In Florida, as is the case in other states, recipients of disability benefits — whether through private disability insurance or through a public program like SSDI — must reasonably follow the treatment plans required by their physicians, and must regularly update their insurer as to their condition. Failure to do so could result in a loss of benefits (through premature termination of benefits), or a reassessment of disability benefits that reduces the amount you receive on a monthly basis.
Reasonable Efforts to Mitigate
Generally speaking, insured policyholders in Florida (including disability insurance policyholders) have a duty to mitigate — in other words, they must make reasonable efforts to minimize their losses. In the disability context, this means that disability claimants must attempt (to the degree possible) to “fix” their disabling condition, or at the very least, to minimize the impact of the condition on their life.
Once your physicians recommend a treatment plan, it is important that you follow said treatment plan. Failure to do so will likely constitute a violation of your duty to mitigate your losses — if you do not follow your physician’s recommended plan, your insurer may terminate benefits prematurely and will likely argue that your disability would have resolved had you followed the plan.
If you failed to follow a given treatment plan, you may still be able to receive benefits, but you’ll have to introduce evidence that demonstrates that your disabling condition would not have improved or resolved even if you had followed the treatment plan at issue.
Insurers Must Be Informed of Changes
As a disability insurance policyholder, you have a responsibility to report any significant changes to your condition that may affect your continued eligibility for disability benefits. For example, if your disabling condition has resolved to the degree that you can return to work part-time, then you may be required (under the terms of your disability insurance contract) to report these changes.
Every plan is different, and some are more strict than others (with regard to reporting requirements). Failure to report changes to your physical condition that could affect your continued eligibility for disability benefits could result in:
- Premature termination of your disability benefits
- Liability for overpayment of benefits
- Reassessment of benefits to reduce the amount paid
- And more
Contact Our Team of Miami Disability Insurance Lawyers for Further Assistance
First-time disability claimants may not realize that their benefits can be significantly affected by the choices they make after having suffered an illness, injury, or other disabling condition. Every plan is different, of course, but as a general rule, disability claimants are required to follow their treatment plans and keep their insurers apprised of new developments. When complications arise, the insurer may terminate benefits early, or may otherwise interfere with your receipt of disability benefits.
Here at Ver Ploeg & Marino, our attorneys have spent decades assisting disability policyholders in a range of disputes with their insurers, whether those disputes involve wrongful denial, termination of benefits, or an unfavorable change in benefits (possibly due to the policyholder’s purported inability to stay the course of treatment). We understand that obtaining your rightful benefits as a disability claimant can be challenging, and can leave you feeling rather vulnerable — as such, we are committed to providing personalized legal representation and maintaining a transparent attorney-client relationship at all times.
Call (305) 577-3996 to speak with one of our experienced Miami disability insurance lawyers today. We will evaluate the situation in a holistic manner and help you move forward with your claims.Share