Helping Miami’s Disabled Overcome Wrongful Denials of Disability Insurance Benefits
Just about any injury or illness can result in disability given the right circumstances. Any injury or illness that directly prevents you from performing the important duties of your occupation may qualify you for individual or group long-term disability benefits. This can include major injuries or illnesses like a cancer diagnosis or even something as minor as a broken hand, depending on your occupation. According to the most recent figures available from the United States Census Bureau, one in five Americans suffers from some kind of disability. In the city of Miami, 29.4 percent of the population—more than 10 percent above the national average—suffers from a disability.
If you’re injured or sick in Miami and worried about your ability to keep your job, we want you to know that you may be entitled to individual or group long-term disability benefits. If you have coverage, the challenge is getting your individual or group long-term disability insurer to pay your valid claim.
Private for-profit insurance companies provide the overwhelming majority of individual and group long-term disability insurance policies. Always keeping an eye of the bottom line, private disability insurance companies are therefore incentivized to wrongfully delay, deny, or terminate your coverage if your long-term disability claim eats into their profit margins. To protect your individual or group long-term disability benefits, call the top-rated long-term disability attorneys or award-winning ERISA lawyers at DarrasLaw today. We have over 100 years of cumulative litigation and claim experience defeating disability insurance companies and collecting individual and group long-term disability benefits. To schedule your completely free disability policy analysis and free claim consultation, contact us today at (800) 458-4577 or online.
The Basics of Long-Term Disability Insurance
Every individual or group long-term disability insurance policy is different, but the basic idea is the same—the insurance policy will provide a specified percentage income replacement if you become disabled and are therefore unable to perform the important duties of your occupation.
Not every policy covers every disability, however valid. Some policies severely limit mental health to 9, 12, 18 or 24 months of total benefits—even if they prevent you from performing the important duties of your occupation. Perhaps even worse, other policies only provide coverage if you’re disabled from all work, not just your specific job. Some policies can also limit self reported claims like fibromyalgia or migraines, and even worse, some policies can cap benefits to 24 months with a musculoskeletal condition.
The following is an overview of the basic disability insurance policies offered in the United States that pay long-term disability benefits:
- Group long-term disability policies – These policies cover a group of qualifying people, such as employees or union members. The private insurer will conduct a risk-benefit analysis that weighs the total group premiums against the risk of coverage—that is, the risk that it will have to pay substantial claims to the members of the group. You must be a member of the group—an employee or union member—to qualify for group disability benefits, and they typically only protect the income from that employer and benefits are usually taxable.
- Individual long-term disability benefits – If your employer doesn’t offer group coverage, or the coverage isn’t sufficient, you can purchase an individual long-term disability plan from an agent or broker. This is similar to purchasing a car or life insurance policy. These plans are beneficial if you are self-employed or have multiple sources of income or the group benefit amount is insufficient in the event of a total loss. Again, the insurance company will weigh your premiums against the likelihood that it will have to pay a valid disability claim.
- Social Security Disability Insurance (SSDI) – If you pay your taxes and have been working for a number of qualifying quarters, you’re eligible to apply for SSDI in the event that you become disabled. These federal benefits run concurrently with your private disability plan, meaning that you may claim benefits under both your private individual or group disability policy and SSDI. SSDI requires a total disability that prevents you from performing any meaningful work before it will pay long-term disability benefits. SSDI provides very limited benefits based on your average income.
Because SSDI provides only limited coverage, individual and group long-term disability policies provide additional benefits that make them very attractive to buyers.
Long-Term Disability Coverage in Miami
On average, most individual and group long-term disability insurers will replace 60 percent of your lost income depending on your level of coverage. That does not mean all of that money has to come from your long-term disability insurer.
If you have any of the following additional sources of income, your individual or group long-term disability insurance company may use it to reduce, or offset, your monthly disability payouts:
- Workers’ compensation benefits for temporary total disability
- Social Security or SSI benefits
- SSDI for your dependents under age 19
- State disability benefits
- V.A. benefits or pensions
- Other group disability coverage
- Pension contributions
- Personal injury settlements, third-party settlements, or judgments
- Wrongful termination settlements
Individual long-term disability insurance works differently because it protects you personally, not just the income from the job that group disability insurance covers. If you pay for a private individual long-term disability insurance policy, you can claim a certain percentage of all lost income as a result of your disability and your benefits are generally paid tax-free.
Different laws apply to individual and group long-term disability plans. A complicated and ever-changing set of federal laws called the Employee Retirement Income Security Act (ERISA) generally govern group long-term disability insurance policies provided by employers. ERISA places very strict limitations on your ability to fight unfair decisions made by your insurer regarding long-term group disability benefits.
People with individual long-term disability policies aren’t generally subject to ERISA’s limitations and enjoy greater freedom and consumer protections in challenging their insurer’s decisions. Individual policyholders can still find themselves fighting a wrongful delay, denial, or termination of benefits and in need of an experienced long-term disability attorney from DarrasLaw.
Common Illnesses and Injuries for Which You May Need Disability Insurance
We mentioned earlier that almost any injury or illness can qualify you for individual or group long-term disability benefits. Some of the most common disabling conditions include the following:
- Carpal or cubital tunnel syndrome
- Knee and hip injuries and replacements
- Back pain, sciatica, ruptured discs, and scoliosis
- Crohn’s disease, IBS, and bowel dysfunction
- Car accident injuries, including whiplash
- Slips and falls resulting in broken hips and spinal cord injuries
- Pregnancy complications, postpartum depression
- Fibromyalgia and other self-reported conditions like migraines
- Heart attacks, strokes, coronary artery disease, and aneurysm
- Lyme disease, Rocky Mountain spotted fever, alpha-gal allergies, and other tick-borne illnesses
- Bunion surgery
- Tennis elbow
- Arthritis, lupus, and other autoimmune disorders
This is not an exhaustive list, and remember that the medical condition must prevent you from performing the important duties of your occupation. For example, properly managed diabetes likely won’t prevent most people from performing the important duties of their occupations. On the other hand, a broken arm will probably keep a carpenter from performing the important duties of that occupation.
To make a claim, your treating physician must also certify that you cannot reliably and consistently perform the important duties of your occupation.
Keep in mind that it’s much more challenging to claim individual and group long-term disability benefits for a disabling illness or injury that makes it more difficult to perform the important duties of your occupation as opposed to one that totally prevents you from working.
However, some injuries and illnesses are so severe that they might totally prevent you from performing the important duties of any occupation. Below are some common disabilities that our clients have faced:
- Traumatic brain injuries (TBIs) – TBIs can consist of anything from mild concussions to long-term comas. Brain injuries typically interfere with memory, focus, and problem-solving skills, thus making just about any occupation extremely difficult to perform.
- Renal (kidney) failure – Kidney failure leads to a build-up of waste in your body. Treatment options may include dialysis or a kidney transplant. Dialysis treatments can significantly interfere with your ability to perform the important duties of your occupation, and a kidney transplant may require months of recovery.
- Spinal cord injuries – Major spinal injuries can result in permanent disability, with severe restrictions on your mobility and the ability to reliably perform the duties of any occupation.
- Cancer – Cancer often results in a disability claim due to the suffering that chemotherapy and radiation treatment can cause. Fatigue, bruising, bleeding, infections, confusion, nausea, weight loss, and bowel dysfunction make it extremely difficult for people to perform the important duties of their occupations, if not impossible.
- Mental health conditions – While certain mental health conditions are situational or temporary, some mental illnesses are more serious. Regardless of the severity, mental health conditions can leave someone unable to perform the important duties of an occupation. Unfortunately, individual and group long-term disability companies resist paying benefits for these self-reported conditions, and may limit the benefits they pay to 9, 12, 18, or 24 months.
Again, these are just some of the most common conditions we have seen over more than three decades of disability litigation. If your doctor diagnosed you with any disabling condition that prevents you from performing the important duties of your occupation, you may be entitled to claim individual and group long-term disability benefits. Despite the validity of your claim, prepare for your individual or group long-term disability insurance company to delay, deny, or terminate your benefits in bad faith.
Consult an Award-Winning Long-Term Disability Lawyer or ERISA Attorney at DarrasLaw Before You File Your Valid Claim
Many people don’t think they need a disability lawyer to help them with their valid individual or group long-term disability claims. However, if you wait until you receive a claim denial, you may start running out of time to file an administrative appeal with your insurance company. Remember, ERISA, which governs most group long-term disability plans, imposes harsh and very unforgiving restrictions on challenging a wrongful delay, denial, or termination of your group disability benefits. The process favors insurance companies and is not easy to navigate.
Furthermore, the Eleventh Circuit, which includes Miami, may interpret ERISA differently than other judicial circuits.
Don’t apply for group long-term disability benefits alone. Call a top-rated ERISA attorney from DarrasLaw before you find yourself fighting a wrongful denial of long-term group disability benefits. DarrasLaw’s stellar ERISA attorneys know how to process and assemble compelling medical evidence and proof needed to successfully pursue an ERISA case appeal or litigation with local counsel in the Eleventh Circuit and elsewhere across the nation.
If You’re Disabled, Call the Award-Winning ERISA Attorneys and Skilled Long-Term Disability Lawyers at DarrasLaw Today
We understand that the prospect of fighting a wrongful delay, denial, or termination of individual or group long-term disability benefits is daunting. With more than 100 years of combined disability law litigation and claim experience, the top-rated ERISA lawyers and premier long-term disability attorneys at DarrasLaw know how to get our clients the benefits they are entitled to. In fact, our founding partner, America’s top-rated long-term disability lawyer, Frank N. Darras, and his firms have recovered nearly $1 billion in insurance benefits. No case is too small or venue too far for our experienced long-term disability lawyers and seasoned ERISA attorneys. To schedule your completely free disability policy analysis and free claim consultation, call us at (800) 458-4577 or send us an email.