Winning Isn't Easy: Long-Term Disability ERISA Claims
Nancy L. Cavey, a seasoned attorney with over thirty-nine years of experience, explains the complex world of filing for Long-Term Disability benefits. Filing for disability can be a confusing, life changing event, so with her deft expertise, Nancy will guide you through:
- The ins-and-outs of ERISA (the Employee Retirement Income Security Act), which governs group Long-Term Disability Claims.
- Information regarding the process and lifespan of a claim, from the initial application to the request for hearing stages.
- Traps and tactics disability carriers (such as UNUM, The Hartford, Lincoln, and MetLife) use to hinder or deny your claim, including independent medical evaluations, surveillance, and arbitrary and capricious arguments downplaying the nature of your disability.
- Insights, overviews, and claimant stories regarding disease-specific content (ranging from commonplace ailments such as workplace injuries or accidents, to difficult to diagnose illnesses such as Fibromyalgia, Multiple Sclerosis, and POTS).
- Pertinent news happening in the disability world, and
- Much, much more.
Each episode of our podcast Winning Isn't Easy will expose you to invaluable tips and tricks for surviving the disability claims process (a system that is often wrought with pressures and pitfalls designed to encourage you to give up the benefits you rightfully deserve). As host, Nancy will often be joined by guest speakers who themselves are industry experts, ranging from lawyers specializing in related fields and doctors focusing on the diagnosis and treatment of specific diseases, to our associate attorney Krysti Monaco.
In her late teens, Nancy's father was diagnosed with leukemia. As someone who witnessed firsthand the devastating emotional and financial impact on both individual and family that being disabled and filing for benefits can have, Nancy is not just an attorney, but an empathetic presence who understands what you are going through.
Do not let disability insurance carriers rob you of your peace of mind. As a nationwide practice, The Law Office of Nancy L. Cavey may be able to help you get the disability benefits you deserve, regardless of where in the United States you reside. Remember - let Cavey Law be the bridge to your benefits.
Check out the links below to engage with us elsewhere:
Website - https://caveylaw.com/
YouTube - https://www.youtube.com/user/CaveyLaw
Winning Isn't Easy: Long-Term Disability ERISA Claims
Having a Life When You Are Collecting Long-Term Disability - Plus, More on Surveillance
Welcome to Season 4, Episode 17 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "Having a Life When You Are Collecting Long-Term Disability."
Host Nancy L. Cavey, a seasoned attorney with extensive experience in disability claims, discusses how you can maintain some semblance of your lifestyle while pursuing Long-Term Disability. Disability carriers have the misconception that a policyholder who is struggling with an illness, stops working, or is seeking their disability benefits, simply stops existing. Carriers seem as though they believe that disabled policyholders cannot live their lives outside of work or being disabled. In this insightful episode of Winning Isn't Easy, host Nancy L. Cavey will dispel these rumors, and discuss how you can have a fulfilling life, while also being disabled, and while pursuing your disability benefits.
In this episode, we'll cover the following topics:
1 - The Two Words That Can Destroy Your ERISA Disability Claim, and Why You Shouldn’t Use the Words “Never” or “Always” on Your ERISA Forms
2 - It Is Freddy Kreuger on the Phone - The Mistakes You Can Make Talking with the ERISA Disability Carrier on the Phone
3 - What Are the Most Likely Times That an ERISA Disability Carrier Will Place Surveillance on You?
4 - Can You Have a Life While You Are Being Paid Your ERISA Long-Term Disability Benefits?
5 - Betting That Your Long-Term Disability Benefits Won’t Be Cut off if You Go to the Big Game?
Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.
Resources Mentioned In This Episode:
LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/
LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/
FREE CONSULT LINK: https://caveylaw.com/contact-us/
Need Help Today?:
Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.
Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.
Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.
Speaker A [00:00:15]:
Hey, I'm Nancy, KV, national ERISA and individual disability attorney. Welcome to winning isn't easy. Before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says that I've got to tell you that now that I've told you that, nothing's ever going to prevent me from giving you an easy to understand overview of the disability insurance world, the games disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Today I'm going to be talking about how you can live your life while collecting long term disability benefits as well as one of the carriers favorite and most devastating denial tools, surveillance. Disability carriers often forget that just because a policyholder is disabled that they don't suddenly cease to exist or have any humanity.
Speaker A [00:01:09]:
What carriers don't realize is that disability policyholders do in fact continue to live their lives while fighting for the benefits they deserve. I'm going to talk about five things today. Number one, the two words that can destroy your EriSa disability claim and why you should never use the words never or always on your EriSa disability forms. Two. Is it Freddy Krueger on the phone? The mistakes that you can make talking with the EriSa disability carrier on the phone. Three, what are the most likely times that EriSa disability carriers or plans will put surveillance on you? Four, can you have a life while you're being paid your ERiSA disability long term disability benefits? Five, betting that your long term disability benefits won't be cut off if you go to the big game. Let's take a break for a moment before we get into this episode. Welcome back to winning isn't easy.
Speaker A [00:02:22]:
Ready to get started? Now? There are two words that can destroy your EriSa disability claim and why you shouldn't use the words never or always on your Erisa disability forms. I gave you a hint, didn't I? An ERISA disability carrier or plan is looking for a reason to deny your disability claim or terminate your benefits. You can give them ammunition to create a denial by exaggerating on your activity of daily living forms or in your calls with disability carriers. What you do or don't do an activity of daily living form is this open ended form that asks you all sorts of questions about your physical abilities or tempted, rather, to exaggerate your answer in an effort to impress upon the carrier how disabled you really are. That's a huge mistake. And that can create a reason for the disability carrier to deny or terminate your benefits. Inconsistencies between what you report on your activity of daily living forms and what you actually do can be a case killer. Now, that activity of daily living form asks you what you can do.
Speaker A [00:03:28]:
Can you bend? Can you lift? You might say, look, I always have my spouse lift things like a case of water. I never carry things as heavy as a case of water. I never bend down to pick up things. Those absolute words, absolute words are an invitation on a silver platter to a disability carrier to put surveillance on you. Now I will tell you that there are some disability carriers like Hartford Unum or Reliance standard who are notorious for putting surveillance on policyholders who are being paid benefits. They want to record you doing an activity that's inconsistent with your response on the activity of daily living forms or what you've been telling your doctor that you're capable of doing. And I promise you that the disability carrier plan will obtain surveillance on you doing the things you said you never could do or the things you said that you would avoid doing time and time again. I have seen surveillance films of clients going to the grocery store, bending over, picking up a case of water, putting it in their trunk, taking it out of their trunk.
Speaker A [00:04:31]:
And if you said you can't do those things, the disability carrier or plan is going to take that surveillance film back to your doctor. They're going to ask your doctor to change their assigned restrictions, limitations. Because after all, your doctor relied on your report of what you could do in rendering their opinion about your abilities being truthful and don't exaggerating. Those are the two key points I want you to take away from this. When you're answering these open ended questions on an activity of daily living forum, it's important that you don't overstate your disability. You don't exaggerate. You need to make sure that you are telling the truth. Now, I think that the most accurate way to answer these open ended questions is to think in terms of ranges.
Speaker A [00:05:22]:
You might have a good day where you can do more, and you might have a bad day where you can do less. Your answer should always be framed in terms of ranges and not absolutes like never or always. Why is this important? Well, it's also important if you are going to be having an examination at the disability carrier's request or you're going to be attending a functional capacity evaluation or even just going to your own doctor's appointment. In those instances, disability carriers will put surveillance on you the day before, the day of and the day after to counter that good day, bad day type of argument that, that we lawyers tend to make. So in answering questions about your activities, you need to be, as I said, using ranges, saying good days, bad days, depends on how I feel, depends on what I've done the day before. But as a range, this is what I am capable of doing or not doing. And do not ever, ever, ever use the words never, ever, ever. Got it? All right, let's take a break.
Speaker B [00:06:31]:
Have you been robbed of your peace of mind by your disability insurance carrier? You owe it to yourself to get a copy of robbed of your peace of mind, which provides you with everything you need to know about the long term disability claims process. Request your free copy of the book@kvlaw.com. today.
Speaker A [00:07:17]:
Welcome back to winning isn't easy. Is Freddy Krueger on the phone? The mistakes that you can make talking to your risk of disability carrier or plan on the phone. Now when I wrote this episode, it was almost Halloween, and it always reminds me of Freddy Krueger and those horror movies. And you can make many mistakes that can destroy your claim. The claims adjuster or the claims representative is going to be calling you in the course of your claim, and you have an obligation to cooperate with them. You have an obligation to speak with them or to respond to their questions, but you can make many mistakes that will destroy your claim. So what are the mistakes that you can make? If you're going to give a recorded statement, I strongly suggest that you get them to agree to allow you to record that call. Number two, if they say no, what you want to do is to ask them to just put all the questions in writing and you will respond.
Speaker A [00:08:25]:
Now again, we want to insist that the telephone call be recorded so there's an accurate record of who said what and ask for a copy of that call recording. You also may ask them to send you that transcript of the recording and the actual recording so that you can review it and make any changes. I think you also should be taking notes during the call or have the call on a speaker phone so that someone else can be taking a note. So if they call you up out of the blue and want to take your statement, say, look, we want to schedule a specific time. Now, I will tell you that some carriers will not let you record the conversation. If that's the case, you want to say, okay, well, let's reschedule the call. And then you're going to have someone who can witness the call. And in those instances, you want that person to be taking contemporaneous notes and memorializing what has been, what was asked and the response.
Speaker A [00:09:27]:
And sometimes I'll even tell them to send a copy of that back to the disability carrier plan to try to keep them honest. I also don't want you to feel like you have to have an answer for every one of the questions. You may not know the answer. You might be attempted to guess in an effort to appear cooperative, but if you guess wrong, the disability carrier plan is going to try to argue that you lied when in fact you were just trying to be helpful. So if you don't know the answer to the question, tell them that you don't know. And that if it's a type of question that you can get the answer to, that you will research the answer to the question and get back to them. Now, there are going to be questions that you are clearly going to probably know, like the doctors you've recently seen, what appointments are coming up, whether you've returned to work, whether you've applied for Social Security disability. You know you can safely answer those questions, so don't feel as if there's things that you can't answer.
Speaker A [00:10:26]:
Now, there may be some things that you're not comfortable answering because either you don't know, you don't want to guess, or you just don't like the question. Ask those questions to be put in writing. And I think that's particularly true if they ask you open ended questions about what you're doing on a typical day, how much driving you do, whether you do yard work or have similar questions. Now, they should have the answer to those questions if they've sent you an activity of daily living form. But I think that asking those questions when they have the forms or even asking the questions when they don't are set up to create inconsistency between either what you put on the form or or what you told your doctor. So they're trying to create this discrepancy so that they can ultimately argue that you're lying and you're not telling the truth to your doctor about your physical capabilities. Again, these are the kinds of questions that I think the carrier or plan should be putting in writing so that you can review your activity of daily living forms, your doctor's reports, and any other relevant information before you formulate an answer. Take your time to prepare written responses and do not exaggerate or embellish in any way, shape or form.
Speaker A [00:11:37]:
Remember that this unscheduled call is designed to catch you in a weak moment. You want your benefits to continue. You don't want to do anything to jeopardize it. You want to get this call over because you're afraid. You're scared. Don't do that. You should be requesting that the disability carrier arrange a specific time to speak with you as opposed to calling you out of the blue. Remember, they're doing that on purpose.
Speaker A [00:12:02]:
They're just. They're trying to catch you in a weak moment. And you might be tempted to rush through this phone call because you're nervous. You don't know the answer. Whatever reason, it's a mistake. It's a mistake. This is not a social call. It's a horror call.
Speaker A [00:12:18]:
It's Freddy Krueger on the line. Got it. Let's take a break. Welcome back to winning isn't easy. What are the most likely times in an ERISA disability claim that you could expect surveillance? Now, one of the most common denial tools in the disability carrier plan's toolbox is surveillance. Now, I know that the idea that someone is following you is both scary and disconcerting and certainly threatening. And I've been there before. I understand these issues and I understand the concerns of my clients.
Speaker A [00:13:33]:
But one of the things I think you need to first understand is what are the times that disability carriers are likely to place surveillance on you in a claim? Number one, there's an inconsistency in your reported activities of daily living and what you told the carrier in a phone call. There are inconsistencies in your reports of activity of daily living, what you told your doctor, the nature of activities you post on social media accounts, including gaming sites. Did I have to repeat that? Posting on social media accounts and playing on gaming sites is not a very good idea because I promise you they will check. They'll even play the game with you on the gaming site that you're on, and they will be recording it. It's happened to some of my clients now. They will also put surveillance on you three days before any independent exams. Independent is a misnomer. It's a joke.
Speaker A [00:14:29]:
And you can expect that surveillance to be the day before, the day of, probably in the doctor's office that day and the day after. And potentially, you know, they're asking you when your doctor's appointments are. You can potentially expect surveillance to be put on you the day of a doctor's appointment. And unfortunately, as I've said, actually have them in the doctor's office trying to surveil you as to how you present and what you do in the doctor's office and how you walk in and out of the doctor's office. If they've got a scheduled call with you or a meeting, most likely they will put surveillance on you. It's not uncommon for surveillance to be done on common holidays like Martin Luther King Day, St. Patrick's Day, Memorial Day, 4 July, Labor Day, Halloween, and sometime during the Christmas holidays. They always like to try to catch somebody putting up Christmas lights.
Speaker A [00:15:26]:
If you suspect that you have surveillance on you, it's time for you to call an experienced risk of disability attorney because you are being set up. Remember, you're only going to have 180 days in which to file an appeal. If your claim is denied and that appeal is a trial of your case, got to rebut that surveillance now. If you suspect that there is surveillance, what you will normally see is a strange vehicle someplace on your block. Ask your neighbors that like you to keep an eye out for that kind of thing and give you a ring. They may do a tail. In other words, they will do a double tail. They will have a car behind you as they're following you.
Speaker A [00:16:09]:
That car will peel off, the second car will be behind you, and they will do this peel off routine to wherever it is they're following you. As stupid as they as this may sound, they like to catch people filling up their gas tank or going through the drive thru to pick up prescriptions or watching you walk into the grocery store if they are threatening to you, if they're too close. If you feel uncomfortable, if you've got kids in the car, call the police and report to them that you are being followed or surveilled. If you have an opportunity to get the license plate number and make of the vehicle, you should be getting that. Give it to your defense, rather to your attorney. Because one of the things that we do is we work backwards and we'll track who owns that vehicle, try to track it back to a surveillance company, and we'll write a cease and desist letter and demand the surveillance. There are carriers who are very aggressive about using surveillance. That includes unum, a Hartford and Reliance standard.
Speaker A [00:17:17]:
If you are insured by any of those people, you should expect surveillance. Now, as I said, it can be scary, it can be disconcerting, but you can live your life without fear so long as you are complying with your doctor's restrictions and limitations. If you do something outside of that restrictions and limitations or something that hasn't been addressed by your doctor, make sure that you go in and say, hey, you know, I've been going to my son's baseball games and sitting on the side, you know, for 2030 minutes. But I have to leave or, you know, whatever it is so that the doctor knows and is not surprised when the disability carrier's liar for hire doctor calls or some tape of you is dumped on your doctor's desk and the doctor is asked to address or readdress your restrictions and limitations. Got it? Don't go it alone. Let's take a break.
Speaker C [00:18:13]:
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Speaker A [00:19:10]:
Welcome back to winning isn't easy can you have a life while you're being paid your ERISA disability benefits? I'm often asked by my clients, can I go on vacation? Can I go to the gym? Can I volunteer? Can I fill in the blank? And my answer is it depends. It depends on what your disabling medical conditions are, individually and in combination. It depends on whether or not you're still recovering or your medical condition is plateaued. It depends on what your doctor says about your ability to do any of the things that you think you want to do. It depends on whether you have to take medication or you have to increase the amount of medication you take when you do these things. It depends on how often you do these things, how long you do them, and this physical or psychological price that you pay for doing any of these things. It depends on whether or not you need accommodations to do these things and the nature of those accommodations. It depends on whether you or anyone you know is going to be doing any social media posting, and please tell me they aren't.
Speaker A [00:20:14]:
It depends on whether you think the price you're going to pay to do these activities is worth it if the carrier decides to terminate your benefits. In other words, a cost benefit analysis. Now, since a lot of activities are done outside or in public places, nothing is going to prevent the disability carrier plan from putting surveillance on you. Then they're going to compare what you said on those activity of daily living forms or what you told your doctor about your activities and that surveillance film and say, hmm, is there an inconsistency? Is there a conflict? If they perceive a conflict, regardless of how small it might be, they're going to approach your doctor and say, look, we're going to see, based on this surveillance, if we can get the doctor to change the restrictions, limitations. And they're going to try to get the doctor to say that you can perform your own occupation or any occupation based on whatever that surveillance film may show or not show. And it's not necessarily unusual that they get, their doctor gets to see all of the surveillance film. Now you have to be very careful before you decide to do any of these things and consult with your attorney before you undertake any of these activities, making sure you understand what you potentially should do, how to document what you're doing, how to protect yourself, and the price that you potentially could pay by doing any of these activities if the disability carrier decides to use them in an effort to deny or terminate your benefits. Got it.
Speaker A [00:21:47]:
Let's take a break. Welcome back to winning isn't easy. Betting that your long term disability benefits won't be cut off if you go to the big game or the Taylor Swift concert. I'm a big baseball and football fan and I love it when I can go to a game. And I bet if you're like me, you like doing that. You like being out, catching, the excitement of the game, the thrill of watching the game and game live, the fan interaction. But I am not collecting ERISA disability insurance benefits, so I'm not really concerned about what I'm doing or not doing. Being caught doing something when you apply for your risk of disability benefits, the disability carrier plan is going to ask you to fill out forms called activity of daily living forms.
Speaker A [00:23:11]:
These forms are going to ask questions about your activities of daily living and may even ask you if you go to sporting events, including professional sports, amateur sports, or just, you know, your kid's baseball game or soccer game. Please number one, do not post any pictures of your tailgating, drinking, cheering, or anything of that nature because I will assure you that the carrier plan is searching on every social media platform, including gaming sites, to see what you're doing. Secondly, as you're filling out those forms, please tell the truth and make sure that your doctor knows what it is you're doing and the price that you pay. Now, you know your doctor might be a gator fan and they understand why you want to go see the Gators play FSU. But the doctor also needs to understand all the things that had to be done to get you to the game, how you may have to use a wheelchair to get there, the fact that you had to use the elevator in a chair or an elevator as you were walking and you sat in a special seat, so you had to get up, we had to leave, and the next day you had to take more pain medication and you felt miserable. But it was worth seeing the gators beat FSU. Okay, so you need to understand that once the carrier or the plan decides to pay your benefits, they are not going to stop asking you to fill out forms. They're not going to stop looking at social media sites.
Speaker A [00:24:36]:
They're not going to stop looking at the history that you put in your medical records. So you got to be very, very careful. And I know that the big game is one that you want to go to so you can cheer your team on, but it might be better to host or attend a game party, your home or that of a friend. And please don't put any social media posting about that. Again, this is a bit of common sense type stuff, but I know you want to live your life and live it to the fullest that you're capable of doing. But be careful. Remember, the disability carriers or plans are looking for a reason to deny or terminate benefits. And please make sure again that there is no social media posting.
Speaker A [00:25:27]:
Even going to a golf tournament, even watching your kids play soccer or baseball or whatever sports they're involved in. If it ends up on social media posts, it is fair game for the disability carrier to put surveillance on you. Take your statement, and ultimately to approach your doctor about changing restrictions and limitations. Don't let your team's big win be your big loss. Got it? I hope you've enjoyed this week's episode of Winning isn't easy. Please like our page, leave a review, share it with your friends and family, and subscribe to this podcast. I look forward to talking with you in next week's episode of winning isn't easy.