 The disability lawyers at the Wagar Law firm represent clients in South Florida, including Miami-Dade, Broward and Palm Beach counties. As your attorney, we will work to obtain the long term disability benefits you are entitled to receive. What follows are several common questions about long term disability benefits and ERISA. If you have any other questions regarding your long term disability claim, please contact one of our lawyers today.
Long Term Disability Insurance - Frequently Asked Questions
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1. What is ERISA and how does it affect my claim for benefits?
The Employment Retirement Income Security Act of 1974. This Federal law governs the administration of employee benefits plans and the rights of the beneficiaries under these types of insurance plans. Most employer-sponsored plans are subject to ERISA. Once all policy requirements have been met --usually by filing appeals, you may be entitled to recover benefits through a lawsuit.
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2. My claim for disability benefits has been denied. What happens next?
After your claim for disability benefits is denied, you must file a written appeal requesting your claim to be reviewed, so later you get the opportunity to file a lawsuit against the insurance company. It also gives you the opportunity to update and provide medical information for the insurance company to consider.
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3. How can my insurance company deny my claim for disability benefits when I am not able work?
Insurance companies will delay or deny disability insurance claims stating the claimant does not meet the definition of disability. They will try to change the definition of disability from "your occupation" to "any occupation." Insurance companies also use many other excuses to delay or deny paying claims including pre-existing conditions or other limitations stated in the claimant's policy.
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4. How can my insurance company deny my claim for disability benefits based on a mental or nervous limitation provision when this is not my disability?
Insurance companies will delay or deny disability insurance claims by referencing a mental or nervous limitation provision in your policy. Often times, they will use the Diagnostic and Statistical Manual of Mental Disorders (also know as the DSM-IV) to find conditions to label the claimant.
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5. Do I have to submit to the insurance company's independent medical exam?
Most likely. You're required to go if this requirement is stated in your insurance policy. Your insurance company may also try to send you to a functional capacity evaluation. They may not have the right to do this unless your policy specifically gives them this right. One of the ways not have to go to an FCE or IME is if the evaluation or examination would cause you pain or is in anyway harmful to your well-being.
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