Auto insurance rates vs coverage

Rate vs. proper coverage ...this is why we are not always the " lowest auto insurance rate" Biggest Auto Insurance misconception: People think when they carry comprehensive and collision AKA: " full coverage" , that they have everything they will need protection wise, in the event of any accident or issue. This could not be farther from the truth. Comprehensive and collision coverage is purely for the vehicle itself and damage that may occur to the vehicle. While it may feel good knowing your vehicle is covered in the event of damage, your real risk lies elsewhere. The liability coverage levels in your policy, are what truly defines your protection. State legal minimums can be as low as 25,000/ 50,000 . This amount clearly would not be enough coverage in the event of any serious accident or claim, yet this amount is "defined" as legal. For perspective, if you were to cause an accident and seriously hurt four people in the other vehicle, at state minimums the maximum amount your insurance policy would pay is 25,000...for the entire accident! Once the carrier had paid this amount, ( tendered limits) you would then be on your own to defend yourself. This exposes you to huge medical liabilities, wage garnishment and punitive damages that can easily force you into bankruptcy. Issues like the above , can be easily avoided if you have proper broker representation at the time of placing coverage. It is our professional duty, to offer proper coverage limits for your risk, NOT just the lowest rate. We will explain the coverage vs. cost value and why you need certain levels of coverage. Take the time to call us at Eagle Harbor Insurance or any other broker, explain your risk /assets, and get what you pay for insurance wise. Like any other purchase, insurance has value, do not cheat yourself out of proper coverage over a few dollars. Short term savings can equal long term disaster. Just todays thoughts :)

Auto insurance rates vs coverage

Rate vs. proper coverage ...this is why we are not always the " lowest auto insurance rate" Biggest Auto Insurance misconception: People think when they carry comprehensive and collision AKA: " full coverage" , that they have everything they will need protection wise, in the event of any accident or issue. This could not be farther from the truth. Comprehensive and collision coverage is purely for the vehicle itself and damage that may occur to the vehicle. While it may feel good knowing your vehicle is covered in the event of damage, your real risk lies elsewhere. The liability coverage levels in your policy, are what truly defines your protection. State legal minimums can be as low as 25,000/ 50,000 . This amount clearly would not be enough coverage in the event of any serious accident or claim, yet this amount is "defined" as legal. For perspective, if you were to cause an accident and seriously hurt four people in the other vehicle, at state minimums the maximum amount your insurance policy would pay is 25,000...for the entire accident! Once the carrier had paid this amount, ( tendered limits) you would then be on your own to defend yourself. This exposes you to huge medical liabilities, wage garnishment and punitive damages that can easily force you into bankruptcy. Issues like the above , can be easily avoided if you have proper broker representation at the time of placing coverage. It is our professional duty, to offer proper coverage limits for your risk, NOT just the lowest rate. We will explain the coverage vs. cost value and why you need certain levels of coverage. Take the time to call us at Eagle Harbor Insurance or any other broker, explain your risk /assets, and get what you pay for insurance wise. Like any other purchase, insurance has value, do not cheat yourself out of proper coverage over a few dollars. Short term savings can equal long term disaster. Just todays thoughts :)

After submission of an ERISA disability appeal, when can I file an ERISA disability lawsuit?

Federal law governing ERISA disability lawsuits requires claimants to submit an administrative appeal of the denial of benefits before they can file a lawsuit in the federal district court. In the recent case of Lewis-Burroughs v. The Prudential Insurance of America, et al., the plaintiff filed an administrative appeal and, according to Prudential’s own rules, consistent with federal law, the insurer had a maximum of 90 days to render its decision.

When Prudential failed to render a decision on the administrative appeal by the 90 day deadline, the claimant filed her disability lawsuit in the New Jersey federal district court just 91 days after the date upon which she had filed her administrative appeal. Despite Prudential’s attempt to have the lawsuit dismissed on the grounds that the statute had been tolled and the lawsuit was filed prematurely, the court agreed with the claimant and allowed the lawsuit to proceed. In ruling for the plaintiff, the federal court made two important findings in response to Prudential’s claims and the time for filing an ERISA disability lawsuit.

The Statute of Limitiations Does Not Restart When Claimants Submit New Evidence

The court strongly disagreed with Prudential’s claim that the statute of limitations started all over again when the claimant submitted additional supportive medical evidence after filing her appeal. The court found the language of the relevant statute controlling and specifically held that the deadline for deciding an appeal begins on the date the “appeal is filed,” not on the date that the insurer determines it has all the information necessary for making its decision. Any other interpretation would deter claimants from providing additional information when such an act would restart the time for the required decision. In this case, Lewis-Burroughs lawsuit was filed after the expiration of the required 90 days without a decision by Prudential. The appeal was deemed denied and the lawsuit was properly filed in the district court.

The Statute is Tolled Only if Specific Requirements Are Met

The statute is only tolled if the insurer gives the claimant notice that more information is necessary in order for it to make a decision. The notice must include the specific information deemed necessary and a date upon which the insurer expects to have a decision. If, in response to the notice, the claimant provides the requested evidence, the statute is tolled during the time beginning when the notice is given until the information is provided.

In this case, the insurer did not send a notice requesting necessary information so the statute was not tolled. Prudential failed to issue its decision within the required time limit and the plaintiff was entitled to pursue her lawsuit in the district court.

Attorneys Dell & Schaefer did not represent Lewis-Burroughs in this action, but if you are in a similar situation, feel free to contact us to discuss how we may be able to assist you.

Disability Caused by Subjective Symptoms

Courts struggle with disability claims caused by subjective symptoms due to the difficulty in quantifying the level of pain and fatigue experienced by a claimant. Unfortunately, pain and fatigue are the principle disabling symptoms caused by many diseases such as multiple sclerosis, fibromyalgia, rheumatoid arthritis, degenerative spine conditions, etc. The Ninth Circuit has recognized that an insurer may not disregard subjective symptoms merely they cannot be quantified or “proved” by objective testing. However, at the same time, courts also recognize the difficulty in assessing or quantifying the level of pain and fatigue caused by a disease.

There are means for helping to determine the severity of one’s pain or fatigue. We encourage clients to keep logs or journals of their symptoms. This is especially useful for those who suffer from migraines, which are unpredictable. Written notes from family members and co-workers who have observed expressions of, or limitations caused by pain may also be instructive.

Courts also look to the treatment obtained by a claimant in an effort to alleviate pain. If one undergoes nerve block injections or a subsequent surgery in an effort to alleviate pain, this is useful evidence. A person does not undergo painful treatments merely to obtain disability benefits.

Referral to a pain management specialist is also evidence of severe pain. Courts consider the fact that the pain was of such severity that a referral was necessary. It is also helpful to have documented treatment with a physician who specializes in pain management.

Finally, evidence of prescription medication for pain is extremely important. If there has been a change or increase in the medication, this is proof that the medication is not “controlling” the symptoms. Pharmacy records prove that the medication was purchased and are an accurate record of what has actually been prescribed over the course of time.

Medications may also cause adverse side effects, such as drowsiness or dizziness. This can be expected with narcotic medication and the side effects alone can be disabling. However, insurers often disregard the potentially disabling symptoms of medication side effects because the adverse symptoms were not “documented in the medical records.” We encourage clients to report side effects to their physicians, even if they are to be expected. This will ensure that all symptoms are accurately recorded in the medical records.

If you have been denied long term disability benefits based on a failure to prove disabling pain, or for any other reason, please call Kantor & Kantor at 800-446-7529 for a free consultation.

Social Security Disability Benefits in Jeopardy

Social Security is obviously a hot political topic. As the number of beneficiaries expands for demographic reasons, politicians have warned us repeatedly that Social Security’s programs are getting too expensive and that we may soon see cuts.

Some politicians, however, are fighting the conventional wisdom that cuts are inevitable. Senator Elizabeth Warren (D. Mass.) introduced an amendment to the Senate budget resolution last month with the goal of not only ensuring that the programs remain solvent, but also expanding benefits.

The amendment had the almost unanimous vote of Senate Democrats. Furthermore, public opinion polls show that voters “overwhelmingly support” increasing Social Security benefits.

Republicans, however, are dead-set against Social Security expansion. All Senate Republicans opposed Senator Warren’s amendment. Furthermore, House Republicans passed a procedural rule in January that potentially sets up a battle for Social Security.

The battle is over the interaction between Social Security’s retirement and disability funds. In the past, Social Security has been able to transfer money from the retirement fund to the disability fund in order to address any disability benefit shortfalls. (Unfortunately, the disability fund has been shortchanged by Congress.)

However, the new House rule has the effect of stopping any such transfers unless Congress addresses the long-term solvency of Social Security by either raising taxes or cutting benefits. (Naturally, Republicans prefer the latter.)

Why does this rule matter? Well, if the rule stands, and Congress is unable to negotiate a way around it, the Social Security disability fund will run out of money sometime near the end of 2016. All disability beneficiaries will immediately suffer a cut in benefits of 20 percent.

If you currently receive Social Security disability benefits, or may need to apply for them, this is cause for concern. Contact your representatives in Washington and tell them this brinksmanship is unacceptable. It is not fair to punish the disabled because Congress cannot agree on long-term Social Security solutions. And keep this dispute in mind when you vote in November of next year.

May is Lupus Awareness Month

Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years.

In lupus, something goes wrong with your immune system, which is the part of the body that fights off viruses, bacteria, and germs ("foreign invaders," like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means your immune system cannot tell the difference between these foreign invaders and your body’s healthy tissues ("auto" means "self") and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.

Lupus is also a disease of flares (the symptoms worsen and you feel ill) and remissions (the symptoms improve and you feel better). These are some additional facts about lupus from the U.S Department of Health and Human Services, Office on Women’s Health:
• Lupus can range from mild to life-threatening and should always be treated by a doctor.
• Research estimates that at least 1.5 million Americans have lupus.
• More than 16,000 new cases of lupus are reported annually across the country.
• It is believed that 5 million people throughout the world have a form of lupus.
• Lupus strikes mostly women of childbearing age (15-44). However, men, children, and teenagers develop lupus, too. Most people will develop lupus between the ages of 15-44.
• Women of color are two to three times more likely to develop lupus than Caucasians.
• People of all races and ethnic groups can develop lupus.

Lupus can be extremely hard to diagnose. The most common symptoms of lupus, which are the same for females and males, are:
• Extreme fatigue (tiredness)
• Headaches
• Painful or swollen joints
• Fever
• Anemia (low numbers of red blood cells or hemoglobin, or low total blood volume)
• Swelling (edema) in feet, legs, hands, and/or around eyes
• Pain in chest on deep breathing (pleurisy)
• Butterfly-shaped rash across cheeks and nose
• Sun- or light-sensitivity (photosensitivity)
• Hair loss
• Abnormal blood clotting
• Fingers turning white and/or blue when cold (Raynaud’s phenomenon)
• Mouth or nose ulcers

Many of these symptoms occur in other illnesses. In fact, lupus is sometimes called "the great imitator" because its symptoms are often like the symptoms of rheumatoid arthritis, blood disorders, fibromyalgia, diabetes, thyroid problems, Lyme disease, and a number of heart, lung, muscle, and bone diseases.

If you or someone you know is suffering from Lupus, or any other illness, and you are being denied benefits by your health or long term disability insurer, please call Kantor & Kantor for a free consultation at 888-569-6013. We can help!

Kantor & Kantor Awarded 2014 Best of Business Award

Congratulations to Kantor and Kantor LLP who won the Small Business Community Association 2015 Best of Business Award for the Small Business category.

We are honored to have our work recognized in this way. Our attorneys and support staff work tirelessly to help those in our community get the benefits paid to which they are entitled. Medical Insurance, Disability Insurance, Long-term Care Insurance and Life Insurance are paramount to the health and longevity of those in our community. When Insurance companies fail to honor their contractual obligations to pay benefits under these policies, it is a detriment to our community.

We are grateful that our clients trust us and know that we get their benefits paid so they can continue to live healthy, fulfilling lives.

Congratulations Kantor & Kantor!

What we " are" as Eagle Harbor Insurance

What really is an insurance brokerage? I get asked this all the time ! I also hear folks around town say "My insurance carrier is Eagle Harbor Insurance". This question or puzzle has a clear , yet broad answer: An insurance brokerage, such as Eagle Harbor Insurance is actually an intermediary between you the client and the true insurance carrier. We as a brokerage represent YOU as our client, and we always strive to find you the best rates and coverage. We shop your coverage annually and make sure we get you the best rate and carrier currently on the market for your risk, It does not cost you ANYTHING more to use our services and truly gives you another layer of expertise advice on proper coverage. We also are not the " insurance carrier", we leave that to the carriers we represent, such as Hartford, Kemper, Guide One , Progressive, Foremost etc. We can handle claims filing , bill paying, and changes to your policy, so this is never an issue. Bottom line, why not use a broker for your insurance? It is free, gives you expert representation, and allows you access to markets you will not find in the direct market to clients. Please call us anytime for a free, complete review and risk analysis of your current policies.

What we " are" as Eagle Harbor Insurance

What really is an insurance brokerage? I get asked this all the time ! I also hear folks around town say "My insurance carrier is Eagle Harbor Insurance". This question or puzzle has a clear , yet broad answer: An insurance brokerage, such as Eagle Harbor Insurance is actually an intermediary between you the client and the true insurance carrier. We as a brokerage represent YOU as our client, and we always strive to find you the best rates and coverage. We shop your coverage annually and make sure we get you the best rate and carrier currently on the market for your risk, It does not cost you ANYTHING more to use our services and truly gives you another layer of expertise advice on proper coverage. We also are not the " insurance carrier", we leave that to the carriers we represent, such as Hartford, Kemper, Guide One , Progressive, Foremost etc. We can handle claims filing , bill paying, and changes to your policy, so this is never an issue. Bottom line, why not use a broker for your insurance? It is free, gives you expert representation, and allows you access to markets you will not find in the direct market to clients. Please call us anytime for a free, complete review and risk analysis of your current policies.

ERISA: Guilty Until Proven Innocent?

Every day we are asked similar questions by our clients and prospective clients. They typically revolve around such themes as "how can my insurance company blatantly refuse to pay?" "Why is it that I have to engage a lawyer to fight for my benefits when my doctor has clearly proved that I am disabled?" And, "why can I only sue for the benefits I am owed and no punitive damages?"Unfortunately, we live with a system where insurers can, and do, deny disability claims that should be paid. Lawsuits are often necessary. Even then, people who need insurance benefits most can sometimes wait up to two years before their case goes to court or settles.

The Employee Retirement Security Act (“ERISA"), which is the law that governs most GROUP insurance policies, is stacked in favor of the insurance companies. ERISA imposes significant procedural limitations on the enforcement of group insurance benefits, and limits those benefits to those provided for in the policy. No emotional distress. No punitive damages. No out-of-pocket or consequential damages. And, attorneys fees only at the discretion of the Court. Employer Sponsored Group Policies fall under the Act unless they are a Government or Church Plan. ERISA is a federal body of legislation that establishes minimum standards for retirement, health, and other welfare benefit plans offered by employers to their employees. The Act expressly preempts all state legislation “relating to" an employee benefit plan, and federal courts have interpreted that phrase broadly, finding that a state law “relates to" a benefit plan “if it has a connection with or reference to such a plan." The Act’s pre-emption clause extends to any state law allowing for recovery under an applicable plan. Unfortunately, this has resulted in a situation where ERISA preempts all common law tort actions for bad faith insurance and, consequently, does not allow plaintiffs to collect extra-contractual or punitive damages on claims involving covered insurance plans.

So what does this mean for the insured and the insurance company? For the insured it means that if they are denied health or disability benefits and they sue the insurance company under ERISA, the most they can hope for is that their benefits will be reinstated and back-paid to the time that they were denied; and that their attorney's fees will be reimbursed in whole or part.

For the insurance company it really only means they may eventually have to pay what they should have paid in the first place. This system essentially creates a disincentive to pay the claims until they are challenged.

Clearly, the law is flawed. But it is the law we and our clients must live with. The good news is that we handle these types of matters every day, and have become quite good at it. We understand how the insurance companies and their lawyers work, and we can navigate this system to help maximize the chances your claim will be paid!

If you have been denied insurance benefits call Kantor & Kantor today for a free consultation on 888-355-5596. We care and we can help.