Fort Lauderdale Disability Insurance Attorney
Fighting Wrongfully Denied Claims in Pompano and Throughout South Florida
How long could you and your family go without being paid? If an injury or illness kept you from working and earning your paycheck, how long could you stay financially afloat? Disability insurance helps workers prepare for situations where a serious injury or illness keeps them from working for a brief or extended period of time. However, many insurers look for any reason to wrongfully deny legitimate claims, leaving policyholders without the benefits they need to cover basic expenses.
Our Fort Lauderdale disability insurance lawyer at Martin J. Sperry, P.A. has over 45 years of legal experience assisting clients with wrongfully denied claims. We have recovered millions of dollars in compensation and have assisted with short-term, long-term, and ERISA claims. Our firm has an extensive familiarity with the legal processes for appealing claims and fighting insurers acting in bad faith. We can provide you with the one-on-one, compassionate legal advocacy you need to secure the compensation you need and deserve.
How Disability Insurance Works
When an injury or illness prevents you from working, disability insurance benefits can cover a significant portion of your paycheck while you recover. A policyholder will pay monthly premiums to receive these protections. Employers will often offer some type of disability insurance and may even agree to cover policy premiums as part of an employee’s benefits package.
When a policyholder is unable to continue working as a result of a qualifying injury or illness, they will need to file a claim with their insurance company. This claim should include information about the disability, medical records that prove its existence, and a written note from a doctor explaining how the disability prevents the policyholder from performing their job responsibilities.
If a claim is approved, policyholders will be subject to an “elimination period” before they begin to receive benefits. The length of this waiting period will vary based on the type of policy. After the elimination period has concluded, the policy will cover a percentage of the policyholder’s base salary during the “benefit period.” Benefits will continue to be issued until the benefit period ends or the policyholder recovers from their disability, whichever comes first. The length of the benefit period and the percentage of coverage depends on the policy.
If a claim is denied, policyholders will receive a letter explaining why as well as means of appealing the decision. If your policy is covered by the Employee Retirement Income Security Act (ERISA), your insurer will be required to make certain other disclosures and give you specific instructions for appealing denied claims. Our Fort Lauderdale disability insurance attorney can assist you with fighting wrongfully denied claims.
The Major Types of Disability Insurance
Disability insurance comes in several major categories, each offering differing levels of coverage. Each specific policy will have specific terms for what constitutes a disability and what benefits are available to policyholders.
Short-term disability insurance is designed to support workers whose conditions keep them from working for a period of several days, weeks, or months. Benefits will typically cover up to 60% of an employee’s paycheck, and the elimination period is often only 1 or 2 weeks. Short-term disability insurance can help cover situations where an employee is recovering from surgery, pregnancy complications, a debilitating but temporary illness, and minor injuries.
Long-term disability insurance is intended for situations where a worker’s condition prevents them from working for several months, years, or even decades. Depending on the level of coverage, a long-term disability policy can cover as much as 80% of an employee’s paycheck. However, policyholders are subject to longer elimination periods, typically 90 days or more. The benefit period is substantially longer than short-term policies, however, and can last for years, decades, or even until retirement. Long-term disability insurance covers scenarios where an employee’s disability is so severe that will not be able to quickly return to their previous job.
Accidental death and dismemberment (AD&D) insurance is sometimes used to supplement short-term or long-term disability insurance. These policies provide coverage for situations where a policyholder is killed or seriously injured due to nonmedical circumstances beyond their control. Policyholders can receive substantial benefits if they survive the incident but lose a limb, their sight, ability to move, or some other essential function. Should the policyholder pass away, their loved ones can claim benefits for “accidental death.”
Why Disability Insurance Claims Are Denied
Many insurance companies will act in bad faith and habitually deny legitimate disability insurance claims of all types. Insurers expect a majority of policyholders will not understand their rights in fighting a wrongfully denied claim or have the means or resources to exercise them.
Insurance companies will leverage numerous justifications in wrongfully denying disability claims, including:
- Allegations of fraud. Policyholders must answer questions about their medical history and occupation and make other requested disclosures when signing up for a new policy. Insurers may attempt to deny a claim if they believe you omitted certain facts or misled them during the application process. However, this justification is often abused as a means of denying legitimate claims.
- Claims of insufficient evidence. When submitting a claim, you must provide proof of the disability and how it prevents you from working. This will typically involve obtaining a letter from your doctor that confirms your condition keeps you from performing your job responsibilities. Insurers will sometimes claim there is insufficient evidence to approve your claim, even if you have provided substantial medical documentation.
- Disagreements over the extent of coverage. Each policy will have its own definition of what qualifies as a disability and terms for accessing benefits. Though some policies will explicitly exclude certain types of conditions and scenarios from coverage, other policies will exploit deliberately ambiguous language to justify improper denials of benefits.
- Disagreements over the policyholder’s abilities. In order to obtain benefits, the policyholder must be unable to perform their current job responsibilities as a direct result of their qualifying disability. An insurance company will sometimes attempt to claim a policyholder in fact can perform their job responsibilities. They may even rely on their own medical professionals to formally disagree with your doctor’s recommendation.
No matter the reason for your claim’s wrongful denial, our Fort Lauderdale disability insurance lawyer at Martin J. Sperry, P.A. is prepared to help.We are extensively familiar with the tactics used by insurance companies to wrongfully deny claims and can leverage our decades of experience to fight for you. We are compassionate to the difficulties you face when your disability benefits are delayed or withheld and will do everything possible to deliver the favorable results you need in your case.