Florida Disability Insurance Claim Attorneys
Did you suffer an injury or illness outside of work? Are you unable to return to work because of it? You might be eligible for benefits if you have a disability insurance policy. While working with an insurance provider can be confusing and complex, at Abell and Capitan Law, we work hard to help our clients get the compensation they need to support themselves and their families.
Approximately 27% of Floridians over the age of 21 have some sort of disability. Only 30% of disabled individuals in Florida have a job. Working with a disability is challenging. However, many people don’t have a choice. Their work may be their only source of income, and their insurance company might have delayed or denied their benefit payments. For others, working isn’t an option, but they still haven’t received the benefits they need.
An estimated 20% of disabled people in Florida receive federal disability benefits. That means 80% of them must rely on an individual or group ERISA long-term disability insurance plan. Unfortunately, the insurance companies that handle those policies look for any reason to deny claims or provide minimal benefits.
At Abell and Capitan Law, our seasoned, skillful attorneys help injured Florida employees understand and receive maximum benefits from their disability insurance plan. We will answer your questions free of charge, and help you determine what to do to receive the benefits you’re owed. Contact us at (267) 419-7888.
Employer-Paid Disability Insurance
Florida law doesn’t require employers to provide disability insurance to their employees. However, if your employer does offer it, you have the option of pursuing benefits after an injury or illness.
Usually, a company will offer a plan as part of your insurance benefits package, or automatically provide a group plan to you. In some situations, employers who automatically provide coverage allow additional, optional coverage options if you want a higher percentage of your salary paid if you’re unable to work.
The Employee Retirement Income Security Act (ERISA) regulates such disability benefits. ERISA requires employers to provide their insured with details about the plan, funding, and important plan features.
It also states that any person with a disability must file a claim along with evidence proving the existence of the disability. If necessary, you have the right to appeal any denied claims by submitting all your losses showing you deserve assistance.
Individual Disability Insurance
Another option if your employer doesn’t provide disability insurance is to purchase an individual or private plan. It covers a single person rather than a group of people, as with an employer-paid benefit plan. You can buy it directly through an insurance carrier.
One of the benefits of purchasing your own policy is that any payments you receive are probably not subject to taxation. Your plan is effective up until you turn 65, after 65, or for the rest of your life. Much like an employer-paid policy, you must file a claim with evidence of your disability to receive benefits.
Short-Term Disability Insurance
Florida law doesn’t require employers to provide short-term disability pay for an injured worker who can’t work temporarily. A short-term disability is a psychological impairment or diagnosed physical injuries, such as a stroke, heart attack, broken bone, back injury, or any disease that negatively impacts a person’s ability to function. You’re eligible for up to 12 weeks of leave from work without the risk of losing your job.
If you have insurance, and the insurance company improves your claim, the waiting period is between zero to 14 days before you start collecting benefits and remains active for up to six months.
Depending on the policy limits on your plan, you could receive up to 50% to 60% of your gross weekly earnings. Once approved, and after the waiting period ends, you can start collecting benefits every month until you return to work.
Long-Term Disability Insurance
Long-term disability is an employer-paid or individual plan purchased through an insurance company. You receive benefits through LTD when you have extended absences from work because of a permanent or long-term condition.
The waiting period after filing a claim ranges from a few weeks to 24 months. You’re allowed to receive benefits up until you reach age 65. Payments begin after your waiting period at a percentage between 50% and 80% of your earnings before you became disabled.
Insurance Company Claim Procedure
After you file your claim for disability benefits, the insurance company will most likely require that you undergo an independent medical examination (IME). It allows them to ensure one of their doctors can determine the extent of your injury or illness.
You also might have to submit to an interview with an insurance representative. The interview is for analyzing an injured person’s disability and other necessary information to approve the claim. If any details are inconsistent or don’t seem relevant to the type of injury claimed, the benefits could get denied.
What if the Claim Gets Denied?
Disability policies are often difficult to understand and may include hidden or confusing provisions and exclusions. If you file a claim, your insurer could deny it initially for any number of reasons. Some of the most common reasons for denied claims include:
- There’s no known origin for your medical condition
- There’s a pending medical procedure
- Your doctor didn’t resolve your treatment
- Your disability policy doesn’t cover your injury or illness
- An existing prior denial
- Failure to undergo treatment required by your doctor
- Submitting incorrect or incomplete claim forms
After denying a claim, the insurance company must provide you with the reason in a denial letter. Along with the reason, the representative must explain their reasoning and provide valid documentation showing you’re not eligible to receive any benefits. They should also provide information on appealing the denial if you choose to do so.
How to File an Appeal
For policies regulated by ERISA, there are strict filing deadlines and guidelines for how to go about appealing a denial. If you don’t adhere to those deadlines and guidelines, it will be difficult for you to get your claim reopened.
You’re allowed to appeal a denied claim within 180 days of receiving the denial letter. You must submit your request for an appeal directly to the insurance carrier that holds your disability policy.
The most important evidence you should submit with your appeal request include:
- Any missing or incomplete medical records from your previous request
- Undergo further treatment and provide that documentation
- Written opinions from your physicians or a specialist that support your disability
- Non-medical evidence, such as letters from family or friends describing how your illness or injury impacted your life and ability to work
The insurer has 45 days to make a decision. In some instances, they could request no more than two 30-day extensions. If they don’t respond to your appeal within the required time or your appeal gets denied, you could file a lawsuit.
Should I Hire a Lawyer to Help Me?
It’s a good idea to seek legal representation if you want to file a claim for disability insurance, or you already filed a request that got denied. Abell and Capitan Law can walk you through each step and help you understand how it works. Our experienced and dedicated attorneys can assist you with every stage of the claims process, including:
- Applications: We can help you fill out all the necessary forms when filing for disability benefits. We’ll review your policy to explain what you’re entitled to and the deadlines you must meet.
- Appeals: If you’re reaching out to us after a denied claim, we’ll help you appeal the decision. You have the right to receive all documents from the insurance company explaining why they denied your claim. We’ll use their denial letter to gather evidence that shows you deserve benefits for your disability.
- Litigation: When appealing a denied claim isn’t successful, you might have to file a lawsuit. Suing an insurance carrier is often intimidating for most people. Having a lawyer by your side increases your chance of receiving the maximum benefits you need.
Legal Representation You Can Afford
We offer a free consultation to all prospective clients. There’s no risk or obligation to meet with us and discuss your case. We’ll review all the details of your injury or illness and let you know the options available to you.
We also work on a contingency fee basis. We understand the financial burden you’re facing and don’t want to add to it. We don’t require any upfront fees or costs from our clients. We don’t get paid until you get paid.
Need Help with Your Disability Claim? Call Abell and Capitan Law Today
Our attorneys are ready to take your call and help you pursue the benefits you need for your injury or illness. We know the frustration of dealing with insurance companies. It’s overwhelming to keep track of deadlines and fill out numerous forms.
Abell and Capitan Law can take care of the complicated aspects of your case for you. We care about our clients and make ourselves available 24/7 through live chat. It’s important to us to provide one-on-one attention to each client we work with to meet their individual needs.
If you were injured or diagnosed with an illness, call (267) 419-7888 today to schedule your free consultation. We’re available to take your call and help you pursue the disability benefits you deserve.