Tampa Long-Term Disability Lawyers
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Long-term disability benefits are intended to 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.
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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 prevent payments to them. Their adjuster has a fiduciary duty, not to them, but to protect the assets of the plan. The adjuster's job is to avoid payments under the plan wherever feasible.
We'll Be Your Advocate
So, while you are working hard to get your benefits under the policy, your insurance carrier is working equally hard to find 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 two years, most disability plans define disability as an inability to perform your own job. After two years, most plans redefine disability to include an inability to perform any job. This change in definition can be very difficult to overcome. Employees receiving benefits during the first two years get lulled into a false sense that their monthly income benefits are secure throughout the policy term. They stop seeing their doctor, and two years later, the rug gets pulled out from under them. The definition of disability suddenly is harder to meet, and they have less medical support because they haven't seen their doctor.
When you receive a denial in the mail, you typically only have 180 days to make an appeal. Once the 180 days ends, you can never add 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, and 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 file that supports your version of events. This all has to be completed by the time the 180-day time limit runs out.
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 with your claim.
Don't delay. Speak to one of the Tampa long-term disability attorneys at Harris & Riviere by contacting our office at (813) 669-2080.
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