As the third-biggest state in the nation by population, Florida sees its share of long-term disability insurance disputes. Unfortunately, providers of individually purchased or employer-sponsored group disability policies in the Sunshine State frequently do their best to avoid paying claimants, even those with legitimate qualifying disabilities in desperate need of monthly insurance benefits. Be sure to contact our Florida bad faith insurance attorney if you have questions.
If you encounter difficulties of this nature, contacting a top-class Florida insurance lawyer is the best first step to protect your interests. Whether you’re dealing with a wrongful claim denial, an unreasonable delay of monthly benefits, or another claim issue, a bad faith insurance attorney will be able to implement a strategy to prevent your insurance carrier from exploiting you.
How to Respond Following an Insurance Claim Denial
If your insurance company has indicated it won’t pay out on your claim, don’t panic; there are ways you can successfully challenge the wrongful decision. The pathway you’ll have to use will differ depending on the type of insurance policy you have.
In most cases, employer-sponsored group long-term disability insurance policies are governed by the Employee Retirement Income Security Act of 1974 (ERISA). This complex body of federal legislation sets out a series of rules and requirements for group insurance companies and policyholders, including when it comes to the appeals process following a claim denial. ERISA prevents claimants from bringing insurers directly to court, requiring them to timely file a mandatory administrative appeal first.
No such restriction exists in relation to individually-purchased long-term disability insurance policies. You can take your individual disability insurer straight to state or federal court if it wrongfully denies your claim or delays your monthly benefits, usually through a bad faith insurance lawsuit.
What Is a Florida Bad Faith Insurance Lawsuit?
A bad faith insurance lawsuit attempts to establish that an insurer failed in one or more of its legal or contractual duties to you as a policyholder and claimant. In cases involving individually purchased long-term disability insurance policies, you can use bad faith law to challenge a wrongful delay or unreasonable claim denial.
Bad faith insurance litigation is the avenue most commonly used by individuals receiving adverse claims denials on individually purchased long-term disability insurance policies. You can file this kind of a lawsuit immediately after winning the breach of contract case; there is no mandatory appeals process to deal with, unlike in cases involving employer-sponsored group policies.
Unlike ERISA cases, bad faith insurance lawsuits are based around legislation and precedent in individual states. In Florida, the rules on bad faith come from the State Statute 624.155, which lists acts and omissions that may cause an insurer to be in breach of the principles of the doctrine. These include:
- A failure to act “fairly and honestly” toward a policyholder
- Making payments to policyholders without adequately indicating the coverage from which the payments arise
- A failure to settle a claim once the obligation to do so “has become reasonably clear.”
Another advantage of bad faith insurance litigation over ERISA for claimants is the fact you can pursue cases in Florida’s state courts, rather than having to go to federal court, as long as your insurer or another potential defendant is also based in Florida. Legal actions at the state level are typically much more straightforward and less costly than those in federal courts.
As the law around bad faith actions is highly specific and varies from state to state, it’s important to get a specialist Florida bad faith insurance attorney on your side when pursuing this type of action. Our attorneys regularly secure excellent results for our Florida-based clients.
What Is a Mandatory Administrative Appeal Under ERISA?
As noted above, employer-sponsored group long-term disability insurance policies are typically governed by ERISA. The legislation sets out a mandatory appeals process that must be followed in the event of a denied claim.
The first step for you following a denied ERISA disability claim will be the compilation of the entire administrative record of all the medical, vocational, and financial evidence that relates to your claim. This must be done in advance of a prescribed deadline, usually 180 days from the date on which you learned of the ERISA claim denial.
If your insurer rejects your ERISA group disability claim again at the administrative appeal stage, you may then bring your case before a federal judge. However, it’s not generally possible to admit any new evidence at this point; the court makes its decision based on the records and reports submitted by both parties before denial and at the administrative appeal stage. Therefore, it’s a good idea to consult with an expert Florida bad faith insurance attorney as soon as you learn your claim has been rejected. Trying to complete the administrative appeals process by yourself leaves you at a much greater risk of omitting an important record or report and fatally damaging your ERISA claim. Additionally, the six-month deadline for submission leaves you with very little time to waste.
How A Florida Bad Faith Insurance Attorney Can Help You
Unfortunately, there are no guarantees of quick and straightforward resolutions when it comes to long-term disability insurance claims. Carriers frequently do all they can to wrongfully delay claims, or unreasonably deny them outright. If you’re facing a situation like this, hiring an expert insurance lawyer is the best way to protect your interests.
Contact DarrasLaw today to arrange a free initial review of your case, including a free initial policy analysis, claim review, or appeal assistance. If your policy falls under ERISA and you’ve already received an initial rejection letter, you need to start the mandatory administrative appeals process as soon as possible to ensure you submit a comprehensive appeal in advance of the relevant deadline.