Long-Term Disability Denials

Don't Stop at a Denial:

man with permanent disability denied disability benefits


Get the Long-Term Disability Benefits You Deserve

If you are struggling to work or keep a full-time job because of a long-term physical or mental health condition, you should apply for disability benefits. Be aware your claim will likely be initially denied but that is usually not the final answer.  You purchased long-term disability (LTD) insurance for one reason to provide you with financial assistance if you became disabled long-term and were unable to work. If your claim for long-term disability benefits has now been denied, your long-term disability insurance company is claiming you are not disabled, disputing your inability to work or just treating you unfairly, you have rights. Here is what you need to know about your long-term disability benefits and why you need a disability attorney fighting for your rights.

What you need to know:

You don't know the rules and they can be used against you. An LTD insurance policy is meant to provide you with a portion of your income when you are no longer able to work due to a long-term injury or illness. But your LTD insurance company is in the business of making a profit and they have incentive to try to pay you less than you are entitled on your claim for LTD benefits. Your insurance company may try to deny your claim based on loopholes in your policy that you were never even aware of. They may try to gather evidence from you in the form of statements, records, even medical examinations that can be used to downplay your injuries or your claimed inability to work and deny your claim. There are also often many types of insurance involved in a long-term disability situation Social Security Disability, Supplemental Security Income, health insurance, life insurance, etc.—which all have to be coordinated together, some even subrogated (offset) against one another, and your LTD insurance company may take advantage of your lack of knowledge of the policy, the law, and the rules at play to try to pay less on your LTD claim.

You don't know the value of your LTD benefits claim.The value of your claim for long-term disability benefits is often governed by many factors, including settlements from previous cases and federal law. Unless you are familiar with these different factors and the applicable law, it is very difficult to assess what you should expect from your LTD claim. If you do not know the law and how to properly calculate the LTD benefits that you are entitled to under your policy, you may unknowingly accept less benefits than you deserve.

You don't need any more stress. Coping with the stress that comes along with an accident or illness that causes you to become disabled long-term and unable to work the way that you did before is emotionally and mentally draining. Adding onto that the stress of dealing with an insurance company that is trained, equipped and motivated to exhaust you during the claims investigation process will only increase your frustration and focus your energies away from adapting to your new way of life in the best, most healthy way possible. At Taylor, Warren & Weidner, we are experienced and skilled at battling the insurance company to get the benefits you deserve. Let us take the burden of fighting your LTD insurance company off your hands so you can focus on coping and moving forward.

Three Things Physicians With a LTD Benefits Claim Need to Remember

Unfortunately, we see it far too often: doctors who try to self-diagnose their own disability and manage their own claim for long-term disability insurance, often to their detriment. If you are a physician suffering from a long-term disability that has changed the way you practice medicine, keep these things in mind:

REDUCED HOURS OR PROCEDURES EQUALS DISABILITY: Many physicians believe simply because their hours have been reduced, or they have shifted their practice to less complicated procedures due to an illness or injury that limits their physical abilities, but they are still practicing, that they are not disabled. Not true. Reduced hours in the practice or reduced numbers or types of medical procedures performed as a result of illness or injury can equate to a long-term disability eligible for LTD benefits. If you have narrowed or changed your practice in any way due to an illness or injury that limits your ability to do the things you previously could at work, you may be entitled to LTD benefits under your policy. Contact a disability attorney who can review your situation and advise you on your entitlement to LTD benefits.

IF YOU WAIT TO FILE AN LTD CLAIM, YOUR NEW OCCUPATION MAY NOW BE YOUR “OWN OCCUPATION”: This is one of the common mistakes we often see doctors, who are suffering with a long-term injury or illness, make. They wait to file for LTD benefits until after they have changed their medical profession to a job their medical condition allows them to do. In doing so, your new occupation may now be considered your “own occupation.” Meaning, you will only be entitled to a portion of your current (perhaps reduced) income, even though you were earning more when your disability began. This is because you waited too long to protect your rights by failing to file a claim for LTD benefits as soon as your long-term illness or injury impacted your ability to practice medicine.

TREATMENT BY A FELLOW COLLEAGUE OR PARTNER CAN HINDER YOUR CLAIM FOR LTD BENEFITS: As a doctor, you often spend your days surrounded by other doctors either your fellow partners in the practice or other doctors in town who are colleagues, acquaintances or friends. It is also not uncommon for doctors to get off-the-cuff opinions and treatment recommendations from these fellow physicians without setting up a formal appointment or creating the necessary medical records, even though a condition is presented and treatment prescribed. Failing to go through the formal channels when seeking treatment can result in a lack of medical records that will give your LTD insurance company potential grounds to deny your claim for LTD benefits. It is better to go through the proper channels for treatment so the necessary medical records are generated to accurately reflect your illness, diagnosis, treatment options and physical or mental limitations.

Helpful Links and Resources

Helpful article from the Florida Department of Health on disability determinations.

Learn about Florida's insurance regulations and requirements governing long-term care insurance.

Helpful guide from the University of Florida's Human Resources department on short-term and long-term disability insurance.

Read Florida law on long-term care insurance policies.

Read Florida Department of Finance's Long-Term Disability Insurance Overview.

The National Association of Insurance Commissioners' guide on the “Top 10 Things You Should Know Before Buying Long-Term Care Insurance.”

Read about the Federal Long-Term Care Insurance Program.

Read the Florida Department of Financial Services' Long Term Care: A Guide for Consumers.

The disability attorneys at Taylor, Warren, Weidner & Hancock, P.A. know the complicated ins and outs of disability law and know how to handle your LTD claim to make sure you get all of the disability benefits you are entitled to. Don't let your lack of knowledge of the law and the pitfalls hinder your ability to collect everything you are entitled to. If you have questions about your rights regarding an LTD claim, give us a call at (850) 438-4899. We will never charge you any fee or cost to inform you of your legal rights. 


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