Empowering People Seeking Disability Benefits
Approximately 50% of people who are disabled longer than six months will remain disabled after five years. When an insurance company refuses to pay for a disability, the results are financially and personally devastating. Often, companies write disability insurance policies with intentionally ambiguous and confusing language.
At the Kimsey Law Firm, P.A., our attorney understands that this can give the insurance companies an excuse to deny or delay the payment of needed disability benefits. He dedicates his time to represent Florida residents who need help recovering their disability claims.
Providing Answers To Frequently Asked Disability Questions
Private and employer-sponsored group disability insurance plans are meant to be a proactive measure to protect individuals’ economic well-being if they 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. Having answers to their questions can help workers make informed decisions.
My employer is now offering group employment disability benefits. What should I look for to determine whether it is a good policy?
Our lawyer 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?
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%.
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 attorney can review your policy and listen to you as well as 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 that I am only “partially disabled” when I really am unable to do my job?
There could be numerous reasons why 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% of your job tasks. Other policies have been written in a way that presumes that you are largely sedentary as you fulfill work tasks – which is clearly not the case for surgeons, anesthesiologists, dentists and many other health professionals. This type of 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 that I must be examined by one of its 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 incomplete. The doctor’s notes may accuse you of exaggerating the extent of your injury. In an Employee Retirement Income Security Act (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 of medical exams. If your policy requires you to participate in one to pursue a claim, then 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.
Helping Clients Recover The Compensation They Are Owed
Our lawyer has 30 years of experience helping thousands of clients recover benefits under disability insurance policies. He has served as counsel to insurance companies, so he knows how the other side thinks.
His process includes reviewing and interpreting disability insurance policies. Then he files claims, helps you obtain needed treatment and assists with appeals if the request is denied. If no solution is found, our lawyer will utilize mediation or litigation for your denied claim.
He can help you with claims including the following:
- Disability claims ranging from six months to retirement age
- Short-term disability of fewer than six months
- Private and group disability policies
- Employees facing denial under ERISA
- Accidental death and dismemberment (AD&D) insurance claims
Free Case Consultation | Call 813-867-2179
Knowledge and advocacy are two crucial things that our attorney provides our clients with as he represents them in disability insurance cases. At the Kimsey Law Firm, P.A., he is pleased to offer free consultations on your case. Call 813-867-2179 today or reach out via our online form to schedule an appointment. Our lawyer serves clients from our Tampa Bay area office location.