Private and employer-sponsored group disability insurance plans are meant to be a proactive measure to protect our economic well-being if we are unable to work. However, many plans contain ambiguous or confusing language, and claims are frequently denied because an enrollee has unwittingly made a mistake during the claims process.
Paul Kimsey and Paul Przepis, attorneys with the Kimsey Law Firm, P.A., have prior experience as legal counsel for insurance companies, so they understand how the other side views your claim. They have prepared answers to some of the most common questions that our firm receives about disability insurance, to better equip you for filing and appealing a claim.
Answers To Frequently Asked Disability Questions
What is the difference between short-term and long-term disability insurance? — Short-term disability insurance is intended to cover injuries that an accident victim may recover from relatively quickly. Many policies are written to begin coverage after a short period in which the enrollee may be receiving pay from their employer. Short-term disability payments usually end after six months. Long-term disability insurance is designed to cover disabilities expected to last more than six months. Like short-term plans, it will pay a portion of your full income — often 66 to 70 percent.
I am enrolled in a private disability insurance plan and it refuses to pay my claim. What should be my next step? — Most likely, you will be required to appeal your claim denial within the terms of the policy first. Our attorneys can review your policy and listen to you, and make recommendations for how to navigate the appeals process. If your internal appeals are denied, you may choose to file a lawsuit, such as one based on a breach of contract, or that asserts that the insurer’s denial of your claim was made in bad faith.
I am a doctor caught up in a battle over my professional disability claim. Why does the insurer insist I am only “partially disabled” when I really am unable to do my job? — There could be numerous reasons the insurer is pursuing this line of action. Many older professional disability policies, especially ones written for doctors, include language that asserts that you are not totally disabled until you reach the point where you cannot perform 100 percent of your job tasks. Other policies have been written in a way that presumes you are largely sedentary as you fulfill work tasks — which is clearly not the case for surgeons, anesthesiologists, dentists and many other health professionals. Professional disability insurance is a subspecialty within general disability insurance, and medical professional insurance policies are even more specialized in how they are marketed and written. Consult with an attorney with experience in this specific area of disability insurance for an assessment of your options.
My long-term disability insurer insists I must be examined by one of their doctors. What should I do? — First things first: understand that what is often called an “independent medical examination” is actually a chance for a physician hired by the insurance company to look for evidence that your disability is not as severe as you have stated. The exam itself is often quick and not thorough. The doctor’s notes may accuse you of exaggerating the extent of your injury. In an ERISA disability case, the examining physician may ignore or have little knowledge of the treatment you have been receiving for your physical or mental conditions, and their review may be valued over the treatment team with whom you have been working.
Consult a lawyer about what your policy says about these types medical exams. If your policy requires you to participate in one to pursue a claim, it is critical to document what happens during the exam itself. Your legal representative can also give you detailed information on the best ways to prepare for the exam, based on the language of your particular policy.
My employer is now offering group employment disability benefits. What should I look for to determine if it is a good policy? — Our lawyers can review the potential policies for specific advantages and pitfalls, but, in general, you will want to know the following things:
- Will both long-term and short-term benefits be offered?
- How do the policies define partial or total disability?
- Are the benefit policies written in clear and easy to interpret language?
- Do the policies offer clear guidance on how to properly file a claim and appeal a claim denial?
- Are there benefit caps on the policies (either one-time or lifetime use)?
- Do the policies discuss options for enrollees if the employer cancels the plan?
We Empower Clients In Disability Insurance Cases
Knowledge and advocacy are two crucial things that we provide our clients as we represent them in disability insurance cases. If you have additional questions regarding your disability insurance, call our office in Tampa at 813-867-2179 or email us to set up a free introductory appointment. We serve Florida clients across the Tampa Bay metro area.