<?xml version='1.0' encoding='UTF-8'?><?xml-stylesheet href="http://www.blogger.com/styles/atom.css" type="text/css"?><feed xmlns='http://www.w3.org/2005/Atom' xmlns:openSearch='http://a9.com/-/spec/opensearchrss/1.0/' xmlns:georss='http://www.georss.org/georss' xmlns:gd='http://schemas.google.com/g/2005' xmlns:thr='http://purl.org/syndication/thread/1.0'><id>tag:blogger.com,1999:blog-3034665093595765997</id><updated>2012-01-31T10:35:54.620-08:00</updated><category term='disability insurance; lump sum; CIGNA'/><category term='insurance disability attorney'/><category term='Twitter'/><category term='full and fair review'/><category term='Allstate'/><category term='video surveillance'/><category term='Metropolitan Life'/><category term='ERISA claim'/><category term='My Space'/><category term='actual cash value'/><category term='disability attorney'/><category term='ERISA appeal'/><category term='surveillance'/><category term='disability benefit denial'/><category term='accidental death insurance'/><category term='Unum'/><category term='ERISA'/><category term='claim denials'/><category term='replacement cost coverage'/><category term='Prudential Insurance'/><category term='disability insurance;'/><category term='bad faith'/><category term='dwelling coverage'/><category term='disability plan'/><category term='State Farm'/><category term='homeowners insurance'/><category term='long term disability'/><category term='drug exclusion'/><category term='Travelers Insurance'/><category term='Hartford Insurance'/><category term='Facebook'/><category term='administrative appeal'/><category term='ERISA lawyer'/><category term='insurance disability Lawyer'/><category term='disability insurance company'/><category term='LTD'/><category term='Stonebridge Life Insurance Company'/><category term='SPD'/><category term='Life Insurance; Life Insurance Attorney; Insurance Attorney; life insurance lawyer'/><category term='appealing the denial'/><category term='functional capacity evaluations'/><category term='disability denial'/><category term='Farmers'/><category term='ERISA plan'/><category term='disability attorney; disability claims; monthly disability benefit; ERISA'/><category term='Life Insurance; Life Insurance Attorney; Insurance Attorney; ERISA; ERISA Attorney; Metropolitan Life Insurance; Met Life:insurance lawyer;life insurance lawyer'/><category term='premises coverage'/><category term='fire insurance'/><category term='ERISA review'/><category term='rescind; insurance application; life insurance; disability insurance; cancelation fo policy; Blue Cross;deny claim'/><category term='drug overdose'/><category term='insurance disability'/><category term='administrative file'/><category term='ERISA Attorney'/><category term='disability attorney; disability claims; monthly disability benefit; buy-outs; ERISA'/><title type='text'>Insurance Claim Attorney</title><subtitle type='html'></subtitle><link rel='http://schemas.google.com/g/2005#feed' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/posts/default'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default?max-results=100'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/'/><link rel='hub' href='http://pubsubhubbub.appspot.com/'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><generator version='7.00' uri='http://www.blogger.com'>Blogger</generator><openSearch:totalResults>11</openSearch:totalResults><openSearch:startIndex>1</openSearch:startIndex><openSearch:itemsPerPage>100</openSearch:itemsPerPage><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-5651705910916206620</id><published>2009-10-15T12:55:00.000-07:00</published><updated>2009-10-20T11:25:41.420-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='disability attorney'/><category scheme='http://www.blogger.com/atom/ns#' term='My Space'/><category scheme='http://www.blogger.com/atom/ns#' term='Facebook'/><category scheme='http://www.blogger.com/atom/ns#' term='long term disability'/><category scheme='http://www.blogger.com/atom/ns#' term='disability attorney; disability claims; monthly disability benefit; ERISA'/><category scheme='http://www.blogger.com/atom/ns#' term='appealing the denial'/><category scheme='http://www.blogger.com/atom/ns#' term='Twitter'/><category scheme='http://www.blogger.com/atom/ns#' term='disability insurance company'/><title type='text'>My Space, Facebook Could Damage Disability Case</title><content type='html'>&lt;span style="font-family:arial;"&gt;&lt;span style="color:#3333ff;"&gt;Facebook, Twitter, My Space&lt;/span&gt;, etc. (collectively referred to as social media sites) are popular with people of all age groups. Long term disability insurance companies and their attorneys use these sites also, to get information about YOU. &lt;span style="color:#3333ff;"&gt;There may be valuable information about you on these sites that could severely damage your long term disability claim.&lt;/span&gt;&lt;/span&gt;&lt;span style="color:#3333ff;"&gt; &lt;/span&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;span style="font-family:Arial;"&gt;The long term disability insurance adjuster's job is to pay you as little as possible or to even deny or terminate your claim. Social media sites and blogs can help the adjusters do their job. The adjuster will try to disprove the extent and nature of your disability by viewing your activities depicted on the internet. Why do long term disability insurance companies look at social media sites? &lt;/span&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;span style="font-family:Arial;"&gt;(1) Doctors rely, in part, on your history and complaints in rendering an opinion about your diagnosis. The long term disability carrier will use the social media site to confirm or disprove that your activities and life style depicted on the internet support the information you gave your doctors that formed the basis of their opinions.&lt;/span&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;span style="font-family:Arial;"&gt;(2) The long term disability insurance company asks you to complete Activities of Daily Living forms, reporting your level of activity. If you say you cannot walk distances and there is a picture of you at Disney on your social media site, you have a problem.&lt;/span&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;span style="font-family:Arial;"&gt;(3) If you claim you are depressed or withdrawn, the long term disability carrier will use social media sites to confirm or disprove whether you interact normally with friends and family. &lt;/span&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;span style="font-family:Arial;"&gt;Pictures, videos, personal information, posts and comments can damage or even destroy your long term disability case. &lt;span style="color:#3333ff;"&gt;Do not post anything you would not feel comfortable having the insurance company or judge read. &lt;/span&gt;Check your privacy settings immediately and &lt;span style="color:#3333ff;"&gt;block anyone you do not know &lt;/span&gt;from viewing your personal pages. Search your name on all sites and on Google. See what comes up. Take appropriate action to remove photos which could be detrimental to your claim. Do not accept any friend request or answer any emails from people you do not know. &lt;/span&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;span style="font-family:Arial;"&gt;For more information or to get help from a disability attorney on long term disability claims, insurance companies, &lt;span style="color:#3333ff;"&gt;ERISA&lt;/span&gt;, appealing the denial of long term disability benefits, or terminations of benefits, see our website at &lt;a href="http://www.stennettcasino.com/"&gt;http://www.stennettcasino.com/&lt;/a&gt;.&lt;/span&gt;&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-5651705910916206620?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/5651705910916206620/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=5651705910916206620' title='43 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/5651705910916206620'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/5651705910916206620'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2009/10/my-space-facebook-could-damage-your.html' title='My Space, Facebook Could Damage Disability Case'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>43</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-4026111177685946790</id><published>2009-07-16T08:30:00.000-07:00</published><updated>2009-10-15T12:55:17.183-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='disability attorney; disability claims; monthly disability benefit; buy-outs; ERISA'/><category scheme='http://www.blogger.com/atom/ns#' term='disability insurance; lump sum; CIGNA'/><title type='text'>Lump Sum In Lieu of Future Disability Payments?</title><content type='html'>&lt;div align="justify"&gt;Frequently an insurance company that has been paying monthly disability payments to you will offer to cash you out. &lt;span style="color:#000099;"&gt;&lt;span style="color:#3333ff;"&gt;What this means is that in lieu of the future monthly disability benefit payments they will offer to fully discharge the future obligations by paying you a lump sum of money.&lt;/span&gt; &lt;/span&gt;You will receive a letter from them outlining what will be paid and how the amount will be calculated.&lt;br /&gt;&lt;br /&gt;Before agreeing to settle on this amount, several factors need to be assessed such as the present value of your claim; your statistical life expectancy; and the anticipated future interest rates. &lt;span style="color:#3333ff;"&gt;It is imperative and often required by the insurance company that before accepting this amount you consult with an attorney.&lt;br /&gt;&lt;/span&gt;&lt;br /&gt;&lt;span style="color:#000000;"&gt;&lt;span style="color:#333333;"&gt;An attorney who is experienced in handling disability claims will review the claim not only from the standpoint of the fairness of the cash out offer but also among other things will review the insurer’s calculation of the monthly disability benefit, (which may be in error) and the interest rate used by the insurer in calculating present value. For example, our office recently reviewed a cash out offer by CIGNA where we found that over several years CIGNA had been underpaying the monthly benefit. We not only recovered those benefits for the client, but also obtained a much larger lump sum buyout for the client.&lt;br /&gt;&lt;/span&gt;&lt;br /&gt;&lt;/span&gt;When you get one of these letters &lt;span style="color:#3333ff;"&gt;you should immediately contact an experienced disability attorney.&lt;/span&gt; Often the insurance company will pay for an attorney to review the buy out agreement. So you truly have nothing to lose in contacting an attorney.&lt;br /&gt;&lt;br /&gt;If you want more information about buy-outs or other insurance issues, go to our web page at www.&lt;a href="http://www.stennettcasino.com/"&gt;&lt;span style="color:#3333ff;"&gt;&lt;span style="color:#3333ff;"&gt;stennettcasino&lt;/span&gt;.com&lt;/span&gt;&lt;/a&gt; where you will find contact information to either call or email an expert in these areas.&lt;/div&gt;&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-4026111177685946790?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/4026111177685946790/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=4026111177685946790' title='0 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/4026111177685946790'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/4026111177685946790'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2009/07/lump-sum-in-lieu-of-future-disability.html' title='Lump Sum In Lieu of Future Disability Payments?'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>0</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-6619868318991524573</id><published>2009-07-08T12:47:00.000-07:00</published><updated>2009-07-08T14:33:04.980-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='ERISA appeal'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA Attorney'/><category scheme='http://www.blogger.com/atom/ns#' term='disability benefit denial'/><category scheme='http://www.blogger.com/atom/ns#' term='disability insurance;'/><category scheme='http://www.blogger.com/atom/ns#' term='disability plan'/><category scheme='http://www.blogger.com/atom/ns#' term='insurance disability attorney'/><title type='text'>My Disability Claim is Denied - Next Step</title><content type='html'>You receive a letter from your insurance company advising you that your disability claim is denied or terminated. After the initial shock wears off, &lt;span style="color:#3366ff;"&gt;what&lt;/span&gt; &lt;span style="color:#3366ff;"&gt;steps can you take to obtain your disability benefits?&lt;/span&gt; What you should NOT do is immediately write back, telling your insurer they have made a mistake, and ask them to reconsider your claim. You will eventually want to do so; however, there are several steps you need to take first.&lt;br /&gt;&lt;br /&gt;If your disability policy is part of an employee benefit plan then it is probably governed by Federal Law known as the Employee Retirement Income Security Act (ERISA). Under ERISA, the insurer/plan must give you 180 days following a termination or denial of benefits in which to request an administrative appeal or review of your claim. However, most plans give you only one shot at an appeal. Thus, you must use this opportunity wisely.&lt;br /&gt;&lt;br /&gt;&lt;span style="color:#3366ff;"&gt;The first thing you should do is request from the insurer, a copy of their entire file on your claim. &lt;/span&gt;&lt;span style="color:#000000;"&gt;They are obligated&lt;/span&gt; to provide it to you, without cost, within 30 days of a &lt;em&gt;written&lt;/em&gt; request. Once you receive this file you should go through and organize it in some fashion, i.e, putting all the medical records together segregated by provider and in chronological order. Once you have organized the file it will be easier for you to see what is missing from the records. If they had your file reviewed by their own medical or vocational consultants, you will see their reports and have a better understanding of why they denied or terminated your claim.&lt;br /&gt;&lt;br /&gt;You should &lt;span style="color:#3366ff;"&gt;also obtain&lt;/span&gt;, if you do not already have it, a copy of &lt;span style="color:#3366ff;"&gt;the plan or&lt;/span&gt; &lt;span style="color:#3366ff;"&gt;disability policy&lt;/span&gt; that sets forth all your rights and obligations. You should be able to obtain the policy from the administrator of the plan who is typically the employer. However, if there is a claims administrator, then they will most likely be able to send that document to you.&lt;br /&gt;&lt;br /&gt;It is at this point I would strongly suggest you &lt;span style="color:#3366ff;"&gt;contact an attorney&lt;/span&gt;. An initial conference with an attorney should not cost you anything. However, make sure the attorney is experienced in handling ERISA benefit claims. The law applicable to these claims is unique and technical. If you have done your homework and have the claim file, the policy and your letter of denial, you should be able to answer many of the questions the attorney will have to help you evaluate your claim. You are most likely emotionally attached to your claim and getting input from an experienced attorney can often be enlightening. Remember, the fact that you are disabled does not guarantee that you will receive benefits. It does not matter how many times you tell the insurer that you are in pain and cannot work. What is important is the presentation of evidence that sets out your physical limitations associated with your illness or injury and how those limitations preclude you from performing the duties of a job.&lt;br /&gt;&lt;br /&gt;If you want more information about ERISA or wish to talk to or email an expert about your claim, visit our website at &lt;a href="http://www.stennettcasino.com/"&gt;www.StennettCasino.com&lt;/a&gt;.&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-6619868318991524573?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/6619868318991524573/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=6619868318991524573' title='0 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/6619868318991524573'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/6619868318991524573'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2009/07/my-disability-claim-is-denied-next-step.html' title='My Disability Claim is Denied - Next Step'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>0</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-2277710047851037193</id><published>2008-12-02T10:49:00.000-08:00</published><updated>2008-12-02T12:00:19.048-08:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='Stonebridge Life Insurance Company'/><category scheme='http://www.blogger.com/atom/ns#' term='Life Insurance; Life Insurance Attorney; Insurance Attorney; life insurance lawyer'/><category scheme='http://www.blogger.com/atom/ns#' term='drug overdose'/><category scheme='http://www.blogger.com/atom/ns#' term='accidental death insurance'/><category scheme='http://www.blogger.com/atom/ns#' term='bad faith'/><category scheme='http://www.blogger.com/atom/ns#' term='drug exclusion'/><title type='text'>Death Caused by Accidental Overdose of Prescription Drug is Covered Under an Accidental Death Policy</title><content type='html'>Accidental death policies, by definition, provide benefits when the insured dies as the result of an accident. However, not all accidents are covered since &lt;span style="color:#cc0000;"&gt;&lt;strong&gt;most policies have exclusions limiting the&lt;/strong&gt; &lt;strong&gt;type of accidents that will be covered&lt;/strong&gt;&lt;/span&gt;. State Insurance Codes have placed limitations on what exclusions an insurance company can place in such policies.&lt;br /&gt;&lt;br /&gt;I assisted a recent client whose 59 year old mother died of an accidental overdose of her pain medication, Oxycodone. Her mother was insured with an accidental death policy from Stonebridge Life Insurance Company. However, her claim for benefits following her mother's death was denied.&lt;br /&gt;&lt;br /&gt;Stonebridge Life denied the claim citing two exclusions in the policy. The first exclusion excluded &lt;strong&gt;losses caused by the use of intoxicants or prescription&lt;/strong&gt; &lt;strong&gt;medications&lt;/strong&gt; &lt;em&gt;unless taken as prescribed&lt;/em&gt;. Stonebridge Life asserted that the insured took more than the prescribed amount, giving rise to the exclusion. The second exclusion cited by Stonebridge Life was an exclusion for &lt;strong&gt;losses caused by illness&lt;/strong&gt; or the treatment thereof. Stonebridge Life asserted that the medication was a treatment for chronic pain and thus, again was excluded by the policy.&lt;br /&gt;&lt;br /&gt;On behalf of my client I argued that California Insurance Code Section 10369.12 limits the insurance company's ability to exclude death caused by drugs. Section 10369.12 allows an insurance policy to include an exclusion "in the form set forth herein." The exclusion for intoxicants in the Insurance Code states:&lt;br /&gt;&lt;br /&gt;"The insurer shall not be liable for any loss sustained or contracted in consequence of the insureds being intoxicated or under the influence of any controlled substance &lt;strong&gt;unless administered on the advice of a physician. &lt;/strong&gt;&lt;br /&gt;&lt;strong&gt;&lt;/strong&gt;&lt;br /&gt;Stonebridge Life's exclusion in its policy was similar, but not identical to the above language. The crucial difference was that Stonebridge Life's exclusion excluded losses caused by a person using drugs &lt;em&gt;unless taken or used &lt;strong&gt;as prescribed by a physician&lt;/strong&gt;.&lt;/em&gt; This language clearly required the insured to take the medication within prescribed amounts. We argued that the language from California Insurance Code - &lt;strong&gt;unless administered on the advice of a physician&lt;/strong&gt; - does not require the patient to take the medication exactly as prescribed.&lt;br /&gt;&lt;br /&gt;A Federal Judge in the Northern District of California agreed with our interpretation of the Insurance Code and the policy and has ruled that in California &lt;span style="color:#cc0000;"&gt;&lt;strong&gt;an insurance company cannot&lt;/strong&gt; &lt;strong&gt;exclude death caused by an overdose of prescribed medication&lt;/strong&gt;&lt;/span&gt;, even though the decedent took more than was prescribed by his/her physician. Based on the same reasoning, the court held that the medical treatment exclusion was inconsistent with the California Insurance Code since it would be just another method of getting around the limitations set forth in California Insurance Code Section 10369.12 with regard to losses caused by use of prescription medication.&lt;br /&gt;&lt;br /&gt;The opinion of the court in &lt;em&gt;Smith v. Stonebridge Life Insurance Co&lt;/em&gt; can be found on Westlaw at 2008 WL 4531818. For more information on this case and other insurance cases, see our web page at &lt;a href="http://www.stennettcasino.com/"&gt;stennettcasino.com&lt;/a&gt;&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-2277710047851037193?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/2277710047851037193/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=2277710047851037193' title='1 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/2277710047851037193'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/2277710047851037193'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2008/12/death-caused-by-accidental-overdose-of.html' title='Death Caused by Accidental Overdose of Prescription Drug is Covered Under an Accidental Death Policy'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>1</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-8113825737405456619</id><published>2008-05-14T11:29:00.000-07:00</published><updated>2008-05-16T10:55:26.257-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='surveillance'/><category scheme='http://www.blogger.com/atom/ns#' term='functional capacity evaluations'/><category scheme='http://www.blogger.com/atom/ns#' term='long term disability'/><category scheme='http://www.blogger.com/atom/ns#' term='LTD'/><category scheme='http://www.blogger.com/atom/ns#' term='video surveillance'/><category scheme='http://www.blogger.com/atom/ns#' term='Hartford Insurance'/><category scheme='http://www.blogger.com/atom/ns#' term='disability benefit denial'/><title type='text'>HARTFORD RECIPE FOR LTD DENIAL</title><content type='html'>&lt;span style="font-family:trebuchet ms;"&gt;If you are receiving benefits under a Hartford disability policy then you should be aware of its recipe for denial. I have seen a consistent pattern of termination of benefits by Hartford. The strategy is to set a trap for the beneficiary that can be avoided if you are aware of the following.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Regardless of the form of your disability Hartford will send a functional capacity evaluation form to the treating doctor which will ask him/her to delineate the number of hours their patient can sit, stand, walk in an 8-hour work day. It will also ask many other questions regarding the patient’s functioning. Typically, the doctor will rely substantially on the patient’s statements of disabilities. The trap is this. The form typically does not conform to the individual disability that you may have. Thus though you may be able to sit for only 20 minutes in a work setting in front of a computer on a consistent basis, you may be able to sit for 2 hours in a car. Or, &lt;strong&gt;&lt;em&gt;on a good day you may be able to do much more than on a bad day,&lt;/em&gt;&lt;/strong&gt; which typically will follow a day of activity. Thus, &lt;strong&gt;&lt;em&gt;the problem in a work setting becomes the inability to perform the same function day after day&lt;/em&gt;&lt;/strong&gt;, 8-hours a day. The functional capacity form is typically filled out by the doctor and by the patient on the basis of the worst case scenario. Thus, the doctor may state that the patient can sit for only 20 minutes consecutively. What the doctor should be stating is that the patient is limited to 20 minutes sitting at a work station consecutively before their abilities to concentrate, etc. are interfered with by pain and discomfort. Or that their capacities vary and thus their limitations are based on an inability to perform consistent, day-after-day activities.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;&lt;strong&gt;&lt;em&gt;The trap&lt;/em&gt;&lt;/strong&gt; is that once the physician sets out the limitations as being the ability to sit "only 20 minutes at a time," then &lt;em&gt;&lt;strong&gt;Hartford sends a surveillance team to videotape the insured&lt;/strong&gt;.&lt;/em&gt; Hartford will camp out at your residence at 6 a.m. and follow you for the entire day. They will do this for 2 to 3 days and if they are unsuccessful in finding you doing any activities they will come back another time and do it again. Inevitably, the insured will leave their home and perform errands such as shopping, going to the bank, going to church, etc. These errands will typically show the insured doing things beyond the limitations placed in the functional capacity evaluation forms completed by the treating doctor.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Once the surveillance is completed then Hartford will send an adjuster to the insured’s home for a 2 to 3 hour interview. During the interview they will obtain a signed statement from the insured listing all the limitations they have due to their disability. Then they pop out the video and ask the insured to identify themselves in the video and that indeed it reflects their abilities. &lt;/span&gt;&lt;span style="font-family:trebuchet ms;"&gt;&lt;strong&gt;&lt;em&gt;The video will show the insured getting in and out of cars, driving cars, sitting in cars for extended periods of time, doing extended shopping for a half day or more. These will be perceived as inconsistent with the limitations the insured and the treating physician placed and thus makes the insured’s claim of disability appear to be false.&lt;br /&gt;&lt;/em&gt;&lt;br /&gt;&lt;/strong&gt;&lt;br /&gt;The reality is that an individual who is disabled from the grinds of a 40-hour work week is not necessarily disabled from life. They still have to perform activities of daily living that are required, whether one is working, or not. &lt;em&gt;&lt;strong&gt;The abilities to go to the grocery store and the bank do not correlate with the ability to work a full time job.&lt;/strong&gt; However, &lt;strong&gt;Hartford’s strategy is to get the insured to at least appear to overstate their disability and then discredit them with the video&lt;/strong&gt;.&lt;/em&gt; If you understand Hartford’s strategy you can avoid the trap. Don’t place unrealistic, definite time limitations on any of your capacities. Concede your ability to do what you can do, with the important aspect being the things you cannot do that prevent you from returning to work.&lt;br /&gt;&lt;br /&gt;For more information on how to protect your disability benefits visit our web site at &lt;/span&gt;&lt;a href="http://stennettcasino.com/"&gt;&lt;span style="font-family:trebuchet ms;"&gt;StennettCasino.com.&lt;/span&gt;&lt;/a&gt;&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-8113825737405456619?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/8113825737405456619/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=8113825737405456619' title='2 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/8113825737405456619'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/8113825737405456619'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2008/05/hartford-recipe-for-ltd-denial.html' title='HARTFORD RECIPE FOR LTD DENIAL'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>2</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-5728919695077275989</id><published>2007-06-19T09:20:00.000-07:00</published><updated>2007-06-20T14:32:40.060-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='rescind; insurance application; life insurance; disability insurance; cancelation fo policy; Blue Cross;deny claim'/><title type='text'>New Standard Set for Insurers who Rescind Policies</title><content type='html'>&lt;span style="font-family:verdana;"&gt;In newer life insurance, disability insurance, and health insurance polices (less than 2 years old) insurers attempt to avoid paying claims by performing what is known as "post claim underwriting." When you purchase a health, disability or life policy, you fill out &lt;strong&gt;an application that asks questions about you and your family's health,&lt;/strong&gt; give the insurer a medical authorization, and sometimes undergo a medical exam. Instead of using the authorization to get the applicant's medical history before wrting the policy, the insurance company waits until a claim is made. At that time, they obtain your medical records to determine if your statements on the application for insurance was 100% absolutely accurate. If not, then the insurance company rescinds (retroactively cancels) the policy, refunds your premiums, and denies your claim.&lt;br /&gt;&lt;br /&gt;On the surface, it sounds reasonable for an insurance company to rescind a policy where the insured obtained the policy through material misrepresentations. But, the &lt;strong&gt;insurance company's applications are full of run-on sentences, ambiguities, and traps for the applicant, who is filling out a form&lt;/strong&gt; that asks for detailed medical information going back 10 years or more while the agent is telling you "we only need the important stuff."&lt;br /&gt;&lt;br /&gt;&lt;strong&gt;A policy holder's honest mistake, inadvertent errors, and other inconsistencies about his medical history in the application should not be a basis to deny claims.&lt;/strong&gt; Particularly, where the inconsistencies are apparent on the face of the application but the insurer does not investigate the flaws until after a claim is made.&lt;br /&gt;&lt;br /&gt;Blue Cross of California has taken a positive step in avoiding the inequities of post claim underwriting in their health insurance policies. Blue Cross has agreed, pursuant to the settlement of a class action lawsuit, to &lt;strong&gt;rescind policies only where there is a finding of a willful misrepresentation in the application.&lt;/strong&gt; Blue Cross has also agreed to use a new application form designed to minimize mistakes.&lt;br /&gt;&lt;br /&gt;Hopefully, this is a step that all insurers will take or the legislature will require insurance companies to take in the future. For more information about improper insurance claim denials see our web site at &lt;a href="http://stennettcasino.com/"&gt;StennettCasino.com&lt;/a&gt;.&lt;/span&gt;&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-5728919695077275989?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/5728919695077275989/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=5728919695077275989' title='0 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/5728919695077275989'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/5728919695077275989'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2007/06/new-standard-set-for-insurers-who.html' title='New Standard Set for Insurers who Rescind Policies'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>0</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-8943163567064647961</id><published>2007-05-08T08:46:00.000-07:00</published><updated>2007-05-08T12:53:33.749-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='full and fair review'/><category scheme='http://www.blogger.com/atom/ns#' term='SPD'/><category scheme='http://www.blogger.com/atom/ns#' term='administrative file'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA Attorney'/><category scheme='http://www.blogger.com/atom/ns#' term='administrative appeal'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA review'/><category scheme='http://www.blogger.com/atom/ns#' term='disability denial'/><title type='text'>What is an Administrative Appeal?</title><content type='html'>You have applied for benefits under an employee benefit plan and you have received a letter from the insurance company or plan administrator informing you that your application for benefits is denied. Whether you are applying for disability, life, health or other benefits the letter advises you that you have a right to an administrative appeal or review of your claim. This article is about that process - what is an administrative appeal or administrative review; what are your rights and obligations; and generally how should you approach this process.&lt;br /&gt;&lt;br /&gt;The administrative appeal/review is your opportunity to convince the insurer/administrator that you are entitled to benefits without having to file a lawsuit. Most people's knee-jerk reaction when they receive the denial letter is to immediately request an appeal, sending a letter to the insurance company telling them how wrong its determination was, that they truly are disabled, and that their doctor has already advised them of that fact. As you will see below, this is the wrong approach to take.&lt;br /&gt;&lt;br /&gt;You have certain rights and obligations under the employee benefit plan and the laws regulating these plans. &lt;strong&gt;You have a right to a "full and fair review"&lt;/strong&gt; of your claim by the claims administrator. Part of the entitlement to a full and fair review includes the right to examine all documents relied upon or reviewed by the plan in denying your benefits &lt;em&gt;and &lt;/em&gt;an opportunity to respond to those documents. Thus, your first step is to obtain those documents. Write to the adjuster and &lt;strong&gt;request a copy of the entire administrative file&lt;/strong&gt; (claims file). The file contains all the communications and internal memos on your claim, the insurance carrier's physicians, vocational consultants, nurses and others' opinions and reports regarding your claim, not to mention all of your medical records. These documents must be provided to you within 30 days at no cost to you. Once you receive this file, then you will know what the claims administrator does and does not have which becomes important when it comes to deciding what additional documents should be submitted to the claims administrator.&lt;br /&gt;&lt;br /&gt;In addition to the administrative file &lt;strong&gt;you should also obtain a copy of the Plan&lt;/strong&gt; itself, which may be in the form of an insurance policy, a summary plan description (&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_0"&gt;SPD&lt;/span&gt;), or an employee handbook. These documents define the specific contractual obligations of the Plan and its participants. Thus if you are looking for the definition of "disability" or "&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_1"&gt;pre&lt;/span&gt;-existing condition" it will be in the Plan.&lt;br /&gt;&lt;br /&gt;Another aspect to your entitlement to a "full and fair review" is the obligation by the Plan to tell you (1) the specific reasons for the denial; (2) reference the plan provisions on which the denial is based; (3) a description of any additional material or information necessary for you to perfect your claim, and an explanation of why such material or information is necessary; and (4) the steps you need to take in order to submit your claim for appeal or review. Thus, &lt;strong&gt;if you look at your denial letter closely you will discover the Administrator's reasons for denying your claim and what additional information you need to present in order to get your claim approved. &lt;/strong&gt;&lt;br /&gt;&lt;br /&gt;Typically, you are given 180 days from the receipt of the denial letter in which to submit an administrative appeal. There is no rush in submitting the appeal. You should take advantage of this opportunity to &lt;strong&gt;fully document your claim&lt;/strong&gt;. If you are &lt;span class="blsp-spelling-corrected" id="SPELLING_ERROR_2"&gt;unsuccessful&lt;/span&gt; in the appeal process, then your only option is filing suit against the Plan. The court in reviewing your case is generally limited to reviewing the evidence contained in the administrative file. If your evidence was not put into the file during the administrative process the court will generally not consider it.&lt;br /&gt;&lt;br /&gt;What you should submit differs depending on the facts of your claim. This is the point in your claim where I highly recommend that you contact an attorney experienced in handling &lt;span class="blsp-spelling-error" id="SPELLING_ERROR_3"&gt;ERISA&lt;/span&gt; or employee benefit claims to at least discuss your options. If your claim is denied after the appeal process is concluded then your only option thereafter is litigation. If you have not contacted an attorney before you have exhausted your administrative remedies you are at a &lt;span class="blsp-spelling-corrected" id="SPELLING_ERROR_4"&gt;tremendous&lt;/span&gt; disadvantage.&lt;br /&gt;&lt;br /&gt;If you would like to discuss your particular claim with an attorney with expertise in employee benefit plans, visit our website at &lt;a href="http://stennettcasino.com/"&gt;&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_5"&gt;stennettcasino&lt;/span&gt;.com&lt;/a&gt;. To see examples of cases that began with a denial and ended with a judgment for the beneficiary, please see our "&lt;a href="http://stennettcasino.com/successes.htm"&gt;Successes&lt;/a&gt;" page.&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-8943163567064647961?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/8943163567064647961/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=8943163567064647961' title='0 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/8943163567064647961'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/8943163567064647961'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2007/05/what-is-administrative-appeal.html' title='What is an Administrative Appeal?'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>0</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-7002902465241089803</id><published>2007-04-12T14:34:00.000-07:00</published><updated>2007-04-30T10:15:10.622-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='claim denials'/><category scheme='http://www.blogger.com/atom/ns#' term='Allstate'/><category scheme='http://www.blogger.com/atom/ns#' term='homeowners insurance'/><category scheme='http://www.blogger.com/atom/ns#' term='dwelling coverage'/><category scheme='http://www.blogger.com/atom/ns#' term='Travelers Insurance'/><category scheme='http://www.blogger.com/atom/ns#' term='Farmers'/><category scheme='http://www.blogger.com/atom/ns#' term='actual cash value'/><category scheme='http://www.blogger.com/atom/ns#' term='fire insurance'/><category scheme='http://www.blogger.com/atom/ns#' term='replacement cost coverage'/><category scheme='http://www.blogger.com/atom/ns#' term='premises coverage'/><category scheme='http://www.blogger.com/atom/ns#' term='State Farm'/><title type='text'>HOW MUCH HOMEOWNERS INSURANCE SHOULD I HAVE?</title><content type='html'>With all of the recent publicity regarding insurance companies denying or limiting claim payouts on homeowners’ policies, many people are asking how they can protect themselves from being a victim of their own insurance company at a time when they most need the protection.&lt;br /&gt;&lt;br /&gt;Here are a few thoughts on how to make sure you at least have adequate insurance. When you purchase insurance coverage for your home it is your intent to cover yourself for;&lt;br /&gt;1) the cost of rebuilding your home,&lt;br /&gt;2) the cost to replace your personal possessions within your home, and&lt;br /&gt;3) the cost of having to live elsewhere while your home is being rebuilt.&lt;br /&gt;&lt;br /&gt;First, decide how much it will &lt;strong&gt;cost to rebuild your home&lt;/strong&gt;. This is not the price you paid for your home nor is it the amount of your mortgage. If you are unsure of how to determine this amount ask your agent since he has more expertise in this area. Give him the exact square footage of the residence, the specific location of the residence, the type of construction, whether the house is a custom home and any other unusual features of your home. Once your agent has this information, have the agent determine the cost per square foot to rebuild your home. In order to determine the amount of dwelling coverage you should carry just multiply the square footage by the cost per square foot. Always confirm &lt;strong&gt;in writing&lt;/strong&gt; what figures the agent quoted you so that if the question of adequate coverage or co-insurance becomes an issue you are protected since you relied upon the agent’s expertise. However, beware that &lt;strong&gt;insurance agents typically under estimate the cost&lt;/strong&gt; &lt;strong&gt;of rebuilding your home&lt;/strong&gt;. Agents want to sell you insurance and to do so they believe they need to keep the premiums as low as possible which means keeping the coverage low.&lt;br /&gt;&lt;br /&gt;In addition to determining how much coverage you need you must decide &lt;strong&gt;what kind of&lt;/strong&gt; &lt;strong&gt;insurance to buy&lt;/strong&gt;. A homeowners policy protects you against numerous perils, such as fire, windstorm, theft, etc. A fire policy is limited to protection only against fire. There are various types of homeowners policies and each type needs to be explored with your agent. Remember, policies that insure you for anything less than replacement cost will not cover the cost of rebuilding your home.&lt;br /&gt;&lt;br /&gt;With regard to the amount of coverage you should carry for the &lt;strong&gt;personal possessions&lt;/strong&gt; in your home, a typical homeowner policy will calculate that amount based upon a percentage of the dwelling coverage. Policies will vary as to whether the personal property coverage will be replacement cost or actual cash value (which applies depreciation). Immediately after you take out your policy and for every year thereafter, videotape the contents of your home (open drawers and videotape what is in them). When you have a loss, insurance companies will require you to file a proof of loss in which you will have to make a list of your personal property. A video recording will not only help you remember what was in your home but it will also prove to an insurance company that you had the item and the specifics of the item. Remember most &lt;strong&gt;homeowners' policies have a limit on items such as furs, jewelry, silverware&lt;/strong&gt;, etc. If you want full coverage for those items ask your agent about a floater policy.&lt;br /&gt;&lt;br /&gt;If you have a loss and are displaced from your home the &lt;strong&gt;additional living expense coverage&lt;/strong&gt; on your policy will reimburse you for hotel bills, restaurant meals and other items that are over and above what you would have spent if you were living in your home. Additional living expense coverage is limited in your policy to a set maximum amount and limited in the time you are covered. Thus if you have 12 months of coverage and it takes 18 months to rebuild your house you will not have coverage for the last 6 months. Know your coverages and plan accordingly.&lt;br /&gt;&lt;br /&gt;For more information on Homeowners Insurance and what you need to do when you have a loss see our &lt;a href="http://stennettcasino.com/homeowner-insurance-claim.htm"&gt;insurance law website&lt;/a&gt;.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;\&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-7002902465241089803?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/7002902465241089803/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=7002902465241089803' title='0 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/7002902465241089803'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/7002902465241089803'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2007/04/how-much-homeowners-insurance-should-i.html' title='HOW MUCH HOMEOWNERS INSURANCE SHOULD I HAVE?'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>0</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-8682060063290910812</id><published>2007-04-10T16:02:00.000-07:00</published><updated>2007-04-25T14:10:20.994-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='Unum'/><category scheme='http://www.blogger.com/atom/ns#' term='Prudential Insurance'/><category scheme='http://www.blogger.com/atom/ns#' term='Metropolitan Life'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA appeal'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA'/><category scheme='http://www.blogger.com/atom/ns#' term='Hartford Insurance'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA plan'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA claim'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA Attorney'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA lawyer'/><title type='text'>What Is ERISA</title><content type='html'>In 1974, Congress passed a law that regulates your employee benefits. Known as ERISA (the Employment Retirement Income Security Act) this law covers your retirement, disability, health, life and other employment-related benefits. It details the responsibilities of your employer regarding your employee benefit plan, and it outlines the steps you can take if you believe your rights are being violated. ERISA is a Federal law. State laws will not apply since they are preempted by ERISA. However, if you are employed by a governmental entity then ERISA does not govern your employment benefits. (State laws of insurance "bad faith" may then apply).&lt;br /&gt;&lt;br /&gt;ERISA has a two-step claims procedure. You first must file a claim, with proof that you qualify for benefits, with the Plan's Administrator. Typically, your employer will provide you with the claim forms. Most disability, life and health Plans are underwritten by an insurance company. (Unum, Prudential, Met Life, Hartford, etc.). In these cases your claim will be reviewed by the insurance company (referred to as the Claim Administrator). Both the Plan Administrator (employer) and the Claim Administrator (insurer) have a fiduciary responsibility "to act solely in the interest of the [Plan] participants and beneficiaries." However it may be fatal to your claim to assume that the Administrator will assist you in proving your claim. You are responsible for proving your own claim.&lt;br /&gt;&lt;br /&gt;If the Plan denies your claim, you have the right to an administrative appeal. The Claim Administrator will review your claim a second time. You have a right to obtain a copy of the administrator's file. Get it! This file will tell you what they have reviewed and what their own internal consultants (medical reviewers, vocational analysts, surveillance video) are saying about your claim.&lt;br /&gt;&lt;br /&gt;The appeal process is a critical point in your claim. A time when you should at least talk to an attorney with expertise in ERISA. The reason being that if your appeal is also denied your remaining remedy is to file suit in Federal court. ERISA limits your rights in court. You have no right to a jury and virtually no right to perform discovery. Thus all of your discovery needs to be done during the administrative appeal process. When the judge reviews your case he will be limited to reviewing what is in the administrative file. You can not hold back the "good stuff" for trial. If it was not presented during the administrative review then the judge will not consider it. There are many things that can be done to bolster your claim. See the article, "Excuses...", for ideas.&lt;br /&gt;&lt;br /&gt;There are usually deadlines both for submitting your claim and filing your appeal, although it may be possible to obtain a deadline extension. Make sure you comply with these deadlines.&lt;br /&gt;&lt;br /&gt;It is highly recommended in these technical ERISA cases that you speak to an ERISA attorney early in your case. If you retain an attorney make sure he/she has specialized knowledge in ERISA and insurance company practices. An attorney can help you to fully document your claim by gathering all the documents, seek out additional experts or specialists, interview witnesses and compile legal and factual support for your claim. If you want to obtain more information about ERISA or wish to email or talk to an expert about your claim visit our web site at &lt;a href="http://stennettcasino.com/disability-insurance-claim.htm"&gt;stennettcasino.com&lt;/a&gt;&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-8682060063290910812?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/8682060063290910812/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=8682060063290910812' title='0 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/8682060063290910812'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/8682060063290910812'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2007/04/what-is-erisa.html' title='What Is ERISA'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>0</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-3208195089271955806</id><published>2007-04-08T20:31:00.000-07:00</published><updated>2007-04-25T14:42:09.917-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='Life Insurance; Life Insurance Attorney; Insurance Attorney; ERISA; ERISA Attorney; Metropolitan Life Insurance; Met Life:insurance lawyer;life insurance lawyer'/><title type='text'>Accidental Death Benefits Denied Because Insured Was Drinking and Driving</title><content type='html'>An accidental death insurance policy will pay benefits when the insured dies as a result of an accident. But when the insured dies in an auto accident with a high blood alcohol rate is that an accident? Metropolitan Life Insurance Company recently denied a widow life insurance benefits when her husband died in a single car accident while driving home from his brother's house. Met Life claimed that since decedent had been drinking beer before driving that the accident was not an accident under the law.&lt;br /&gt;&lt;br /&gt;Met life interpreted "accident" to mean "not reasonably foreseeable." Met Life claimed that it was reasonably foreseeable that one would become involved in a serious accident when combining drinking with driving. Thus since the accident was reasonably foreseeable it was not an accident under the law. Met Life cited court decisions from Illinois (&lt;em&gt;&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_0"&gt;Cozzie&lt;/span&gt; v. Metropolitan Life&lt;/em&gt;, 140 F.3d 1104 (7&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_1"&gt;th&lt;/span&gt; Cir. 1998)) and Wisconsin (&lt;em&gt;&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_2"&gt;Weatherall&lt;/span&gt; v. &lt;span class="blsp-spelling-error" id="SPELLING_ERROR_3"&gt;ReliaStar&lt;/span&gt; Life &lt;span class="blsp-spelling-error" id="SPELLING_ERROR_4"&gt;Insuranc&lt;/span&gt;&lt;/em&gt;e 398 F.Supp.2d 918 (W.D.Wis. 2005)) to support its position.&lt;br /&gt;&lt;br /&gt;Fortunately, the auto accident occurred in California. In California, the courts recognize that accident insurance is purchased to protect insureds from their own miscalculations, misjudgements and careless conduct. Thus, California courts interpret the term accident to include accidents where the insured did not perceive the resulting death or injury to be a "substantially certain result of his conduct." (&lt;em&gt;&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_5"&gt;Padfield&lt;/span&gt; v. &lt;span class="blsp-spelling-error" id="SPELLING_ERROR_6"&gt;AIG&lt;/span&gt; Life&lt;/em&gt;, 290 F.3d 1121 (9&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_7"&gt;th&lt;/span&gt; Cir. 2002)). The widow retained the law firm of &lt;span class="blsp-spelling-error" id="SPELLING_ERROR_8"&gt;StennettCasino&lt;/span&gt; who are attorneys experienced in handling life insurance and accidental death benefit claims.  They pointed out the difference between Illinois and California law, and presented Department of Transportation statistics that illustrated that there is a less than 1% correlation between drinking and highway deaths. Since most drivers do not believe that combining drinking with driving is "substantially certain" to result in death then (at least in California) a resulting accident is an accident.&lt;br /&gt;&lt;br /&gt;The widow in this case prevailed once the law was persuasively pointed out to Met Life. The accidental death benefits were paid. For more information visit our insurance law web site at &lt;a href="http://stennettcasino.com/life-insurance-claim.htm"&gt;StennettCasino.com&lt;/a&gt;.&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-3208195089271955806?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/3208195089271955806/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=3208195089271955806' title='0 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/3208195089271955806'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/3208195089271955806'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2007/04/accidental-death-benefits-denied.html' title='Accidental Death Benefits Denied Because Insured Was Drinking and Driving'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>0</thr:total></entry><entry><id>tag:blogger.com,1999:blog-3034665093595765997.post-2025076922741500388</id><published>2007-04-08T20:21:00.000-07:00</published><updated>2007-04-25T14:19:17.374-07:00</updated><category scheme='http://www.blogger.com/atom/ns#' term='Unum'/><category scheme='http://www.blogger.com/atom/ns#' term='insurance disability'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA'/><category scheme='http://www.blogger.com/atom/ns#' term='insurance disability Lawyer'/><category scheme='http://www.blogger.com/atom/ns#' term='ERISA Attorney'/><category scheme='http://www.blogger.com/atom/ns#' term='insurance disability attorney'/><title type='text'>Excuses Used By Insurance to Deny Disability Claims</title><content type='html'>Every denial of disability benefits includes the language "your medical records do not support a claim for disability as defined in the Plan." What does that mean and what can you do about it? Plenty. First you must understand that there are two issues presented in that often used excuse to deny benefits. The definition of disability in the Plan and your medical records. (The issues are the same in an &lt;span class="blsp-spelling-error" id="SPELLING_ERROR_0"&gt;ERISA&lt;/span&gt; Plan, Governmental Plan and Individual Plan).&lt;br /&gt;&lt;br /&gt;How is "disability" defined in your Plan? You must read it to know. For example is it "the inability to perform the material duties of your &lt;em&gt;own occupation&lt;/em&gt;" or "the inability to perform the material duties of &lt;em&gt;any occupation&lt;/em&gt;"? If it is "your own occupation" then get a copy of the job description from your employer. If it is incorrect or incomplete then tell the Plan. Once the job duties are defined then determine how your illness/injury prevents you from performing those duties. If your job requires you to sit at a computer terminal 7 hours a day and you can only sit 2 hours a day then make sure your medical records reflect that fact.&lt;br /&gt;&lt;br /&gt;How do you control what is in your medical records? The doctor performs the examination orders the diagnostic tests and makes the diagnosis. But the diagnosis alone does not necessarily define what your limitations are in a work setting. One person with a bulging disc may not even know he has a problem while another with the same diagnosis may be totally disabled. Each person is unique and each person reacts &lt;span class="blsp-spelling-corrected" id="SPELLING_ERROR_1"&gt;differently&lt;/span&gt;. To determine how an injury/illness affects you the doctor has to rely on what you tell him.&lt;br /&gt;&lt;br /&gt;Do not just tell the doctor that your back hurts and you cannot work. Tell the doctor that your job requires you to sit at a computer 7 hours a day and you can only sit for 30 minutes before the pain gets so bad that you need to lay down for 20 minutes to lessen the pain. Every time you see the doctor and he asks "how are you doing" give him something interesting to write in the medical record so that it supports your inability to perform the material duties of your occupation. Tell him that you really want to return to work but at work you have to get on your knees all the time and you cannot do that yet. Tell him it bothers you that you cannot invite friends over for dinner because you cannot sit at the dinner table long enough to be social. Tell the doctor how your injury/illness affects your life. Let the medical record support your disability&lt;br /&gt;&lt;br /&gt;There are many other methods to fully document your disability as well as many other excuses insurers like &lt;span class="blsp-spelling-error" id="SPELLING_ERROR_2"&gt;Unum&lt;/span&gt;, Prudential, Hartford, Met Life, Reliance Standard and others use to deny disability claims. Please visit our insurance disability web site at &lt;a href="http://stennettcasino.com/disability-insurance-claim.htm"&gt;&lt;span class="blsp-spelling-error" id="SPELLING_ERROR_3"&gt;StennettCasino&lt;/span&gt;.com &lt;/a&gt;for additional information or to contact a disability attorney who can answer your questions whether you are dealing with an &lt;span class="blsp-spelling-error" id="SPELLING_ERROR_4"&gt;ERISA&lt;/span&gt; disability plan or a private disability plan.&lt;div class="blogger-post-footer"&gt;&lt;img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3034665093595765997-2025076922741500388?l=insuranceclaimattorneys.blogspot.com' alt='' /&gt;&lt;/div&gt;</content><link rel='replies' type='application/atom+xml' href='http://insuranceclaimattorneys.blogspot.com/feeds/2025076922741500388/comments/default' title='Post Comments'/><link rel='replies' type='text/html' href='http://www.blogger.com/comment.g?blogID=3034665093595765997&amp;postID=2025076922741500388' title='0 Comments'/><link rel='edit' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/2025076922741500388'/><link rel='self' type='application/atom+xml' href='http://www.blogger.com/feeds/3034665093595765997/posts/default/2025076922741500388'/><link rel='alternate' type='text/html' href='http://insuranceclaimattorneys.blogspot.com/2007/04/excuse-1-medical-records-do-not-support.html' title='Excuses Used By Insurance to Deny Disability Claims'/><author><name>Insurance Claim Attorney</name><uri>http://www.blogger.com/profile/01107853085989956792</uri><email>noreply@blogger.com</email><gd:image rel='http://schemas.google.com/g/2005#thumbnail' width='16' height='16' src='http://img2.blogblog.com/img/b16-rounded.gif'/></author><thr:total>0</thr:total></entry></feed>
