Tampa Long Term Disability Lawyers
We Are Here To Help You - Call (813) 229-2667
Long term disability benefits are intended protect workers against loss
of income due to illness or disease. If you are covered by a disability
policy, it may be a private policy that you purchased directly from an
insurance carrier, or it may be a policy purchased in whole or in part,
by your employer. Depending on the policy, you may be eligible for income
replacement benefits representing anywhere from 50% to 80% of your wages.
Generally, if your policy was purchased by your employer, your lawsuit
will be governed by ERISA regulations. You begin a claim by filing an
application for disability benefits with your insurance carrier. In the
application, you will provide a brief synopsis of your job description,
the nature of your disability and the medical care you have received.
The insurance company then begins an investigation of your claim, gathering
medical records and asking your assistance in getting your physicians
to detail your restrictions. If your inability to work is well documented,
you may be approved for benefits under the plan. If you receive a denial,
the denial letter must specifically state why your claim was denied and
make specific reference to the policy provisions which support the denial.
If your application lacks supporting documentation, the denial letter
must tell you how to fix the problem.
All through the application process, your primary contact will be with
an adjuster, representing the disability carrier. While the adjuster may
seem fair and friendly on the phone, many policyholders are often shocked
to discover their adjusters are actually working to try and prevent payments
to them under the policy plan. Their adjuster actually has a fiduciary
duty, not to them, but to the plan as a whole, to protect the assets of
the plan. The adjuster's job is to avoid payments under the plan wherever feasible.
So while you are working hard to get your benefits under the policy, your
insurance carrier is working equally hard to find some means to avoid payment.
The insurance carrier has a distinct advantage in this regard. The insurance plan your employer purchased is a contract, written entirely
by and to the advantage of the insurance carrier that wrote it. The insurance
company got to define what constitutes disability under the policy and
more importantly, they reserved the right to decide whether you meet their
definition. In almost every contract for disability insurance, it is the
insurance carrier who decides if and when you meet the definition of disabled.
There is no impartial panel who decides if you are disabled, no jury and
no judge. It is the insurance carrier, whose assets are generally at risk
under the policy, that gets to decide if you are disabled.
The fact that the policy gives the insurance carrier the exclusive right
to decide if you are disabled, makes the playing field uneven. The courts
have offered no remedy. If the policy is written in favor of the insurance
company, then don't buy the policy, has been the court's response.
When litigating these cases, most policy denials occur because the client
fails to meet the definition of disability. This problem may be remedied
by obtaining supporting medical documentation.
Definition of Disability in the Policy
The second most common reason for denial occurs during the change in the
policy's definition of disability. During the first 2 years, most
disability plans define disability as an inability to perform your
own job. After 2 years, most plans redefine disability to include an inability
any job. This change in definition can be very difficult to overcome. Employees
receiving benefits during the first 2 years get lulled into a false sense
that their monthly income benefits are secure throughout the policy term.
They stop seeing their doctor and then 2 years later, the rug gets pulled
out. The definition of disability suddenly is harder to meet and they
have less medical support because they haven't seen their doctor.
Here's what you need to understand. When you receive a denial in the
mail, you typically only have
180 days to make an appeal. Once the 180 days runs, you can never add any additional information to
your claim file. Suing an insurance carrier for disability benefits allows
a judge to review your claim file and decide if the adjuster acted arbitrarily
in denying your claim. There is no live testimony. No doctors get called
to the stand. It is just a paper review of your file. If you want to win
your case, you need to have a strong case file. In order to get a strong
case file you need to medically document your work restrictions and put
vocational evidence in the claim file that supports your version of events.
This all has to be complete by the time the 180 day time limit runs.
So don't vainly try to document your own case file, hire a lawyer to
get the necessary documentation in and do it quickly. The longer you wait
to hire a lawyer, the more of the 180 day time limit passes, leaving a
lawyer less and less time to assist your claim.
Contact Us For the Representation You Need
Don't delay. Speak to one of the long term disability attorneys at
Harris & Riviere by contacting our office at (813) 229-2667, send us an
email, or fill out one of our
free case evaluation forms.