Short-Term Disability Insurance in Florida — The Basics
Short term disability insurance benefits serve as a form of temporary wage replacement for those who are suffering from a serious disability (though it’s worth noting that not all plans require employment, or a history of employment, to qualify for disability benefits). If you have been seriously injured in a car accident, for example, to such an extent that you can no longer work for a period of time following the accident, then your short term disability insurance will kick in and you will be entitled to receive benefits.
Many people unfamiliar with disability insurance do not understand what short term disability insurance is, and whether they can actually receive benefits pursuant to their policy. There is a real and unfortunate “knowledge gap” when it comes to short term disability, particularly in scenarios where the policyholder may be automatically covered under an employer-based group plan.
In reality, short term disability insurance is fairly straightforward to understand. Consider the basics, and if you have any questions, contact the Miami disability insurance lawyers at Ver Ploeg & Marino.
Short Term Disability Benefits
Short term disability benefits payout when you have been injured, or are suffering from an illness or condition that is severe enough to disable you — in other words, enough to prevent you from fully and adequately handling your job/career duties for a specified time period (up to one year, usually). Benefits vary depending on the insurance plan, and sometimes, on the nature of the work that you are involved in. Some plans pay a percentage of your wages, while other plans pay a set amount of funds (that does not vary, regardless of your wages or other supplementary earnings). The time structure of payment — weekly, monthly, etc. — may also vary, depending on the insurance plan.
In the short term disability context, insurers frequently deny claims on the basis of the injury not being sufficiently “disabling.” The insurer benefits a great deal from denying or otherwise delaying the processing of your claim, as policyholders may find the prospect of going through an appeals process (or litigation) too overwhelming to pursue, particularly if their disability will be corrected within the year. Insurers count on the fact that many policyholders resign themselves to the denial and do not bother to mount a challenge. With the assistance of the Miami disability insurance lawyers at Ver Ploeg & Marino, however, the denial can be properly challenged and damages may be rightfully and efficiently recovered.
Common Reasons Insurers Deny Short Term Disability Claims
There are a myriad of reasons why the insurer will deny a claim for short term disability benefits. While this denial is sometimes justified, at other times it is not. When it isn’t, it is time to reach out to the Miami disability insurance lawyers at Ver Ploeg & Marino. The following are common reasons why insurers deny short term disability claims.
Lack of Evidence
The insurer will not honor your claim based solely on your statement that you are suffering from a short term disability. You must provide medical evidence of the disability and failure to do so can result in a denial of your disability claim. To prevent this, be certain your claim contains all requested medical documentation proving your disability.
Condition Not Covered
When you purchase your insurance policy, it is important to review exactly what it will and will not cover. It is not safe to assume that any condition that renders you disabled is automatically subject to payment. For example, the insurance policy may not provide coverage for giving birth or an on-the-job accident (which would be a workers’ comp situation).
The Insurer Does Not Believe You
Insurers will check your claims for validity, and this includes looking at your social media accounts. If you are claiming short term disability for a leg injury but post pictures of you skiing on your social media accounts, you can expect your claim to be denied.
Social media is not the only way insurers will check up on your claim. They may even speak to neighbors, friends, and coworkers, or they may conduct surveillance to verify the validity of your claim.
If your claim is for a condition that existed prior to the issuance of the insurance policy, the insurer may deny the condition as pre-existing. Not all policies will deny coverage for preexisting conditions, however. It is best to check the terms of your policy to know for certain.
The terms of the insurance policy itself are always the first place to look to see what the insurer will or will not cover. If the insurer does not honor the terms of the policy, it is time to speak with the Miami disability insurance lawyers at Ver Ploeg & Marino.
Requirements and Limitations of Short Term Disability Insurance
Short term disability insurance plans tend to be quite different from one another. Your insurance plan may have a strict definition of disability, for example, that requires that you be rendered fully disabled, as opposed to partially disabled. Your plan may also establish a significant waiting period for benefits, require that you be employed full-time to qualify for benefits, and demand regular, consistent updates on your medical condition. Generally speaking, all plans require a minimum period of disability of two months (sometimes more).
Once your short term disability insurance period runs out (up to one year later), then you may qualify for long term disability benefits, if you have such insurance. Otherwise, your benefits will simply end, even if you continue to suffer from the disability at-issue.
What Makes Long Term Disability Insurance Policies Different?
While short term disability insurance can be very helpful in many situations, there are times when long term disability insurance is more appropriate. Typically, this is when the period of disability is expected to be longer than a year. Generally, plans range in years from 2 years all the way up to the remainder of your life or retirement, depending on the particular policy. However, long term disability almost always pays less than short term disability and they have a longer elimination period.
Contact Miami Disability insurance Lawyers Here at Ver Ploeg & Marino Today
Ver Ploeg & Marino is a Miami-based insurance litigation firm that has represented clients throughout the state of Florida in insurance-related disputes since 1995. Our attorneys have an extensive track record of success in helping policyholders obtain a favorable resolution to their claims, including short term disability claims.
Are you involved in a short term disability insurance dispute? Call (305) 577-3996 or reach out to us online to get in touch with experienced Miami disability insurance lawyers here at Ver Ploeg & Marino. During your initial free consultation, our attorneys will evaluate your claims and help you identify a winning strategy for resolving the dispute at-issue.Share