Please find below a list of services offered to attorneys and individuals who are currently litigating (or will be entering litigation, or, the appeal process) for any disability claim.

Contract Eligibility Reviews

As a contract specialist, I will be able to provide you with a detailed description of disability policy provisions, and how the insured's benefits may be impacted by the insurance company's interpretation. A comparison will be provided describing the insured's individual claim for benefits with the individual or group policy provisions.

Definition of Disability

The definition of disability is the most important policy provision within the disability contract. An understanding of these provisions including phrases such as "own occupation", "any occupation", and "total disability" are essential to the disability claims decision. I can provide assistance with understanding the various contract series and changes in the definition of disability. Provisions requiring "indexing" and other special calculation regarding partial earnings will be explained and/or calculated.

Assistance with Internal Appeal Process for ERISA claims.

As a former insurance claims handler I also offer attorneys assistance with claim specific language appropriate for submission as part of the ERISA appeal process. For Individual Claims, I assist attorneys with deposition and interrogatory recommendations and suggestions.The appropriateness of the actual claims process is reviewed and discussed.

Pre-Existing Conditions and Benefit Riders

As part of a detailed eligibility review, I will be able to make appropriate recommendations concerning possible pre-existing conditions, prudent person contract wording, and other unusual policy provisions such as COLA, Disability Plus Riders, and Pension Contributions.

Expert Witness

I am available to assist the plaintiff and their attorneys as an expert witness with disability cases in litigation. My experience and knowledge of the disability claims review process is essential in understanding the "why" and "how" disability insurers make their final liability claim decisions. I am available throughout New England for expert testimony concerning issues relating to the disability process or claim decision.

Mental and Nervous and Self-Reported Claims Expert.

Disability claims being paid under the Mental and Nervous provisions of a policy will generally terminate after 12 or 24 months. Don't be caught off-guard at the last minute. As an experienced claims examiner from the psyche impairment unit, I will be able to make appropriate recommendations and advise counsel concerning the process taking place within the insurance company around the 18th month of paid benefits. I am also a claims specialist regarding other self-reported impairments such as Chronic Fatigue, Fibromyalgia, Headaches, Dizziness, Vertigo, and Tinnitus. In addition, I have experience in managing cardiac, cancer, orthopaedic, and general medical impairments.

Disability Claim File Reviews

I will also review copies of the claim file provided to claimant's counsel,and will render a detailed explanation of the process used by the insurance company to determine eligibility for benefits. As a Disability Claims Consultant, I provide detailed information, based on the claim copy provided, regarding documentation and internal process leading to the disability claim decision.

Bad Faith Claim File Reviews

I am able to alo provide counsel with a full file review and a description of all activities, process, or procedures which may be of interest to the insured or counsel regarding the process or protocols used by the insurance company in rendering claims decisions outside of the restrictions and limitations provided by the primary care physicians. As an expert claims specialist, Linda will be able to provide attorneys with descriptions of claims practices within the industry as well as information regarding insurance reserves and industry standards.

Discovery Recommendations

As part of the claims review process, I am able to work with counsel and make specific recommendations concerning reports, internal documents and/or communications which may be requested during the discovery period.

Preparation of Affidavits and Declarations.

As required by counsel, I am experienced with the format and acceptable content of affidavits and declarations resulting from her file review and will provide counsel specific information concerning the appropriateness of the claim decision made by the insurance company.

General Information and Recommendations to Counsel.

As an experienced disability claims examiner, I will be able to offer valuable information to attorneys with clients who are just beginning the disability claims application process, and who may need assistance with paperwork or other information regarding the claims process.

Individual Services Available to the Insured include:

Your Initial Application for Benefits

As an experienced claim process expert, I will help you complete all disability claim forms in a clear and honest manner, and one which presents your medical impairment to your claims representative in a positive way. Attempting to get a clear picture of what is being asked is often difficult at a time when you are not feeling your best. The initial application for benefits is very important and may set the stage for all future communication with the disability insurer.dd>

The Importance of Good Medical Communications

Unfortunately your physician may not take the time to honestly, but accurately report restrictions and limitations which prevent you from working. This information is vital to the disability insurer who will use whatever records are available to make decisions regarding your claim. Knowing how to communicate with your physician is important, but even more so, is the ability of your physician to communicate with the insurance company. Advice on how to communicate with your physicians is vital to your claims decision.

Independent Medical Evaluations (IME)

Your insurance carrier may request you to submit to an Independent Medical Evaluation which is often a very intimidating experience. I can provide you with information concerning the evaluation process and what to expect based on the particular evaluation requested by your insurance company. Being prepared and comforation with the examination process may make the difference between continuing payments or a claim termination. It is important to "be prepared" and remain in control of the IME process and review.

Dealing with Claim Denials

Receiving a disability claim denial letter in the mail is an extremely emotional and devastating experience. What do you do next? How can you prove to the insurance company you really can't work? I will be able to provide you with recommendations and advice as to what steps need to be taken when your claim is denied. Disability insurers deny claims for many different reasons, some legitimate, some not. It is important to you, to understand your rights and the steps you need to take to provide information to the insurance company when your claim is denied. The process is different depending on whether have an Individual Policy or a claim subject to ERISA. It is extremely imporant to understand the workings of the appeal or reconsideration process.

Objective vs. Subjective Symptoms, Self-Reported Complaints

Disability insurers often look for you to provide "objective medical evidence" as proof of disability, even when your policy does not require you to do so. For some impairments, there is no known objective evidence other than the recommendations of your primary care physicians. It is extremely important for you and your physician to know precisely what information is required by your insurance company since many claims are denied based soley on the subjective nature of the information you sent them in support of your claim. Does my policy contain a provision for self-reported impairments? If it does, what are the consequences for me and the review of my application?

Contract/Poicy Reviews

It is always important to obtain a copy of your disability policy(ies) and understand the provisions describing your obligations vs. that of your insurance company. For example, it is crucial to understand the difference between the defintion of "Occupation" given in an ERISA claim, as compared to the defintion in an Individual Policy. What does the defnition of disabilty mean in your policy? How will you be paid residual benefits if you return to work part-time? What is the pre-exisiting condition provision mean and will the provision apply to me and my claim? What is indexing, or "other income deductions?" If I apply for Social Security Disability benefits will I get to keep my benefit, or will I have to pay back my retroactive SSDI award? These are all important questions you need to know at the time you apply for benefits. Linda can provide you with the answers.

Any Occupation Investigations

The first question asked by most insureds is "What is an any occupation investigation?" Am I going to lose my benefits? Who does the Transferable Skills Analysis, and what does "gainful" mean. Any occupation investigations are most common in group LTD policies, an area of expertise for Linda. These investigations by the disability insurers are "milestone" events in the history of each claim and could mean the termination of future benefits after 12, 24, 36, or 60 months.

Surveillance/Data Base Activity Checks

It is a well known fact that all disability insurers contract with private investigators who may be asked to observe your activities for several days. What impact will surveillance reports have on your future benefits? Can your claim be denied solely on surveillance tapes? Based on your particular claim and circumstance, is it likely your insurance company will surveil you? How can you recognize a surveillance team? Linda can offer invaluable advice concerning possible surveillance and the inevitable outcomes for your claim.

Residual Benefits/Working Part-Time

For some, it may be possible to return to work in a limited capacity over time. Does your policy contain provisions which allow you to return to work? If so, what will you be paid and for how long? A major concern for those who work part-time is making sure partial benefits received from the insurance company are accurate based on your current earnings level. It is important to ensure your monthly benefit is not being reduced by a residual percentage outside of your policy language.

Are You Being Paid Accurately?

Does your policy contain a Cost of Living Allowance Provision (COLA)? Or, a Revenue Income Protection Provision which compels the insurer to make pension payments while you are disabled? What is indexing and when should my part-time earnings be indexed? What are benefit offsets, and when can the insurance company reduce my benefit for other income? These are all very important questions, since the accuracy of the amount you are being paid may affect your family and financial situation.

If you are an attorney or an individual insured, and are interested in any of the above services, please contact me for further details. I will be happy to send a copy of my credentials, and discuss how I may be of service to you as an individual who is currently making application for benefits, or an attorney searching for a consultant or expert witness. Please feel free to contact me at: (207) 793-4593,or, by email. If you would like to see a copy of Linda's background and experience, please click on the link below. Curriculum Vitae 60 Hicks Rd
West Newfield, ME 04095 (207)793-4593 lindanee@cyberwc.net

Email: lindanee@cyberwc.net