August 17, 2008
Understanding your disability insurance policy is important. Often, however, the most important provision goes unnoticed or gets only a simple glance. The single most important provision in a disability policy is the definition of disability.If there is an earnings provision associated with the definition of disability, you must meet not only the duties definition but also the earnings test. Thus, one can meet the duties definition yet fail the earnings test. How can this be, you ask?Take for example an attorney who works on commission or any other occupation that is paid based on commission. He may have settled a case in March; however the settlement may not be received until April and disbursed in May. He may suffer an injury that totally precludes him from performing any of his occupational duties in April. However, he continues to get his regular paycheck from commissions made months earlier. Under this scenario he would not meet the definition of disability as he did not pass the earnings test because his income did not fall below a set percentage.
It is important when purchasing a disability policy that you study the language in the policy and ask questions to be assured that you are getting the benefits that you need. Don’t wait until you file a claim to ask questiona, by then it’s too late.
Claudeth Henry, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
August 14, 2008
Did you know that writing your own appeal in your long term disability case can help prove that you are not disabled? At least that what CIGNA thought. Well thankfully, in Krizek v. Cigna Group Insurance, 345 F.3d 91 (2nd Cir. 2003), the Second Circuit overturned the lower Court’s grant of summary judgment to the defendant in part because the District Court had no evidence to conclude that plaintiff’s ability to prepare her administrative appeal discredited her complaints of pain. Id. at 101.
This should be a warning to disabled individuals who draft their own appeal letter. A poorly written appeal could cost you the case if you are not able to fully and clearly articulate your position and why the insurance company’s reasoning is flawed. On the other hand, a well written appeal can still cost you, as your ability to express yourself clearly and concisely may help established that you are not cognitively impaired or establish skills that can be transferred to other occupations.
Claudeth Henry, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
August 12, 2008
This past weekend, my single goal was to blog. Instead my husband surprised me with tickets to the Caribbean festival in Marion Oaks at Champaign’s farm. What an awesome weekend we had! It was great seeing old friends like Dr. Pam Lewin and Heather-Dawn, as well as meeting new friends and acquaintances. But who can talk about a Caribbean festival without talking about the food? Food was provided from morning until night. Breakfast included ackee & salt fish, green banana and fried dumplings. For lunch there was fish, jerk pork, chicken, run down and festival. Then there was dinner and supper with all the great island food including curried goat, gungu pea and red pea soup and much, much more. The food and the sounds of island music brought back fond memories of growing up in Jamaica.
So what does any of this have to do with ERISA and long term disability, you ask? Well, it got me thinking. As a child, I don’t recall anyone being on disability. Not that there wasn’t any sickness or injury. There was plenty to go around. However, what I do recall is that families lived in close proximity to each other, usually on the same land. The older members took care of the children, and the middle-aged members took care of those who were old or sick. If someone was “down on their luck” (out of a job) the community got together and pitched in. It was truly one for all, and all for one. Having family and good friends were our most important assets. Maybe I’m idealizing what life was a like on the island, but these are my memories.
In my new homeland, I have found that for most people, their job is their most important asset. They live pay check to pay check, and one brief illness or injury could wipe out what they have acquired by years of hard work. For that reason, their disability insurance policy plays a big role in their financial planning. However, one should not buy a policy simply to have one. Rather, they must make sure the policy they purchase will truly meet their need. They need to know how the policy defines disability. Does it offset other income you have or may be entitled to receive? What percentage of your pay will it cover? Can you survive on that percentage? What is the elimination period? Do you have enough money to meet your expenses and necessities throughout the elimination period? What will happen if the insurance company denies your claim? Don’t wait until you need the benefits to get the answers. You need to know now, so that you can plan wisely.
To find out if your long term disability policy offers real protection or is just an illusion, we have written a book to answer many of these questions. For your free copy of our long term disability book, just contact us. It is written in plain English for the average person and easy to read.
Claudeth Henry, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
August 9, 2008
I frequently get calls from long term disability claimants wanting to know if their disability insurance company can get all their social security back benefits. Often they recall some discussion with the insurance carrier about coordination of benefits, but fail to fully appreciate what it meant.
In a nutshell, most group disability policies have a provision that allows the insurance company to offset other income benefits. This means they take credit for the income the disabled individual received from other sources of income such as social security disability, pension, retirement, worker’s compensation, or even settlement from an accident that resulted in the disability benefits. In some cases they can take credit for the social security income that their children receive as a result of the disability.
If you have or are entitled to receive benefits from other sources, you need to seek legal advice. If your worker’s compensation attorney or personal injury attorney is not familiar with all the intricacies of ERISA law, they should consult with an ERISA lawyer to discuss how the settlement of your claim could affect your disability benefits.
I tell clients faced with a request for reimbursement from their disability policy to do the following:
Ø Get a complete copy of their policy.
Ø Verify the information provided by the company. Sometimes the carrier may take credit for a child’s benefit when the policy doesn’t allow offset for a dependent’s benefit.
Ø Get a copy of the calculation worksheet to determine how they arrived at the overpayment.
Ø Seek legal advice before agreeing to repayment.
Most ERISA disability lawyers offer a free initial consultation. There is no reason that you should not fully understand your rights under ERISA.
Claudeth Henry, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
July 27, 2008
A new article was recently published indicating the Fake Bad Scale adopted by the University of Minnesota Press as a part of the MMPI2 scoring package has results in over 50% of women, depending on the cut score used, in a hospital with documented eating disorders actually failing the scale.
The article is critical of the process by which the scale was actually adopted and concludes, “The FBS does not appear to be sufficiently reliable or valid test for measuring “faking bad” nor should it be used to impute the motivation to malinger in those reaching its variable and imprecise cutting scores.”
12/17/07, Butcher, James, Gass, Carlton, Cumella, Edward, Zina, Kally, Willliams, Carolyn
Potential for Bias in MMPI2 Assessment Using the Fake Bad Scale. Psychol. Inj and law
Dorothy Clay Sims, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
July 23, 2008
Check out “Insurance Company Rules” - a collaboration between Health Care For America Now (HCAN) and Public Service Administration (PSA).
Click here to see the video.
Claudeth Henry, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
July 6, 2008
If you are accused of malingering based upon the fake bad scale on the mmpi2, read about the creator of the fake bad scale in an article called:
Welding’s Toxic Legacy: Did a 5 Billion Dollar Industry Cover up the Health Risks of Manganese to Thousands of Workers?
It showed Paul Lees Haley, the creator of the fake bad scale, being paid 860,000.00 (he’s not even a medical doctor) The same article cites Dr. Erin Bigler, a professor of psychology at Brigham Yong University saying, “It has every appearance of the industry buying science” http://www.publicintegrity.org/Manganese/Default.htm
Dorothy Clay Sims, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
July 5, 2008
After running a story in April about a breast cancer survivor’s battle to get disability insurance benefits from Cigna Group Insurance, Good Morning America said that they have received a flood of e-mails from viewers who were struggling with similar problems.
According to GMA, U.S. House Rep. Debbie Wasserman Schultz, D-Fla., heard their report and says she wants to pursue legislation that would penalize insurance companies if they wrongly deny claims. They quoted her as saying “Right now there is no punishment. I’m going to make sure that we pursue these insurance companies and make sure that they are covering the claims that they are supposed to until we can get this law passed.”
I often hear from clients who says, “This law isn’t fair” or “I wouldn’t buy this policy if I knew I wouldn’t get my benefits when I needed them”. Now is an opportunity for every Floridian to get involved in the legislative process. I encourage every one to contact their representative, and express your concern. Let’s get a movement going to right these wrongs.
Click here to contact Representative Wasserman:
http://wassermanschultz.house.gov/zipauth.htm
Click here to contact your representative:
https://forms.house.gov/wyr/welcome.shtml
Claudeth Henry, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
July 1, 2008
Plaintiff lawyers Dorothy Clay Sims and Matthew D. Powell obtained a $1.5 million dollar verdict for a client who was charged with malingering. Read the full story here.
Dorothy Clay Sims, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
June 26, 2008
Is your medicine cabinet filled with expired drugs or medications you no longer use? How should you dispose of them?According to the Food and Drug Administration (FDA) most drugs can be thrown in the household trash, but consumers should take certain precautions before tossing them out. A few drugs should be flushed down the toilet. And a growing number of community-based “take-back” programs offer another safe disposal alternative. Read more by clicking below.
http://www.fda.gov/consumer/updates/drug_disposal062308.pdf
Claudeth Henry, Esq. ~ Sims, Stakenborg & Henry, PA.
Offices in Ocala, Marion County, Florida and Gainesville, Alachua County, Florida. We provide service to the surrounding areas. Our telephone number is: 352-629-0480. Please visit our website at: www.ocalaw.com
0 Comments