For many people, long-term disability is a very real possibility. Research tells us that one out of every four 20-year-old workers today can expect to be disabled for at least a year before they reach the typical age of retirement and, every seven seconds, a working-age American will suffer a disabling injury or illness that affects them for about a month. In many cases, the period of disability can last for years and even become permanent.
Getting long-term disability (LTD) benefits is not always straightforward- an estimated two-thirds of SSDI claims are initially rejected, and disability insurance carriers don’t always come through for policyholders when they’re supposed to. If this happens to you, a Florida long-term disability attorney at My Insurance Case may be able to help you request a reconsideration or appeal and, if necessary, file a lawsuit.
What You Need to Know About Florida Long Term Disability Benefits
Most disabling accidents are not work-related, which means that workers’ compensation will not step in if you’re unable to continue working. You may, however, be eligible for Social Security Disability benefits or benefits available through a group or private LTD insurer.
Social Security Disability Insurance (SSDI)
According to the U.S. Census, more than 36 million Americans are classified as disabled, which amounts to about 12% of the population. Common reasons for long term disability claims include:
- Musculoskeletal disorders (27.6%)
- Cancer (15.0%)
- Injuries such as broken bones, sprains, and strained ligaments or muscles (12.0%)
- Mental health issues (9.3%)
- Circulatory (stroke, heart attack) (8.2%)
If you’ve paid your taxes and worked for a number of qualifying quarters, you’re eligible for SSDI if you become disabled. Benefits under this program run concurrently with your private disability plan (if you have one), so you may claim SSDI while also claiming benefits under your individual or group disability policy.
Social Security Disability benefits are aimed at those with long-term disabilities that are expected to keep them from working for at least a year. The Social Security Administration’s definitions of disability are strict, however, and the majority of applications are denied the first time around. It may take you several rounds of appeal to receive the SSD benefits to which you are entitled.
Group Long Term Disability Insurance
Approximately one-third of U.S. workers in the private sector have long-term disability insurance. These policies typically cover employees or union members. The private insurer will perform a risk-benefit analysis in which it weighs the total group premiums against the risk of coverage- that is, the risk that it will be forced to pay substantial claims to the group members. Group long-term disability benefits only protect the income from that particular employer.
Even if you are covered, there’s always the chance that the insurance provider may deny your claim for benefits if you are unable to work. They may claim that your injury or illness doesn’t meet your policy’s definition of disability, forcing you to go through an administrative appeals process or even file a lawsuit against the insurer.
Individual Long Term Disability Insurance
If your workplace doesn’t offer group coverage, or if the coverage is insufficient, you can buy an individual long-term disability plan. The process is similar to buying a car or life insurance policy. When you are self-employed or have multiple sources of income, these plans are especially beneficial.
Your insurance company will weigh your premiums against the likelihood that it will have to pay a valid disability claim. Like group insurers, companies offering individual LTD plans sometimes dispute a claim for benefits, requiring you to take further action. These complications can make an already stressful time even more frustrating, so let a long-term disability benefits lawyer at My Insurance Case help you fight for the benefits you need.
Social Security Disability vs. Long Term Disability
Although SSDI and long-term disability insurance pay disability benefits to successful claimants, there are some differences between them.
The Social Security Administration uses a five-step sequential evaluation to determine disability. Specifically, it asks whether:
- You have engaged in gainful employment
- You have a sufficiently disabling impairment
- You meet a listing in the Blue Book, which is the SSA’s manual of disabling impairments
- You can go back to doing the same work you did before becoming injured or ill
- You can do other work based on your education, age, and transferable skills
Alternatively, each long-term disability policy has its own definition of disability, which is that the insured cannot perform the substantial and material duties of their occupation. Unlike the SSA, which considers advancing age when determining eligibility, LTD insurers don’t take age into account in their definition of disability.
Do I Need to Hire a Lawyer for My Disability Claim?
Florida law does not require you to use a lawyer for your long-term disability claim, but it’s definitely recommended.
If you wait until you receive a claim denial, you may run out of time to appeal. The SSA has strict deadlines on when you can submit your request for reconsideration or an appeal. The federal Employee Retirement Income Security Act (ERISA), which governs most group long-term disability plans, also has firm restrictions on challenging wrongful denials of group benefits. The process favors insurance companies and is difficult to navigate.
Disability claimants who use a Florida long-term disability attorney are usually more successful at winning benefits upon initial application than those who do not. Even if you’re denied at the application stage, your chances of being approved increase upon reconsideration or appeal when you have legal representation.
How Much Does It Cost to Hire a Florida Long-Term Disability Attorney?
When you contact My Insurance Case for a free consultation, a Florida long-term disability attorney will review your case and explain how we can help. We know that this is a difficult time for you and are committed to making the benefits application or appeal process as stress-free as possible.
We take disability benefits cases on a contingency fee basis, which means that you don’t pay any legal fees or costs upfront. Our fees will come from a percentage of your final settlement or court award. If we don’t succeed in winning the benefits you need, you owe us nothing. If you have questions about our fee structure, your disability lawyer will be happy to answer them.
My Long Term Disability Claim Was Denied! What’s Next?
If your disability claim was denied, don’t give up!
If you applied for SSDI benefits, having your initial application rejected is common. Your next step should be to request reconsideration. You can do this by filling out a Request for Reconsideration and submitting it within 60 days of the date on your notice of denial.
Many disability claimants are approved at this stage because they corrected the errors in their original application, but if you are denied once more, you can request a hearing before an administrative law judge. About half of the cases heard by an ALJ are approved, but if for some reason you are denied, you can ask the Appeals Council to review the decision. The final stage of appeal is a federal court.
If you sought disability benefits through an LTD insurer, the appeal process will depend on whether your plan is employer or self-funded.
- If you are covered by your employer, you must follow a precise appeal process set out in ERISA. You must first file an internal appeal with the long-term disability insurance company. If the company denies your appeal, you may file a lawsuit in a federal court.
- ERISA does not apply if you have a private LTD policy. Instead, Florida’s insurance and contract laws govern the transaction. You can file a lawsuit in a Florida state court without having to go through any type of internal appeals process with the insurer.
Long-term disability appeals, especially those that involve ERISA, are extremely complex. In addition to meeting filing deadlines, you must analyze and understand insurance company documents and vocational and medical evidence. A single mistake can mean the end of your claim. Rather than take this risk, reach out to an experienced Florida long-term disability attorney at My Insurance Case.
How Can My Insurance Case Help Me?
Unfortunately, if you are sick or injured, it may be difficult for you to collect the benefits you are entitled to. The lawyers at My Insurance Case are familiar with common reasons for SSDI and LTD insurance denials and know how to address them. When our clients file a claim, we carefully guide them through the process and help them obtain all the documents and records they need to support their case.
Our attorneys know how to build a claim file that gives you the best chance of receiving long-term disability benefits. Using our years of experience and industry knowledge, our team will collect and assemble the most convincing evidence for your case, such as MRIs, CT scans, and other medical tests. When you work with a Florida long-term disability attorney at My Insurance Case, we do everything we can to maximize your chances of success.
Get a Free Consultation From a Florida Long Term Disability Attorney
If you are unable to work due to an illness or injury, you should contact a disability attorney at My Insurance Case right away. Our skilled lawyers have years of combined experience helping clients get the disability benefits they need to make up for a loss of income. To learn more, contact us today for a free initial consultation about your disability claim.