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Facing a disability dispute can be overwhelming. If you’ve been denied access to the benefits you deserve from a group disability insurance policy you have through your work, you don’t have to appeal alone.
At Herman & Wells, our disability attorneys, led by Bill Demas, are here to help. With over 20 years of expertise in handling ERISA and first-party disability disputes, he brings both knowledge and compassion to every case.
Don’t let the complexities of ERISA disability law deter you from pursuing your claim. Contact Herman & Wells today for a free initial consultation with a Florida disability dispute lawyer. Let us show you what kind of difference we can make. Call (727) 821-3195 or use the contact form on this page to request your complementary consultation with one of our attorneys.
Unless you work for the government or a religious organization, group disability insurance policies provided by an employer are governed by a law called ERISA (the Employee Retirement Income Security Act).
At Herman & Wells, our experienced Florida disability dispute attorneys are here to guide you through each step of this complex process, ensuring your case is handled with the expertise and attention it deserves.
Disability insurance companies’ adjusters act like they are on your side until you get word that they denied your claim. This denial will leave you confused, upset, and scared. The reasons for the denial can range from the fact that the insurance company claims it did not get the right information from you and your doctors to the fact the adjuster determined that you are not disabled.
Some common reasons for claim denials are:
Insurance adjusters seem supportive initially but are not working in your best interest. They are working in the best interest of their employer and trying to increase the company’s bottom line at the expense of you and your family. What the adjuster fails to tell you is they have never been working in your best interest, even though the law tells them they have to.
The adjuster will tell you that you can appeal the denial and that it is an easy process. They do not tell you the appeal process is complicated and is one of the most important stages of a disability claim. A claim for disability is won or lost in the appeal even before you have a right to file a lawsuit.
Under ERISA, the insurance company must give you the right to file at least one appeal. That means you must file an appeal before you can file a lawsuit. The appeal allows you to correct any mistakes or supplement any evidence to prove your claim.
The insurance company must give you 180 days from the date of its denial letter to appeal. Use this time wisely. Gather all the medical evidence and other evidence you believe proves your case.
Do not just send in a letter that says, “I APPEAL,” and trust that the adjuster will get the evidence to prove your case—they will not.
Once you file your appeal, the insurance company has 45 days to make a claim decision. They can extend that time by another 45 days if they have good cause and notify you before the first 45 days expire.
Make sure you respond to all the insurance company’s requests quickly. If the insurance company sends you a form to fill out, by regulation, that request stops or tolls its 45 day period until you respond. This also applies to requests they make to your doctors. You must work with your doctor to have the information sent quickly to the insurance company.
The appeal process is the most important part of the claim for disability insurance benefits. Once the appeal is denied, adding additional evidence after filing a lawsuit is most likely impossible. Therefore, it is essential to consult with a Florida disability dispute attorney to assist you with your appeal.
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 disability dispute lawyer in Florida fighting on your side.
Navigating the complexities of insurance disability claims can be challenging. Here are some tips from Florida attorney Bill Demas to help you manage your claim effectively and ensure you have the best chance of success.
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.
It does not matter what you tell your doctor; what matters is what your doctor documents in your medical records. Make sure you review your doctor’s records to verify that all your complaints are noted and that the records are accurate. Doctors can make mistakes, and with electronic medical records, it is easy for doctors to copy and paste findings.
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.
An experienced attorney in Florida is crucial because they understand the complexities of ERISA disability law and can navigate the appeal process effectively. They will fight for your rights and help you secure the benefits you need.
Don’t let the complexities of ERISA disability law deter you. Contact Herman & Wells today for a free initial consultation and let us show you what kind of difference we can make.
Call (727) 821-3195 or use the contact form on this page to request your complimentary consultation with a Florida disability dispute lawyer. Our team is committed to helping you achieve the justice and compensation you deserve.
