In a recent posting under this website's Frequently Asked Questions (FAQ) section, the following question was asked: What are the trademarks of the right long term disability insurance lawyer? In response to this question, I went on to describe certain characteristics I would look for in an attorney before representing me in a long term disability insurance claim. You can go here to review this question and answer.
Recently, on November 3rd, 2009, the United States Court of Appeals for the Fifth Circuit on appeal from the Southern District of Texas agreed with the lower court and affirmed its decision that the insured failed to exhaust administrative remedies prior to bringing suit.
In a nutshell, the insured had coverage under a long term disability benefits policy issued by Hartford Life Insurance Company which was governed by the Employee Retirement Income Security Act (ERISA). After having received benefits for a period of time, the insurer notified the insured that benefits would be terminated since the insured was cleared to return to work. The policy allowed the insured to appeal within 180 days. The insured hired an attorney who wrote a letter stating that insured ‘intended" to appeal the termination of benefits and requested various documents in hopes of supplementing the record. The insurer did not consider this letter a formal appeal and treated it as such.
Some three and half years later, the same attorney submitted a formal appeal package including medical records and a vocational expert's reports, etc. Since this appeal arrived way past the 180 days appealable period, the insurer rejected the appeal. The insured filed suit and shortly thereafter summary judgment was ruled in favor of insurer. The insured then appealed the decision and the court ruled in favor of the insurer. To read the entire decision, please go here.
It appears from these facts that the attorney representing the insured was not very familiar with ERISA law and how it pertains to long term disability plans. This potentially cost the insured thousands of dollars of lost long term disability insurance benefits. The hiring of an experienced long term disability insurance lawyer is very important.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.If you are receiving disability benefits a private investigator may be following you. Insurance companies have been known to employ "sneaky" tactics to deny disability coverage. One of these tactics includes hiring a private investigator.
The investigator will try to catch you in the act of doing something that doesn't coincide with your disability. This person may park outside your home with a video camera ready to film you participating in an activity that the insurer can use as proof that you are not really disabled. The private investigator might even follow you to the store, your kid's soccer games and other events.
Some insurers will follow up the surveillance with a personal interview. An insurance representative might come to your house in hopes that you will try to play up your disability. He or she will then show you the video footage or pictures. At this point, you could end up saying something that you shouldn't.
It is unfortunate that insurance companies use these tactics, because people who are disabled do not want to be that way and often "overdo it" by trying to participate in the activities they once enjoyed. If you have been the victim of insurance company tactics and have been denied disability benefits, contact a Miami insurance claim lawyer at the law firm of J.P. Gonzalez-Sirgo, P.A. at (305) 461-1095 or toll free at (866)-71-CLAIM.
Many individuals are not able to pay their bills once they become disabled. Long-term disability insurance is designed to provide benefits to people who are disabled and can no longer work. Applying for these benefits can be overwhelming and many valid disability claims are denied. Knowing this information may lead you to ask - should I handle my long-term disability claim myself or hire a Miami insurance claim lawyer?
Disability benefits should be able to provide you with the necessary income to support yourself and your family. Since long-term disability benefits are so vital, it is often advisable to work with an experienced Florida insurance lawyer who can walk you through the entire process to help improve your chances of being approved.
Claims are sometimes denied and you do have the right to appeal. An attorney will be able to help you with the appeal and ensure that the right evidence is presented that will back up your claim.
An insurance lawyer in Miami can provide much needed assistance if your benefits have been delayed or terminated. Insurance companies are known for using tactics to deny or stop benefits, but a knowledgeable disability insurance lawyer will be able to step in on your behalf to make certain that you receive the compensation in which you are entitled.
Contact J.P. Gonzalez-Sirgo at 305-461-1095 or 866-71-CLAIM, for more information regarding your long-term disability claim.
When a policyholder files a disability insurance claim, the disability insurance company has the right to request that you undergo an independent medical exam or IME. In addition, the disability insurance company has the right to review your medical records, pay their own doctor to review your medical records, decide which medical tests to use in evaluating your claim, and hand pick which test results to take into consideration when evaluating your claim. Furthermore, the same insurance company serves as the "administrative board" in claims that are challenged or appealed by policyholders. This is especially true in ERISA type claims. Go here to learn more on ERISA claims.
Well, recently the United States Supreme Court handed down a decision that will begin shifting the balance a little more in the policyholder's direction regarding claims filed under ERISA. In the case, Met Life v. Glenn, the Supreme Court was faced with the following question(s): Can the same insurance company that pays a claim, also be the same entity that decides if payments be made or not? Can this structure or set-up provide a fair review of a claim?
For the first time, the court decided that there is a conflict of interest that exists when reviewing the legitimacy of the claim determination.
This decision was followed by a federal court decision that stated that the independent medical exam or IME is not independent after all.
If a doctor is hired and paid by an insurance company to prepare an "impartial review" of the insured's medical records how can this be a true impartial analysis of the medical records when the doctor is literally on the insurance company's payroll.
Due to the U.S. Supreme Court's ruling, it will be interesting to see how other lower level courts decide on similar issues. Stay tuned.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
Long-term disability insurance should be part of everyone's financial planning. It protects you and your family in the event you are unable to work due to an illness, injury or other medical condition. To the surprise of disability insurance policyholders, the claim's process can be riddled with complexities that exist to stymie claims and benefit payments. Below are a few tips to consider when filing a long term disability insurance claim:
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
According to the Council for Disability Awareness (CDA), surprisingly the recession has not increased disability insurance claim filings. It is important to note that CDA member firms represent over 75% of the commercial disability insurance marketplace, creating a solid base for gauging disability insurance claim trends. Based on CDA's 2008 survey of member firms, there were 573,500 disabled individuals receiving long term disability insurance payments. This was only a 1.5% increase over 2007's results. In addition, 156,000 new disabled individuals were approved for long term disability benefits during 2008, while 147,745 stopped receiving long term disability benefits for one reason or another. In total, CDA member firms paid out $7.9 billion in long term disability insurance payments during 2008. Obviously it is difficult to ascertain the exact reasons why the recession has not increased long term disability claims. Historically, past recessions have proven disability claims increase. However, it is believed that one reason claims are flat during the current economic downturn is that employees are ever more fearful that if they go on disability leave, their jobs will not be around when they are able to return to work.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
According to the Council for Disability Awareness (CDA), a non-profit organization whose goal is to inform and educate the public about disability trends and the economic impact it creates. CDA member firms represent over 75% of the commercial disability insurance marketplace. Based on its annual long term disability claims review, the 2008 survey exposed some interesting statistics.
CDA member firms reported that 95% of disability claims were not work related, the incidence and duration of individuals filing and staying on long term disability is flat or declining, new cancer, nervous system related and cardiovascular/circulatory, AIDS and musculoskeletal/connective tissue disorders are all declining or trending down. During 2007 and 2008, the primary causes of long term disability insurance claims included musculoskeletal/connective tissue disorders, cancer and cardiovascular/circulatory problems. Currently, musculoskeletal/connective tissue disorders account for 22.8% of all new claims filed, followed by cancer (13.7%), injuries & accidents (10%), maternity-related (8.7%), cardiovascular/circulatory (8.5%), mental disorder/psychiatric (6.4%), nervous system-related (5.8%). Other claims made up 24.1% of all new claims filed.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
Last month, a federal judge ruled in favor of an individual in a lawsuit filed against First Unum Life Insurance Company. In doing so, the claimant was granted long term disability insurance benefits retroactively beginning in 1995. In addition, it was discovered that Unum operated under a conflict of interest by not only acting as the claim benefits payer, but also the claims administrator. The claimant in this case was insured through a disability policy purchased by his employer and later under a conversion policy. Initially, Unum denied coverage citing that the policy had terminated and the conversion policy did not apply because the allowable time for filing a claim had expired. Unum unsuccessfully argued this point and in addition argued that the claimant should not be entitled to benefits because the claimant had tried to return to work during this time period. However, the attorneys for the claimant successfully argued that the attempted effort to return to work was involuntary due to his financial situation. The court agreed.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.According to the National Association of Insurance Commissioners (NAIC), the number one complaint logged by state insurance regulators is policyholder's dissatisfaction with their insurance companies' handling of their claim payments. This includes claims delays, claim denials and low ball settlement offers. Disability insurance ranked highest in the type of insurance category, while life insurance ranked in the lowest insurance type category.
Because of this, it's important for those searching to buy any insurance, especially long term disability insurance, to check out the insurance company's complaint record with their state insurance regulator's office. This is especially true if the company you are considering is small or lacks in the reputation arena. In Florida, you can go here to check the complaint history of the insurance company you are considering.
In addition, it is important for policyholders to have a mechanism to file complaints against their insurance company. Filing a complaint against your insurer may result in your state's insurance regulator applying additional pressure to the insurance company regarding your claim. In Florida, if you find yourself in the unfortunate situation where you must file a complaint against your insurer, you can go here.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
When you file a long term disability insurance claim, your disability insurance company will assign a "case manager" to your disability claim. The case manger will act as your point of contact for the disability insurance company. Initially, the case manager will be friendly, helpful and seem very nice. Don't be fooled. Case managers are trained to extract information from claimants that will later be used against you when denying your claim. When filing alone, claimants have the tendency to get comfortable with their case manager. The reality is that case managers are trained to find reasons to deny your disability claim, not help you get your disability claim approved. Remember, disability insurance companies are interested in protecting and increasing their profits, not paying out monthly disability insurance benefits.
The best approach to use against case managers is to think carefully before answering their questions. Case managers are trained to carefully question claimants on the merits of their disability application. If you are contacted by the case manager on the spur of the moment and are not prepared to answer questions, be courteous and ask the case manager to contact you at a more appropriate time. Alternatively, you may obtain his or her direct line so you may contact the case manager at a later time when you are better prepared to answer questions.
By following this advice, you will be better positioned to deal with your case manager and avoid hampering your disability claim.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
Human resource managers need to do a better job of selecting a group long term disability insurance plan for their employees. A disability insurance policy can save an employee from financial ruin. Because of the importance of such a policy, human resource managers need to pay special attention to the fine print of the plan, particularly, the policy's definition of disability. The "own occupation" versus "any occupation" definition can determine your employees' ability to collect disability benefits.
Under the "own occupation" definition, an employee may become eligible for disability benefits if the employee becomes unable to perform the specific duties of his or her job at the time of the disability. Under the "any occupation" definition, an employee would have to be unable to perform the material duties of any occupation for which he or she is qualified to perform based on past experience and training. As you can see, this can mean the difference between receiving disability benefits or not. If an employee has an "any occupation" policy, the employee will have to prove that not only can he or she not perform the specific duties of their job at the time of disability, but is also unable to perform the material duties of any occupation that he or she may be reasonably suited for based on experience and training. Obviously, under this policy type the potential for denial of your employees disability claim is greater. The ability of an insurance company to dispute a claim if an employee is able to work in some other job based on experience or training increases compared to the "own occupation' policy.
Some other plan areas to dissect include coverage length and definition of employee compensation for disability benefits calculation purposes.
By making sure you understand the group long term benefits plan you are proposing to your employees you can avoid minimizing disputes and unfulfilled expectations when one of your employees files a disability claim.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
City, county, state and federal employees are government employees. Government employees are considered public employees. Public employees enjoy many benefits, including participation in a government sponsored retirement pension plan, but there is one other great benefit you may not be aware of. Your long term disability insurance claim is exempt from the Employee Retirement Income Security Act (ERISA) which governs employee benefit plans. ERISA is an arcane federal law which is complicated and ambiguous and affords less protection to employees than Congress intended when it passed the act in 1974. Under ERISA, the deck is stacked against the employee when filing for long term disability insurance benefits. Therefore, as a public employee your long term disability insurance claim is considered non-ERISA.
As a non-ERISA claim, your claim is treated similarly to that of an individual who went out into the open market and purchased a private long term disability insurance policy. This is important because your legal rights are affected for the better since you are afforded more favorable consumer protection laws. If you should become disabled due to sickness or injury and are unable to perform the material and substantial duties of your occupation, you can file for long term disability benefits. If your claim is denied, you are entitled to bring suit for breach of contract in state court, have a jury trial, bring new and additional evidence into trial, recover attorney's fees, and sue for bad faith and punitive damages.
In essence, the difference between having your claim handled under non-ERISA vs. ERISA provisions can mean the difference between having your long term disability insurance benefits granted or denied. As a public employee in the local, state or federal government, you have this added benefit.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective if the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, termination, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
Statistics show that nearly 70% of long term disability claims are denied. Studies also show that an individual not represented by an experienced disability attorney is six (6) times more likely to be denied long term disability benefits. The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents professionals in various occupations that have had their long term disability insurance claim benefits denied or abruptly terminated. Common reasons for denial and termination of benefits include, but are not limited to:
Professionals we can assist include:
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective if the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, termination, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
Total disability is defined in your disability insurance policy. This definition can vary from policy to policy. Three commonly used definitions include own-occupation, modified own-occupation and gainful occupation.
Own-occupation is the most flexible definition of total disability for the insured. If the insured is unable to perform the material and substantial duties of his or her occupation at the time you become disabled, the disability insurance company will pay the claim even if you are working in some other capacity or employment that is not similar to your occupation.
Modified own-occupation is also referred to as income replacement insurance and is the most widely used definition of total disability in policies today. Under this definition, a disability insurance company will pay your claim if you are unable to perform the material and substantial duties of your occupation and you are not working in any other occupation.
Gainful occupation is the most restrictive definition and the most commonly used by employer group long term disability policies. Under this definition, a disability insurance company will pay your claim if you are unable to perform the material and substantial duties of your occupation, or any occupation for which you are deemed reasonably qualified by education, training or experience.
Residual disability is defined in your disability insurance policy. Residual disability is also referred to as partial disability. This definition can vary from policy to policy. Two commonly used definitions include loss of income and loss of time/duties.
Loss of income is when you have suffered a residual disability and can still perform the material and substantial duties of your occupation, but you have suffered a loss of income of at least 20%. The disability insurance company will stop paying your claim when your loss of income is less than 20%.
Loss of time and duties is when you have suffered a residual disability and can still perform the material and substantial duties of your occupation, but you have suffered a loss of time and duties. The disability insurance company will stop paying your claim when you are back to working full-time.
It is important to know and understand how total disability and residual disability are defined in your policy. Before deciding to purchase a long term disability policy, ask how total and residual disability is defined.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective if the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, termination, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
It is not uncommon for an individual whose long term disability benefits have been wrongfully denied, terminated or delayed to attempt to personally resolve the matter on their own. But, when these efforts are exhausted, some simply choose to "give up." Exactly what disability insurance companies want! The remainder may choose to protect their rights and seek legal representation. Exactly what disability insurance companies do not want! But what happens if after calling a few attorneys and explaining your situation, you are told "sorry, can't help." My advice - do not give up.
Disability insurance law is not an area of law many attorneys practice. In addition, disability insurance law is not an area of law an inexperienced attorney can all of a sudden learn overnight. This is due to the fact many long term disability policies were issued through an employer group plan and such policies are governed through ERISA (Employer Retirement Income Security Act), a complicated federal law enacted in 1974. Individual policies are governed by state law, including insurance bad faith laws, which can further complicate matters. Therefore, it is not uncommon for an individual who needs legal representation with their long term disability insurance claim to find attorneys unable or unwilling to help. If you are in a situation whereby other attorneys have told you "sorry, can't help" please do not give up.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective if the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, termination, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
In the U.S., obtaining long term social security disability benefits is difficult. In fact, government statistics show that the approval rate is approximately 35%. Obtaining long term disability benefits from a private policy or employer based group plan is just as difficult if not more difficult where an estimated 70% of claims are denied. As a matter of fact, an individual may get their social security disability claim approved, but get denied on their private or employer group plan disability claim.
Common denial reasons include:
In addition, if you eventually do obtain long term disability benefits, hanging on to those benefits is a challenge in and of itself. Disability insurance companies routinely terminate, cancel or cut-off disability benefits due to various reasons, sometimes years after approval.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective if the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, termination, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
Long term disability insurance companies have the right to sue policyholders for all disability benefits ever paid out if policyholder fraud or other violations exist. Disability insurance companies will cut-off your benefits and possibly sue for all back payments if their investigations show that you were never really disabled and that you filed a fraudulent application for disability benefits. In addition, if their investigation show you are no longer disabled, they may seek to sue you and recover all payments they have made to you since you became well enough to engage in whatever activity an otherwise disabled person could not possibly do. Examples include working a new job, managing your own business, doing certain household chores, participating in sporting activities, and other activities. Even driving your car, walking your dog and dancing can be construed to mean you are no longer disabled. Disability insurance companies are known to hire private investigators to undertake a thorough investigation and surveillance of policyholders receiving long term disability benefits. This includes secretly visiting your home, videotaping your daily activities, following you, questioning your neighbors, researching if you're currently working or seeking employment, run your own business, or are playing tennis on Saturday afternoons. If you have a MySpace, Twitter or FaceBook account with pictures and comments about your recent ski trip, they will read it and use it against you. Disability insurance companies will use any excuse to cancel your disability payments and sue you to recover all prior payments.
If your disability insurance company has terminated your disability payments and is suing you for a refund of all back disability payments, you should seek experienced legal counsel to help you protect your rights.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective if the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, termination, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
Your long term disability benefit was approved years ago. All of a sudden, you receive a letter from your disability insurance company informing you that effective immediately your monthly disability payments have been permanently terminated. Even worse, you are being sued for all past payments ever made to you, along with lost interest, costs and attorney fees. In addition, they have forwarded your case to local police authorities seeking to prosecute you for insurance fraud. Unfortunately, every day in the U.S. disability insurance companies routinely engage in this sort of behavior to some degree.
Disability insurance companies are known to abruptly cut-off monthly disability benefits after conducting surveillance, including secretly videotaping you doing activities a person with your disabilities could not possibly do. These activities could include doing yard work, playing golf or some other sport, dancing, driving, walking without a cane, etc. Other reasons disability insurance companies use to suddenly cancel disability payments include:
Disability insurance companies conduct secretive investigations into your current life and look for any reason to terminate or suspend your long term disability benefits. Investigators will "Google" your name on the internet, go through your Facebook page, MySpace page, Twitter page, or any other website or blog page you might maintain. Investigators will also search public records, including corporate records and business and professional licenses you may own. Investigators may also follow you, call you or talk with you in hopes of obtaining information that may be used against you in order to cut-off your disability monthly payments.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective if the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, termination, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
The Employee Retirement Income Security Act (ERISA), enacted by Congress in 1974, is a federal law which governs employee benefit plans. Almost all employer group long term disability plans are governed by ERISA.
Statistics show that over 70% of long term disability claims are denied. The hiring of an experienced disability attorney is highly recommended during the appeal stage. When your long term disability claim is denied, you usually have 180 days to appeal from the date you receive the denial letter. You have the right to appeal the denial as per the instructions outlined in your employee benefits plan. The appeal must be in writing and filed with the insurance company. Usually, if your appeal is denied, you may have an opportunity to file a second and final appeal with the insurance company. The appeal process gives you an opportunity to update your medical records. The filing of an ERISA appeal is probably the most important step in the entire claim process. This can be a very difficult task for an inexperienced person to undertake.
As per ERISA, you are required to exhaust all appeals before initiating the filing of a lawsuit. It is very important to know that a federal court may not review any additional material, including witness or physician testimony or prior medical data not previously provided, and will probably be limited to the administrative record at hand. This is why it is important to submit a comprehensive submission of favorable data during the appeal process.
If the filing of a lawsuit is necessary, the suit is brought in federal court with a judge deciding the outcome of the case, not a jury. Typically, the judge reviews the administrative record, memorandums of law, pleadings submitted by lawyers on both sides and issues a summary judgment. In addition, bad faith laws and punitive damages do not apply in ERISA claims.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective if the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, termination, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. helps insurance policyholders recover what they are due on their insurance claims, zealously advocates on behalf of victims of catastrophic personal injuries or wrongful death and fights for the rights of consumers and small businesses in Miami and throughout Florida. If you would like a Free Consultation and Case Evaluation, please fill out the Quick Contact Form to the right or click here and a member of our firm will contact you promptly. You may also contact us directly at (305) 461-1095 or Toll Free at 1-(866)-71-CLAIM.
About The Firm
J.P. has been certified as a life member of the Million Dollar Advocates Forum and the Multi-Million Dollar Advocates Forum. The Million Dollar Advocates Forum is recognized as one of the most prestigious groups of trial lawyers in the United States. Membership is limited to attorneys who have won million and multi-million dollar verdicts, awards, and settlements. Fewer than 1% of U.S. lawyers are members. J.P. has also been awarded the top rating of 10.0/10.0 or "Superb" by Avvo. Avvo's Rating system helps people navigate the complex and confusing legal industry, including choosing the right lawyer - an incredibly important decision. The Avvo Rating system takes into consideration a lawyer's background, including years in practice, disciplinary history, professional achievements and industry recognition.
In addition, the firm maintains an A+ rating with the Better Business Bureau. The firm is highly respected by other lawyers and members of our community and maintains offices in the historic Douglas Entrance complex in Coral Gables, Florida. Please click here for further information regarding office location and directions.
Prior to attending law school, J.P. Gonzalez-Sirgo worked as a claims adjuster for a busy independent adjusting firm in Miami where he handled hundreds of claims. Before founding the law offices of J.P. Gonzalez-Sirgo, P.A., Mr. Gonzalez-Sirgo worked for a prominent insurance defense firm in Miami. He now uses the insight that he gained working for the insurance industry for the benefit of his clients.
Attorney J.P. Gonzalez-Sirgo has built his entire career on protecting the rights of insurance policyholders, personal injury and wrongful death victims and fighting for the rights of Florida consumers and small businesses. The firm has recovered millions of dollars for victims of denied or underpaid insurance claims, victims of catastrophic personal injuries and wrongful death and on behalf of those that have been taken advantage of by Big Business and Big Insurance.
Active Legal Memberships
The Florida Bar
American Association For Justice 
Florida Justice Association
Community & Charitable Involvement
The Law Firm of J.P. Gonzalez-Sirgo, P.A believes that representation of our clients does not stop in the courtroom. We believe in giving back to our community by participating in local charitable events. The firm participates or donates to various local charitable and research organizations. Of special importance to the firm are those organizations that support many of the illnesses, syndromes, diseases, disabilities and aliments that afflict so many of our past and current clients. In addition, J.P. is proud to be a volunteer for Lawyers for Children America (LFCA). As a pro-bono LFCA volunteer lawyer, an opportunity exists to protect the rights of children who are victims of abuse, abandonment and neglect by providing free legal representation and collaborating for systematic change to improve the lives of children.
Free Case Evaluation & Consultation
If you would like a Free Consultation and Case Evaluation, please fill out the Quick Contact Form to the right or click here and a member of our firm will contact you promptly. You may also contact us directly at (305) 461-1095 or Toll Free at 1-(866)-71-CLAIM.
There is never a charge to speak with an attorney at our firm. Unlike other law firms, we are available to come to you at your hospital bed side, home, office or other location throughout the entire State of Florida.
You Pay Zero Attorneys' Fees If No Recovery
We understand that many of our clients do not have the resources or means to pay lawyer fees out of pocket. This is why we offer a free consultation and case evaluation. In the great majority of cases, if we decide to go forward with your case, we will work on a contingency fee basis. This means that if there is no recovery on your claim, you do not pay fees for our services.
If you would like a Free Consultation and Case Evaluation, please fill out the Quick Contact Form to the right or click here and a member of our firm will contact you promptly. You may also contact us directly at (305) 461-1095 or Toll Free at 1-(866)-71-CLAIM.
Se Habla Espanol
For our Spanish speaking clients, please click here for Espanol.
A Message To Insurance Policyholders In Florida
There are numerous challenges facing policyholders attempting to have their life insurance and disability insurance claims timely honored by insurance companies: The delays in investigation of claims, the endless request for documents, requests for sworn statements or examinations under oath, requests for recorded statements, fraud accusations, application issues, material misrepresentation issues, requests for medical evaluations, bad faith insurance issues, and litigation.
In the great majority of cases we will be able to help you with these challenges. Attorney J.P. Gonzalez-Sirgo helps disability and life insurance policyholders recover what they are due on their insurance claims. If you would like a Free Consultation and Case Evaluation, please fill out the Quick Contact Form to the right or click here and a member of our firm will contact you promptly. You may also contact us directly at (305) 461-1095 or Toll Free at 1-(866)-71-CLAIM.
A Message To The Victims of Catastrophic Personal Injuries or Wrongful Death
There are numerous challenges facing victims of catastrophic injuries and wrongful death in their pursuit to obtain a full measure of justice from those doing wrong.
The good news is that in the great majority of cases we will be able to help you with these challenges. Attorney J.P. Gonzalez-Sirgo zealously advocates on behalf of victims of catastrophic personal injuries or wrongful death. If you would like a Free Consultation and Case Evaluation, please fill out the Quick Contact Form to the right or click here and a member of our firm will contact you promptly. You may also contact us directly at (305) 461-1095 or Toll Free at 1-(866)-71-CLAIM.
A Message To Our Referring Public Adjusters
We understand and appreciate the value a Pubic Adjuster brings to a property insurance claim. For years, we have worked side-by-side with Public Insurance Adjusters and their respective clients in helping to resolve any claim issues through our legal representation.
Public Adjusters recognize that sometimes a client's difficult insurance claim requires the need for aggressive legal representation. Experienced public adjusters recognize all of the obstacles presented by an insurer during a challenging claim. The Law Firm of J.P. Gonzalez-Sirgo, P.A. routinely works with clients that have retained the services of a Public Adjuster. We prefer to work together as a team consistent with the best interests of the client's claim. During the claim's process, we seek to keep all members of the team in the loop and engage your advice and services whenever necessary. All efforts put forth by our law firm and your adjusting firm will always be in the best interest of our mutual client.
We also work with corporate counsel and corporate risk managers to resolve any insurance claim disputes.
If you would like a Free Consultation and Case Evaluation, please fill out the Quick Contact Form to the right or click here and a member of our firm will contact you promptly. You may also contact us directly at (305) 461-1095 or Toll Free at 1-(866)-71-CLAIM.
A Message To Our Referral Attorneys
For years, the Law Firm of J.P. Gonzalez-Sirgo, P.A. has been welcoming attorney referrals from our colleagues. Many of our clients come to us as a result of referrals from other attorneys, including from out of state lawyers and lawyers from other countries, who know of our success in handling insurance claims litigation. We encourage and welcome these co-counsel opportunities and routinely pay referral fees in accordance with the rules regulating the Florida Bar and Florida law. Over the years, we have paid hundreds of thousands of dollars in referral fees to our referring attorneys. We recognize the trust placed in us by our referring attorneys and so we make sure that our referring attorneys are kept in the loop throughout our representation, from the initial intake through the conclusion of the case.
To discuss a case with us, please call (305)-461-1095 or Toll Free 1-(866)-71-CLAIM. Alternatively, you may click here and fill out our "Contact Us" form and an attorney at the firm will contact you promptly.
Serving Florida & Our Local Communities
J.P. Gonzalez-Sirgo, P.A. provides experienced legal representation for individuals and businesses throughout Florida and Miami Dade County, including Aventura, Bal Harbour, Carol City, Coral Gables, Doral, Florida City, Golden Beach, Hialeah, Hialeah Gardens, Homestead, Kendall, Key Biscayne, Medley, Miami, Miami Beach, Miami Lakes, Miami Gardens, Miami Shores, Miami Springs, North Bay, North Miami, Opa Locka, Pinecrest, South Miami, Sunny Isles Beach, Surfside, Sweetwater, Virginia Gardens, West Miami, Westchester, all of the Florida Keys communities, and Broward and Palm Beach Counties. Covering all of South Florida. Attorney J.P. Gonzalez-Sirgo is admitted to practice in all of the Federal and State courts in Florida, from the Florida Keys to Florida's Panhandle.
Disclaimer
The use of this Website or use of our "Contact Us" form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship and does not constitute legal advice. Time-sensitive or personal confidential information should not be sent through the "Contact Us" form. You are not forming an official attorney-client relationship with the Law Firm of J.P. Gonzalez-Sirgo, P.A. or its attorneys unless and until you have signed a written retainer agreement with this law firm. Submission of the "Contact Us" form does not create a written retainer agreement. If you would like to enter into a written retainer agreement with the Law Firm J.P. Gonzalez-Sirgo, P.A., please call (305)-461-1095 or Toll Free at 1-(866)-71-CLAIM.
The accounts of recent trials, verdicts, and settlements contained in this website are intended to illustrate the results of my work ethic and experience. Of course, each case is unique and the results in one case do not necessarily indicate the quality or value of any other case.
J.P. Gonzalez-Sirgo, P.A.
Douglas Entrance
804 Douglas Road
Suite 373
Coral Gables, FL 33134
Phone: (305) 461-1095
Fax: (305) 461-1096
Toll Free: (866) 71-CLAIM
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