage (payment) under state law.
If you are involved in a long-term disability claim and need a qualified attorney to review your case at no charge, please call the professionals at Cody Allison & Associates, PLLC (615) 234-6000. You can also visit our website LTDanswers.com. At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonLong-Term Disability Future Benefit Buyout
Once a long term disability payment amount is reached, the question of a future benefit buyout may arise. Sometimes, the insurer or the insured wants to settle the entire claim for a one-time lump sum buyout of all future benefits. The insured has many questions to consider before doing this. You need to consult a professional — that’s why were are here. Call us today.
Does a future benefit buyout make sense for your claim? How much is your buyout worth?
My law firm deals with these two questions weekly. The answers are dependent on the facts of each individual claim. There are many factors to consider, such as:
1) Claimant’s basis of disability;
2) Policy definitions;
3) Mortality considerations;
4) Claimant’s age;
5) Proper calculation of future value and assessment of present value of the policy;
6) reinsurance agreements;
7) interest rates at the time of buyout proposal;
8) Personal financial obligations of the Claimant.
It’s important to remember each buyout situation is different. Just because an insurance company is offering a potential buyout doesn’t necessarily mean that a future benefits buyout is right for you. At Cody Allison & Associates, we understand these are difficult considerations. That’s why we have a team of professionals ready to assist you in assessing your individual situation. Further, we ONLY get paid if we successfully negotiate a buyout on your behalf.
If you are involved in a long-term disability claim and need a qualified attorney to review your case at no charge, please call the professionals at Cody Allison & Associates, PLLC (615) 234-6000. You can also visit our website LTDanswers.com. At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonFibromyalgia In Long Term Disability Claims
Long-term disability can arise from a variety of reasons. One of these reasons my be Fibromyalgia. Below is an explanation of the condition and a warning that making a claim for benefits may be a long and complex process. If you need help making such a claim, contact us. We are ready to help.
Fibromyalgia is a real condition which may have a great effect on an individual’s ability to work; however, fibromyalgia claims for ERISA long-term disability benefits are difficult and need extensive documentation.
Symptoms of fibromyalgia include widespread pain and fatigue; however, some tests may not show this. Fibromyalgia is not like other chronic conditions such Rheumatoid arthritis, Multiple Sclerosis, or degenerative disc disease. Fibromyalgia does not appear on what are called objective tests, such as MRIs, x-rays, or even blood tests. It is often difficult condition to diagnose.
Many ERISA and non-ERISA long-term disability claims are denied because the claimant does not maintain regular treatment with a physician. Treatment with a medical doctor is important in the evaluation of fibromyalgia. If the doctor does not see you on a regular basis, it may be difficult for them to have a clear picture of your struggle with this condition. It is also important to make sure the right specialist treats you. A rheumatologist is the specialist for a patient with chronic widespread pain often associated with fibromyalgia. You can get a referral to a rheumatologist from your primary care physician.
Don’t forget, it is important to make sure that all your symptoms are consistently documented with your medical providers. The insurance company looks for this in your medical records when deciding your claim.
If you are involved in a long-term disability claim and need a qualified attorney to review your case at no charge, please call the professionals at Cody Allison & Associates, PLLC (615) 234-6000. You can also visit our website LTDanswers.com. At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonTreating Doctor v. Insurance Company’s Doctor
When there is a dispute regarding your disability, any court hearing comes down to a “battle of the experts.” In these case of long term disability, the experts are doctors and other medical professionals. The insurance company may want to to have an “independent” medical examination by a doctor that they want to see, and this doctor may end up disputing what your treating physician says about your condition. This is why it is so important to get the right legal professionals working for you. At Cody Allison and Associates, we stand ready to help.
Long-term disability claims primarily involve gathering the right information from your doctors in order to show an accurate picture of your limitations and inability to work based on the definitions in your policy. Many times the insurance company will attempt to contradict the opinions of your doctor by sending your medical records to an “independent” (peer review/insurance company) doctor. The insurance company doctor does not know you and has never even seen you, yet often times, will support the insurance company’s decision to deny benefits. At Cody Allison & Associates, PLLC, our attorneys can effectively argue against the insurance company doctor’s review based on the credentials of the doctor, their bias, as well as the quality of the review itself.
The case law in the Sixth Circuit of the United States Court of Appeals shows that in an ERISA long-term disability decision, the treating doctor of the claimant should be given adequate weight to insure a fair decision is being made. The courts are looking to see if the insurance company acted arbitrarily and capriciously in denying benefits. They are prohibited from relying solely on their “hired guns” when making a decision.
Every case is different. Just like you are a unique individual, your case is unique as well.
At Cody Allison & Associates, PLLC we fight denied long-term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonUnderstanding The Definitions in Your Long-Term Disability Policy for Own Occupation to Any Occupation
Just like most areas of the law, long term disability policies have their own “jargon” that you need to be familiar with to make a claim. Below, you will find information regarding being about to define “own occupation” within the context of your policy. Unfortunately, this is not the only term that you are going to run into when you are dealing with your policy provider that you will need to know the meaning of. Contact us — we are here to help you and answer your questions.
Most ERISA Group Long-Term Disability Policies pay disability benefits for the first two years you may qualify for disability benefits under your policy’s definition of “own occupation”. It is important to know what your long-term disability policy’s definition of “own occupation” is defined as. The definition in these group policies can vary with many different versions of a definition for “own occupation”. Certain policies may use the term “regular occupation” instead of “own occupation”. It is extremely important to understand not only the definition of your “own occupation”, but all the definitions in your long-term disability policy. In most ERISA Group policies, after two years of benefits have been paid for your “own occupation” period, the definition then changes to “any occupation”. If you do not have a copy of your long-term disability policy, we would recommend you request the policy and review the definitions so you know what you need to do in order to qualify to receive these benefits. Just because you have the policy in place, does not automatically mean you will receive the long-term disability benefits because your doctor says you can’t work. There are many definitions and variations of definitions that you need to be aware of. We will be happy to review your long-term disability policy free of charge and answer any questions you may have.
If you are involved in a long-term disability claim and need a qualified attorney to review your case at no charge, please call the professionals at Cody Allison & Associates, PLLC (615) 234-6000. You can also visit our website LTDanswers.com. At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonSystemic Lupus Erythematosus
Depending on your medical condition, it is necessary to seek out the appropriate kind of doctor to be treated by in order to make a claim under a long-term disability policy. It can be difficult for a lay-person to determine what sort of doctor needs to treat them in order to have a valid claim. Below are instructions about a helpful webside, Medline Plus, which has valuable information about Systemic Lupus Erythematosus. If you are having problems making a claim, or if you have questions about treatment for your specific medical problem, call us. We are ready to help.
The website Medline Plus, a service of the U.S. National Library of Medicine and the National Institutes of Health, has a great deal of information on Systemic Lupus Erythematosus, or SLE, which we have attached below.
If SLE is causing a disability, a person claiming long-term disability benefits needs to see a specialist who can administer all relevant testing. Rheumatologists are the appropriate specialists to diagnose and treat lupus. If a claimant suffering from SLE has not treated with a rheumatologist, it will be difficult for them to prove that they qualify for long-term disability benefits. Regular treatment is necessary to control symptoms, although there is not a known cure at this time. A claimant of long-term disability benefits must maintain regular treatment, or they may not be able to show the severity of their symptoms.
If you are involved in a long-term disability claim and need a qualified attorney to review your case at no charge, please call the professionals at Cody Allison & Associates, PLLC (615) 234-6000. You can also visit our website LTDanswers.com. At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
MEDLINE PLUS INFORMATION ON SLE:
Symptoms of Systemic Lupus Erythematosus vary from person to person, and may come and go. Almost everyone with SLE has joint pain and swelling. Some develop arthritis. The joints of the fingers, hands, wrists, and knees are often affected.
Other common symptoms include:
- Chest pain when taking a deep breath
- Fatigue
- Fever with no other cause
- General discomfort, uneasiness, or ill feeling (malaise)
- Hair loss
- Mouth sores
- Sensitivity to sunlight
- Skin rash — a “butterfly” rash in about half people with SLE. The rash is most often seen over the cheeks and bridge of the nose, but can be widespread. It gets worse in sunlight.
- Swollen lymph nodes
Other symptoms depend on which part of the body is affected:
- Brain and nervous system: headaches, numbness, tingling, seizures, vision problems, personality changes
- Digestive tract: abdominal pain, nausea, and vomiting
- Heart: abnormal heart rhythms (arrhythmias)
- Lung: coughing up blood and difficulty breathing
- Skin: patchy skin color, fingers that change color when cold (Raynaud’s phenomenon)
- Kidney: swelling in the legs, weight gain
Some people have only skin symptoms. This is called discoid lupus.
Exams and Tests
To be diagnosed with lupus, you must have 4 out of 11 common signs of the disease.
Your doctor will do a physical exam and listen to your chest. An abnormal sound called a heart friction rub or pleural friction rub may be heard. A nervous system exam will also be done.
Tests used to diagnose SLE may include:
- Antibody tests, including antinuclear antibody (ANA) panel
- CBC
- Chest x-ray
- Kidney biopsy
- Urinalysis
You may also have other tests to learn more about your condition. Some of these are:
- Antithyroglobulin antibody
- Antithyroid microsomal antibody
- Complement components (C3 and C4)
- Coombs’ test – direct
- Cryoglobulins
- ESR
- Kidney function blood tests
- Liver function blood tests
- Rheumatoid factor
- Antiphospholipid antibodies
Treatment
There is no cure for SLE. The goal of treatment is to control symptoms. Severe symptoms that involve the heart, lungs, kidneys, and other organs often need treatment from specialists.
by Cody AllisonMy Long Term Disability Insurance Company Thinks I’m “Cured.”
Just because an insurance company tells you something it true, does not make it so, especially something as subjective as when you are well enough for benefits to cease. Don’t just take their word for it — get some professional assessment. Here at Cody Allison and Associates, we have experience in reviewing medical records and insurance policies, and we can act as another set of eyes to review the documents in your case to help you decide if you are really not entitled to further benefits. Call us today — we are ready to help!
Cody Allison & Associates, PLLC recently, successfully, represented a very nice lady who said something that stuck in my mind. When providing a testimonial for our website,www.LTDanswers.com, she stated, “One day, I was receiving my benefits and the next day I was cut off. It was like the insurance company decided I was cured.” This happens far too frequently in long-term disability cases. The insurance company’s decision to discontinue benefits is seemingly arbitrary and without merit. Clearly, they benefit financially from such a decision. If this has happened to you, you should be asking yourself, what has changed? Why am I no longer disabled? Why is the long term disability insurance company allowed to stop my checks out of the blue?
If this has happened to you, remember, you have legal rights. These rights include appeals and the possibility of a lawsuit. Your legal rights are time sensitive.
Most importantly, don’t give up. That’s what the big insurance companies want you to do.
At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonHas UNUM Denied Your Long Term Disability Claim?
Many people are just not familiar with what to do if your benefit has been denied. Below is some explanation of what to do if your carrier is UNUM and they deny your benefit. They have to follow certain procedures to deny this benefit, and you should check and make sure these procedures have been followed. If you need help, please call us. We are ready to help!
Formerly know as UnumProvident, UNUM is one on the largest providers of long term disability (LTD) insurance in the United States. They are based in Chattanooga, TN and trade on the New York Stock Exchange under the ticker symbol UNM. They are a Fortune 500 Company, have over 9000 employees, and reported revenues topping 10 billion in 2013.
How does the claimant stand a chance against such a large corporation? Answer: Exercise your rights under the law.
If denied, UNUM, or any ERISA based long term disability plan, is required to notify you in writing through a denial letter. Further, they MUST give you a reason for the denial. Some reasons given for denial of your benefits include: lack of medical documentation, lack of detail about your disability, or failure to meet certain LTD policy definitions.
If denied benefits after your initial application, should you accept the insurance company’s denial as the end of the road? NO!
You have rights which include appeals and the possibility of a lawsuit; but be sure to act quickly, your rights are time sensitive. Most importantly, don’t give up. That’s what the big insurance companies want you to do.
At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonSixth Circuit Decision Affirms 3,800,000.00 “Disgorgement Award”
We are asked if the insurance company can be “punished” for failure to pay off a rightful claim. Below is an example of that happening. One of the things that a court must consider in these cases is the fact that, if an insurance company doesn’t pay a substantial claim for a long period of time, that company is getting the benefit of holding on to the claimant’s money, including using it operating capital and earning interest from it. Here, there is a disgorgement award ordered — the insurance company not only has to pay out the money that it wrongfully denied a claimant, but it has to pay out profits it received from holding on to that money. In effect, the court is punishing the company for its wrongful act.
If you feel that you have a claim that is being wrongfully denied, contact us right way. We are here to help!
In an ERISA long-term disability (LTD) case, disgorgement refers to the Court ordering the insurance company to pay, not only the claimant’s benefits under their policy, but also profits the insurance company made while denying the claim (and holding onto the money).
On December 6, 2013, the Sixth Circuit Court of Appeals decision in Rochow v. Life Insurance Company of North America (LINA) sent a message that, not only did the Court have the authority to make such an award, but it would use that authority to right what it perceived as a wrong. The basis of the large monetary calculation was ROE, or return on equity. The Court used this method to determine the level of unjust enrichment to the LTD insurance company and then returned the determined amount to the claimant. The Court also appeared to be sending a message to the LTD insurance industry to act in good faith when evaluating a claim, or the Court might make a disgorgement award.
Many ERISA and non-ERISA long term disability claims are wrongfully denied each year. Wrongful denials enable the big insurance companies to hold your money while they seek to make profits the longer they hold your money. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states. We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonLong Term Disability Benefits Wrongfully Denied — Cigna to Pay Over $77 Million
Sometimes, people feel like they are having to fight against a faceless corporation that really doesn’t have their best interests at heart, just to recover benefits that they are entitled to under an insurance policy that they have paid years of premiums to have. These corporations have excessive amounts of money and attorneys at their disposal and can continue to deny claims for years. This is why is it is so important to get someone on your side to fight these folks. In this case, the Court found that Cigna had spent years wrongfully denying claims, and ordered them to go back through these denied claims and re-evaluate them, which could result in Cigna paying many millions of dollars to claimants.
Here at Cody Allison and Associates, we stand ready to assist you. If you feel that your claim has been wrongfully denied, call us. We can help.
Cigna Insurance Company is one of the top five largest group disability insurance companies in the Country. Following a very lengthy investigation which began in September, 2009 and was concluded on May 13, 2013 by the Department of Insurance Investigators from the States of California, Maine, Connecticut, Pennsylvania and Massachusetts. The investigation regarding the long-term disability claims handling practices of Cigna Insurance resulted with the signing of a Regulatory Settlement Agreement (“Cigna Agreement”) on May 13, 2013. The Agreement which Cigna Insurance has entered into requires Cigna Insurance Company to re-evaluate thousands of long term disability claims that were previously denied which could result in Cigna paying out $77 Million for potential claims that were wrongfully denied.
At Cody Allison & Associates, we handle ERISA long-term disability claims and are based in Nashville, Tennessee, however we handle claims all throughout the state of Tennessee as well as other states. If you have a long-term disability claim that has previously been denied by Cigna Group Insurance, please call Cody Allison & Associates at (615) 234-6000 for a free case analysis. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.