Generally speaking, in Florida and throughout the country, disability insurers will utilize whatever means necessary — whether you have short-term disability insurance coverage or long-term disability insurance coverage — to undervalue a policyholder’s claim, or to otherwise avoid having to payout the claim altogether. Insurers rely on the fact that many policyholders are unwilling to challenge their decision, even if their decision is not justified by the evidence.
If you’ve had a legitimate disability claim denied by your private insurer, you do not have to standby and accept their decision — if you appeal the decision or pursue traditional litigation thereafter, it may be possible to have it reversed.
What is Long-Term Disability Insurance?
Long-term disability (LTD) insurance is private disability insurance coverage that acts as an income replacement if you are rendered disabled and therefore incapable of working. LTD insurance lasts for a year (at minimum), and up to a lifetime (at maximum) — depending on the policy that you have entered. As such, it can function as a permanent income replacement in some cases.
By contrast, short-term disability (STD) insurance is private disability insurance coverage that acts as a temporary income replacement, usually between three months and one year in duration.
STD insurance and LTD insurance need not conflict. In fact, comprehensive insurance coverage generally involves purchasing STD and LTD insurance policies that overlap. Once the STD insurance benefits period has ended — assuming that you are still disabled — then the LTD benefits will kick in, ensuring a smooth transition to a more permanent income replacement option.
Unique Considerations in Insurance Disputes
There are very few “absolute truths” in the LTD insurance context. The length of insurance coverage, and even the waiting period (up to 6 months in some cases), may vary significantly from policy-to-policy. Benefits may be based on a percentage of your total monthly income or may simply be a flat amount. Further, the definition of disability — and how strictly or loosely it is construed by the insurer— may also vary depending on the policy.
Though there is significant variation between policies, the lengthy duration of most LTD insurance policies means that there are certain considerations that routinely become more of a disputable issue (as compared to short-term policies).
Among these are:
All policyholders have a duty to mitigate their losses. You cannot, for example, avoid the treatment and rehabilitation regimen recommended by your doctors, thus lengthening the period of your disability, and subsequently make a claim for benefits — the claim will almost certainly be denied.
In the short-term context, however, mitigation is not always relevant, as the duration of the benefits is not lengthy enough for treatment or rehabilitation to “work” and resolve the disability. In the long-term context, by contrast, your attempts to mitigate the disability at-issue will be evaluated closely.
Keeping the Insurer Informed
LTD insurance can last for many years. During the period of your receipt of benefits, the particularities of your disability may change — it may become less or more severe over time. If there has been a relevant change in circumstances, then you must report that change to your insurer so that they have the opportunity to reconsider benefits in light of such circumstances. Failure to do so could lead to termination of benefits (and in extreme cases, civil and criminal liability for fraud).
Own Occupation and Any Occupation Issues
Your disability insurance policy may have a broad “any occupation” definition of disability, or a strict “own occupation” definition. If the policy has a stricter, “own occupation” definition, then you may lose out on benefits if the insurer decides that you are capable of working in an alternative role, or in a different profession. This is not as serious issue in the STD insurance context, but in the LTD insurance context, where benefits may be paid out over decades, the insurer will almost certainly evaluate — regularly — whether you are disabled to the extent that you cannot perform the duties of a different occupation.
Contact an Experienced Miami Disability Insurance Lawyer for Assistance
Ver Ploeg & Marino is a Miami-based insurance litigation firm that has — for well over two decades — helped disabled clients overcome a wrongful denial, delay, or mishandling of their legitimate disability claims. We have worked with numerous policyholders who have long-term disability insurance, and as such, we are well-positioned to navigate the complications of such coverage. Our results speak volumes: over the years, we have secured significant monetary recovery on behalf of our policyholder-clients.
If you’re currently involved in a long-term disability insurance dispute, it’s important that you get connected to a qualified attorney who can evaluate your claims and provide further guidance as to proceeding with an appeal, and potentially, with traditional litigation.
Call (305) 577-3996 or submit an online form today schedule an initial consultation with one of the experienced Miami disability insurance lawyers here at Ver Ploeg & Marino, P.A.Share