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I have been dealing with this since March I have given them all the info they have asked for the problem I think is my doctor has not given me a diagnoses they can not figure out my situation. Please help
The law gives an employer group disability plan administrator a certain period of time to decide your claim. the Department of Labor's regulations - specifically 29 CFR Section 2560.503-1 - gives the insurance company 45 days to decide your claim, but they can get two extension of 30 days each if they write you and tell you more time is needed and provide the reason. If they ask you for information during that process, they can stop the clock while they wait for your response. That means they can take up to 105 days from the date they received your application if they do not ask you for information.
If they have taken over 105 days or violated the rule by not writing you and telling you they need more time passed 45 days, you have the right to file suit against them. From your question, I do not know where you stand in their time process. If they have violated the deadline, I urge you to consult with an attorney immediately, because there are advantages to filing suit quickly when the insurer misses their deadline.
if they are within their time deadline, you cannot make them decide your case sooner. You can only provide them with the evidence needed to decide you are disabled. Medical records alone are rarely enough. You need to proof to show how you are limited or restricted from doing job duties. That may be medical records, but a suggestion would be to add a detailed statement from you or former co-workers explaining how your symptoms impact doing your job or another job (depending on the definition of disability in the plan). There are other types of proof you could submit, but without knowing more about your claim, it is hard to give you advice on more specifics.
When you contact an attorney, you do not want to hire just a local insurance lawyer. You need someone who focuses their practice on ERISA. You also can hire an attorney in any state, because ERISA is an area of federal law. Call multiple attorneys and ask about their experience, or view them online or on avvo.com. ERISA is so unique compared to other areas of the law that you can hurt your claim by hiring an attorney who is not knowledgeable in ERISA. Do not accept general answers. Ask specifics, and find a good fit for you.
John V. TuckerSee question
My husband receives SSA disability, along with our child automatically gets a payment each month as well. His LTD provider Prudential through his previous employer is stating we have to pay all that we received in retro pay for our child and are ...
If your husband has LTD benefits through an employer plan, it is governed by ERISA (the Employee Retirement Income Security Act). ERISA allows employers to draft insurance benefit plans in almost any way they want. Most employers buy a group insurance policy to fund their group Long Term Disability plan. In nearly every group disability insurance policy today, the insurance companies take a credit for Social Security Disability payments that both the disabled person and their children receive. It seems morally wrong that they would take your childrens' money (and it is in my view), but the law allows it.
When I started practicing ERISA disability law 24 years ago, these reductions (called "Other Income" offsets) were not that common. However, today we see them in almost every group disability plan offered by Prudential and other insurance carriers. We also see these provisions creeping into individual policies.
Here are some links to help you learn more about ERISA and other income offsets:
Im a QA analyst, working in IT insurance company. I'm currently WFH. Going thro' chemo. Just finished use my PTO. wanted to go for STD for 12 weeks. Will my job be secured? please advise. email@example.com
You should ask for a leave under the Family and Medical Leave Act through your human resources office. Generally, you would be entitled to 12 weeks of FMLA leave if your employer is large enough (if you have not used it already). Once that is used up though, they can terminate you if you cannot perform the duties of your job, unless there is something in your employee handbook that promises a longer period of time. It is not a violation of the law to terminate an employee who cannot perform their job in that situation. You definitely want to make sure you continue with your STD and then apply for Long Term Disability benefits to make sure you keep income coming into your house.See question
told me I have reached the maximum benefits on my policy. Can they do this? I thought long term was for life . 24 months is does not seem to be long term.
AS Mr. Weidner explained, it is common for disability insurers to have definitions of "disability" that change after 24 months. It is also common to have limitations for certain types of conditions (mental/nervous, "self-reported" symptoms like migraines, etc.), so look at the limitations section in your policy too. Just because they decided you are no longer disabled does not mean they are right. Read the terms, and if you think they are wrong, you should immediately call an attorney that is experienced in handling Disability Insurance. You do not want a Social Security attorney or a personal injury attorney that says they do insurance too, you want to call a Disability Insurance attorney.See question
I went to the ER in Nov. 2013 for flu like symptoms. At that time was ordered by ER Physician to have chest x-ray done. I was diagnose with the flu and was advised to see my Oncologist because they seen a spot on my lungs and had suspension of c...
Whether it is a preexisting condition depends on your medical records and the timing of when you began to be covered by the LTD plan vs. when you made your claim. As Mr. Bordelon noted below, you should not appeal this on your own. You want to hire an attorney that is well-versed in disability plan benefit claims covered under ERISA (the Employee Retirement Income Security Act). You have a very technical problem, and the documentation you submit on appeal will make or break the claim. It will likely be the only evidence a Judge considers if Prudential denies the appeal and you have to appeal to federal court. Keep in mind that you only 180 days to appeal after the date on the denial letter, so call an Employee Benefits/ERISA attorney as soon as possible.See question
I worked for Lowes for 17 1/2 years. An Advantage 2000 rep is calling me tomorrow to apply for SS benefits. I was diagnosed with Charcot Marie tooth disease in 2004. I was told by a Dr. at Cleveland Clinic in 2008 to start an application with SS o...
You do not have to use an agency hired by your LTD Plan or former employer. Often, these groups are non-attorneys and they not disclose that to you. Even if they are attorneys, you have the right to an attorney that you choose who has no connection to the LTD plan (and possibly may have a conflict of interest). I recommend that you speak to a local attorney experienced in both ERISA LTD and Social Security Disability, because what happens in your SSD case can impact your LTD claim. "ERISA" is the federal law that regulates employee benefits, and it operates differently that traditional state insurance law.See question
Is social security tax deducted from FRS disability retirement payments? Also, is social security tax deducted from MetLife long term disability payments?
You did not say, but if you are getting FRS Disability and MetLife, you should certainly apply for Social Security Disability benefits. Note that both FRS and Social Security Disability are likely to be offsets (reductions) from your MetLife disability payment, and MetLife probably has a provision in its policy (particularly if it is a group policy) requiring you to apply for SSD.See question
My mother had a policy with them that we did not know about. The letter states that the beneficiary is the exercutor of the estate. My question is , does this life insurance policy go to the exercutor of the estate only or does it go to the esta...
That should mean that it goes to your mother's estate, not the executor personally. This often happens when someone passes and they had not filled out a beneficiary designation form or the designated beneficiary dies before the person with the life insurance.See question
Had an heart attack 5 yrs ago, I only have 30% percent of my heart left. Case recently reviewed. Decision still in my favor. If I find I can't preform at 40 hours, can I get my disability back?
I agree with Mr. Stennett. I would add that you need to review your disability plan to see how long you may try to work before you have to file a new claim. Many plans let you try to work for up to 30 days and if you cannot continue, you can go back to receiving benefits. However, some use shorter periods of time. Read the plan's terms to be sure.See question
Under the Florida Retirement System, would an individual who has severe seizures many times per month and has missed many days of work due to seizures be considered “totally and permanently” disabled? I understand that an inability to render u...
You certainly could be. The key to FRS claims is how your doctor's fill out the forms, and whether their office notes back up the level of restrictions they have given you. Having the doctors document the types of seiziures, how often they happen, and how and why they cause absences will help you a lot.See question