Navigating disability disputes in Florida can be daunting: you may be facing a mix of urgency, confusion, and uncertainty about what comes next. If you're an employee with a workplace-related disability who's having trouble accessing the benefits and rights afforded to them by law, you don't need to go it alone.
At our practice, we are here to help — with attorneys who have over 20 years of experience helping clients with disability disputes. Whether you have a short term or long term disability claim, we bring expertise and compassion together to assist those looking for justice. If you're in the midst of filing a Florida disability dispute, contact Herman & Wells law firm.
In this post focused on Florida Disability Disputes, our goal is to arm employees and their families with knowledge so they can understand their legal options. We want readers of all backgrounds and experiences to level up their understanding of workplace disability disputes in order to make informed decisions that ultimately lead them down the path toward receiving the compensation they deserve.
Why Most Disability Insurance Claims Are Denied
It is important to understand why Florida disability insurance claims are often denied. The primary reason that Florida disability insurance claims are denied is that ERISA (Employee Retirement Income Security Act) regulations require employers and insurers to adhere to certain guidelines when it comes to making decisions regarding the approval of disability benefits. This means that in many cases, Florida disability insurers have a vested interest in denying claims that might otherwise be approved.
There are several other factors that can lead to Florida disability insurance claims being denied:
Common Reasons For Denial
- Change in employer definition for disability eligibility (i.e. could change the requirement from “any occupation” to “gainful occupation”)
- Pre-existing conditions not covered
- Doctor says person no longer qualifies as disabled (insurance company can order a second opinion)
- Doctor was confused by insurance forms (insurance companies invest heavily in order to develop forms that are misleading or only have limited response options for doctors. These forms don’t account for impact of stress on work ability, only physical symptoms.)
- Denied because insurance company claims the person applying for disability owes them money
- Failure to follow treatment plan
- Income or assets above the maximum limit
How To Identify The Specific Reason For Denial
If you’ve been denied disability benefits in Florida, it’s important to understand why. Knowing the specific reason for denial can help you take the right steps to challenge the decision and potentially receive your benefits. The most common reasons Florida disability claims are denied fall under two broad categories: medical and non-medical.
A medical denial could mean that the Social Security Administration (SSA) determined you didn’t meet their definition of disability, which is based on your physical or mental condition. A non-medical denial could include failing to provide enough evidence to prove your disability, not completing necessary paperwork or forms, or violating the rules of a plan subject to the Employee Retirement Income Security Act.
Next Steps In The Florida Disability Claims Appeals Process
Your Florida disability dispute may involve an ERISA-governed plan. The Employee Retirement Income Security Act (ERISA) requires that employers provide employees with certain disability benefits. ERISA gives disability claimants the right to file a claim, appeal a denial, and challenge any other aspect of their disability benefit plan.
If your Florida disability dispute involves an ERISA-governed plan, you may be able to pursue an administrative appeal before filing a lawsuit in court. This process generally involves submitting additional paperwork or evidence to the plan administrator.
If you want to take advantage of Florida’s administrative appeals process, you should contact your disability insurance company and notify them that you intend to file an appeal. You will then submit any additional information or evidence needed to support your claim, including medical records, employment records, and witness testimonies.
Request for Reconsideration
When Florida residents are faced with a disability dispute, they have the right to request a reconsideration by the responsible party. This process begins with an individual submitting an appeal document that outlines their case, which is then reviewed by medical and vocational experts.
The experts determine whether or not the disability benefits are justified in a particular situation. Once the experts have reviewed the appeal and rendered a decision, Florida residents have the right to challenge the determination by filing an ERISA claim.
Hearing with an Administrative Law Judge
Once the ERISA claim has been filed, Florida residents can request a hearing with an administrative law judge. This is an independent, impartial judge who will assess the evidence and make a determination regarding the disability dispute.
During the hearing, Florida residents have the right to present their evidence and be represented by a Florida disability dispute attorney. At the end of the hearing, the administrative law judge will render a decision based on the evidence presented.
How to Prepare for a Florida Disability Dispute Hearing
If you are faced with a Florida disability dispute, it is important to prepare thoroughly in order to maximize your chances of obtaining the benefits you are entitled to. Before attending the hearing with an administrative law judge, there are a few steps you should take:
- Review any documents related to the dispute and make sure you understand all of the relevant information.
- Collect any evidence that supports your claim, such as medical records or statements from doctors confirming your disability.
- Finally, consider consulting with a Florida disability dispute attorney to help ensure that you have done everything possible to prepare for the hearing.
By taking these steps, Florida residents can ensure that they are as prepared as possible when facing a disability dispute. With the right preparation and assistance, Florida residents may be able to obtain the benefits they are entitled to.
Federal Court Review
A Federal court review of a disability dispute in Florida is typically required when the disability claim is governed by ERISA. When an employee's disability claim is denied and the claim is subject to ERISA, the employee must file a lawsuit in federal court.
The employee will need to prove that his or her disability claim was wrongfully denied and should have been approved. Florida courts strongly enforce ERISA rules, so it is important for employees to understand their rights when filing an ERISA-governed disability claim.
Frequently Asked Questions About Florida Disability Claims
What If Your Condition Has Worsened Since The Denial?
If your disability has worsened since the initial denial, you may be able to appeal the decision or re-file the claim. You may also want to consult a Florida lawyer who specializes in ERISA (Employee Retirement Income Security Act) and disability disputes.
Your attorney can evaluate your situation and provide legal advice on whether an appeal is appropriate for your case. Submitting updated medical evidence is one way to potentially overturn a denial of a Florida disability claim.
Here are the steps to follow:
- Contact your Florida disability attorney to discuss the possibility of submitting new medical evidence when appealing a denied claim.
- Your lawyer can help you prepare an appeal letter and any necessary supporting documents.
- File the appeal with the insurance company or disability administrator in charge of your claim.
While your Florida disability attorney can help you prepare an appeal letter and other supporting documents to submit updated medical evidence, it is important to be aware of the risks associated with asking your doctor to send your medical records directly to the insurance company.
Sometimes, insurance companies may use medical records to deny a disability claim rather than approve it. It is best to discuss your options with a Florida disability lawyer before taking any action.
Insurance Is Required To Make A Decision Regarding A Disability Claim Within 45 Days
When it comes to disability claims in Florida, the insurance company or disability administrator in charge of the claim is required to make a decision quickly. In most cases, a decision must be made within 45 days of receiving the appeal letter and any necessary supporting documents. This time frame may be extended if more information is needed from either party or if there is a backlog of appeals.
What Are The Typical Eligibility Requirements For Disability Benefits In Florida?
Individuals living in Florida who believe they are unable to work due to a disability may be eligible for disability benefits from either the Social Security Administration (SSA) or an employer-sponsored plan. In Florida, eligibility requirements vary based on the type of disability benefit sought.
For disability benefits provided by the Social Security Administration, applicants must meet certain medical and financial criteria. Specifically, applicants must have a disability that meets the definition of disability under Social Security law, they must not earn more than $1,260 per month in income (for 2021), and they must have worked long enough to be insured under Social Security Disability Insurance.
For disability benefits provided by an employer-sponsored plan, the eligibility requirements must be outlined in the employer’s summary plan description (SPD). Generally, individuals must have worked long enough to become covered under an employer’s disability plan and they must meet medical criteria as outlined by their SPD.
Re-applying for disability benefits can be a complex and lengthy process, requiring careful preparation and documentation. Generally, individuals must demonstrate that their condition has not improved and that they still meet the eligibility requirements for receiving benefits.
How Can You Better Support Your Florida Disability Claim Case?
When you experience a disability and file a disability claim, they may have several options to support your case. One of the most important ways you can support your Florida disability dispute is by ensuring that you provide clear, comprehensive medical documentation. This medical documentation should include detailed records from any doctors or specialists who have treated your disability. It should also include your complete medical history.
Evidence of Insurability (EOI) is used to evaluate the risk associated with a disability insurance claim. Important documents related to EOI include detailed medical records, along with past and present employment information. This information helps provide a complete picture of your health, background, and lifestyle — all of which help insurers determine the level of risk associated with a disability claim.
If you have a disability and are considering filing a disability claim, it is important to understand that a well-written appeal can make all the difference. It is important to work with an experienced Florida disability lawyer to ensure that all of the necessary evidence and documentation are included in the appeal process.
An experienced Florida disability dispute lawyer will be able to provide you with advice on the best way to present evidence and ensure that all of the legal requirements are met. With their help, you can have peace of mind knowing they've done everything possible in order to secure your entitled benefits.
How Long Does The Florida Disability Appeals Process Take?
The Florida disability appeals process can be a long and frustrating process for those facing a denied disability claim. Depending on the complexity of the case, it can take anywhere from several weeks to several years to resolve a Florida disability dispute. The timeline for each step of the Florida disability appeals process is dependent upon various factors, such as the workload of the Florida disability office and the complexity of the case.
Tracking the progress of your Florida disability dispute can help make sure that all necessary steps are being taken and that your disability claim is not delayed unnecessarily. The Florida disability office will typically send out decisions about disability disputes in the mail. If you have not received a response from the Florida disability office, you may consider contacting them by phone to inquire about the status of your Florida disability dispute.
You may also wish to seek the guidance and advice of an experienced Florida disability dispute lawyer who can advise you regarding your legal rights and options and will represent you throughout the Florida disability appeals process.
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Helpful Online Resources If Your Florida Disability Claim Was Denied
- Florida Department of Financial Services: This site provides essential information about Florida disability claims and appeals.
- Social Security Administration: The SSA website contains a wealth of resources for Florida residents with disability issues, including links to their local office’s contact information and the ability to apply online for Disability Insurance Benefits (DIB).
- Florida Disability Adjudication Services: The Florida Division of Vocational Rehabilitation administers the Florida Disability Adjudication Services (DAS), which provides assistance to Florida residents who have been denied disability benefits.
- Florida Association for Individuals with Disabilities: This nonprofit organization was founded by disability rights advocates and provides Florida disability claimants with information, support, and resources.
- Florida Council of the Blind: This organization offers a range of services to Florida residents who are blind or visually impaired, including advocacy for those who are fighting disability disputes.
- Florida Bar Association: The Florida Bar Association provides Florida residents with resources to help them find an experienced disability lawyer.
- Florida Justice Center: This organization assists Florida residents in obtaining legal representation for disability disputes and appeals.
- Schedule a Consultation: Book a consultation with our ERISA dispute attorney if you have a question about your disability claim or wish to challenge a denial.
Talk To An Experienced Disability Claim Dispute Attorney
At the end of the day, Florida residents who have been denied disability benefits will benefit from talking to an experienced Florida disability lawyer. An experienced Florida disability dispute attorney can provide invaluable guidance and representation throughout your entire disability claims process.
With their help, you can better understand why your claim was denied, explore all potential appeal options, and fight for the benefits you deserve. If you have been denied disability benefits in Florida, don’t hesitate to contact Herman & Wells.
Our disability dispute attorneys strive to provide clients with the best legal support and guidance possible. Call (727) 821-3195 today to schedule a free consultation to learn more about how we can help with your Florida disability dispute claim.