Florida Disability Disputes Attorneys

• Mandatory Appeals: ERISA has rules and regulations that require mandatory appeals before filing lawsuits. This means you must go through the appeal process with the insurance company before taking any legal action.
  • Most of the time, evidence that is not submitted during the appeal process will not be considered in the lawsuit. This makes the appeal process critically important for the success of your claim.

• Federal Court Filings: ERISA lawsuits must be filed in Federal Court. This is a crucial distinction as it affects how your case is handled and the legal procedures involved.

• Judge Determinations: ERISA cases are determined by a judge, not a jury. There most likely will not be a trial, and the judge will make their ruling based on written submissions from both parties.

• Change in employer definition for disability eligibility (i.e. could change the requirement from your “own occupation” to “any occupation” or “any gainful occupation”)

• Pre-existing conditions not covered

• The insurance company’s Doctor says the person no longer qualifies as disabled

• The insurance company feels a person has failed to follow the treatment plan

• The information your Doctor filled out on a form. Most Doctors are confused by insurance forms (insurance companies invest heavily in order to develop forms that are misleading or only have limited response options for doctors.)

Unfortunately, with disability insurance policies, the deck is stacked in favor of insurance companies. The rules and laws favor insurance companies and their doctors. But that does not mean there is nothing you can do.

Those same rules also set certain procedures they must follow. However, the insurance company does not have to tell you what those rules and procedures are and how to implement them. That is why you need an experienced attorney fighting on your side.

You need to get a copy of the disability policy. This is the rule book, and you can’t win the game if you don’t know the rules. Under ERISA, your employer is required to provide you with a copy of the policy when you ask. Although you can ask the adjuster handling your case for it, they often do not provide it. Always ensure you have this document to understand your rights and obligations.

Do not trust the adjuster handling your case to obtain all your medical records. The best way to avoid a denial is to gather your medical records yourself and send them directly to the adjuster. In most disability policies, it is YOUR responsibility to send in the medical records. Do not rely on the adjuster or your doctor’s office to coordinate this.

If the adjuster tells you they are waiting for something from your doctor, ensure you get a copy of the records or completed form and send it to the adjuster yourself. Adjusters often claim they do not receive faxes from doctor’s offices, even when the patient has witnessed the documents being sent.

Always confirm your conversations with the adjuster in writing. Email is the best method for this. Often, the adjusters’ notes on phone conversations can be taken out of context or misrepresent what was actually said. Keeping a written record helps ensure accuracy and accountability.

To obtain your medical records, you can use a HITECH form to get your records for free or for less than $10.00 per request. You can find a HITECH form here. Alternatively, you can use a service like Sync.MD, which uses HITECH forms to gather records and stores them in one place, allowing you to view and send them from your phone. There is a cost associated with this service.

Maintaining a daily journal of your symptoms and issues can be invaluable. There are many symptom journal apps available for your phone. Choose one that allows you to report on your condition, provides a report or summary of your entries, and enables you to download the reports for sharing with your doctor and/or the insurance company. Be mindful that many free versions may not offer these features.