Frequently Asked Questions and Answers

  • Page 6
  • Do long term disability insurance companies treat Bipolar Disorder under the policy's two-year limitation on mental and nervous disorders?

    Yes, currently all long term disability insurance companies treat Bipolar Disorder as a mental disorder and limit benefits to the 24 month limitation time period.  However, currently there is a class action lawsuit asserting that Bipolar Disorder is a biologically based illness that does not come under the definition of mental disorder in the policy. 

    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.

  • I filed for long term disability and my insurer approved my claim, but under the mental and/or nervous provision of the policy. Why is this if this condition is physical rather than a mental/nervous disorder?

    Disability insurance companies have been known to approve an insured's claim, but under the mental and/or nervous disorder provision of the policy in order to cap benefits under the policies 24 month benefit limitation clause.  At the expiration of the 24 month limitation provision, the insured's benefits are terminated. 

    If you feel your disability was improperly classified as a mental or nervous disorder under the cap limitations provision of your policy, you should seek an experienced long term disability insurance lawyer immediately.  

    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.

  • How is my treating doctor involved with my disability claim?

    Besides treating you for your disability, your doctor will be playing an active role in your disability claim, both during and after your claim is approved.  During the pendency of your claim, your doctor will be documenting and reporting on your disability to your disability insurance carrier.  If your claim is approved, your doctor will have to routinely provide updates to your disability company by completing forms provided by your disability company.  The form takes only a few minutes to complete, but some doctors are known to charge a relatively high fee for completing this form every month.

    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.

  • I was approved for long term disability benefits, but my disability insurance company is requesting a "medical recertification." What is this and must I submit to this request?

    Most long term disability insurance policies contain a provision that if your benefits are approved, as a condition for continuing to receive benefits, you must submit to a medical recertification process every year.  This means that once a year, you must undergo a re-evaluation of your medical condition if you want to continue receiving benefits.  

    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.

  • During my annual medical recertification evaluation, my doctor noted that my disability has dissipated and that I am now able to go back to my job or some other job. Can my benefits be cut-off or terminated based on my doctor's indications.

    Absolutely.  If your doctor has indicated in your annual medical recertification evaluation that you have regained your ability to work in your job or any gainful job for that matter, your benefits may cease.  It will depend on the definition of disability in your policy.

     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.

  • I received a call from my disability insurance company' "Case Manager." Who is this?

    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 with 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.

  • In your representation of clients, what are some of the more common disability or medical conditions encountered?

    Below are just some of the disabilities or medical conditions that may entitle you to disability benefits:

    • Acoustic Neuroma
    • Agoraphobia
    • AIDS
    • Anxiety Disability
    • Bell's Palsy
    • Bi-Polar Disorder
    • Cancer
    • Cardiac Impairment
    • Cardiogenic Syncope
    • Carpal Tunnel Syndrome
    • Cervical or Lumbar Radiculopathy
    • Chemical Imbalance
    • Chemical Sensitivity
    • Chiari Malformation
    • Chronic Fatigue Syndrome ("CFS")
    • Chronic Heart Failure
    • Chronic Pain Syndrome
    • Chronic Stress
    • Complex Regional Pain Syndrome (CRPS)
    • Congestive Heart Failure
    • Coronary Dysfunction
    • Crohn's Disease
    • Degenerative Disc Disease
    • Demyelinating Disease
    • Depression
    • Dercum's Disease
    • Diabetes
    • Failed Back Syndrome
    • Fibromyalgia
    • Hepatitis C
    • High Blood Pressure
    • Human Immunodeficiency Virus (HIV)
    • Interstitial Cystitis
    • Lupus
    • Lyme Disease
    • Menieres Disease
    • Migraine Headaches
    • Multiple Sclerosis
    • Myofascial Pain Syndrome
    • Nervous Disorders
    • Osteoarthritis
    • Post-Traumatic Stress Disorder ("PTSD")
    • Primary Biliary Cirrhosis
    • Reflex Sympathetic Dystrophy ("RSD")
    • Restless Leg Syndrome
    • Retinitis Pigmentosa
    • Rheumatoid Arthritis
    • Schizophrenia
    • Seizure Disorder
    • Sleep Apnea/Sleep Disorder
    • Temporal Lobe Phenomenon
    • Thoracic Outlet Syndrome
    • Ulcerative Colitis
    • Vestibular Dysfunction
    • Many Other Medical Conditions

    Disability conditions encompass a wide range of medical conditions which may qualify you for long term disability benefits.  Please contact our office to discuss your case in more detail.

    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.

  • What is the administrative appeals process for my private individual long term disability policy?

    Only by reading your disability policy can one determine the exact administrative appeals process for your specific policy.  Individual long-term disability plans, those not covered by ERISA, are governed by the statutory and common law of the state in which the policy is issued. Each policy should outline the appeals process for disputing long-term disability claim denials. If your insurer has a specific appeals process, you need to abide by those rules. When you sign a contract for long-term disability insurance, you are agreeing to the terms, which include the appeals process.

    If you have been denied long-term disability benefits, your insurer should have explained the reason for denial in writing. If not, you can also contact the claims manager by drafting a letter that requests the exact reason for the claim denial.

    If your claim has been denied, you may not have to file an administrative appeal.  Instead, you may be able to file a lawsuit without exhausting your administrative remedies. 

    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.

  • What are some of the common disability insurance companies your firm represents clients against?

    Below are just some of the disability insurance companies that we can represent you against:

    • Aetna Insurance
    • American Insurance Group
    • AIG
    • Assurant
    • AXA Insurance
    • Berkshire Insurance
    • CIGNA
    • CNA
    • Colonial Life Insurance Company
    • Continental Casualty Company
    • Equitable
    • First Unum
    • Fortis
    • Genworth Financial
    • Guardian
    • Hartford Life
    • Horace Mann
    • ING
    • Jefferson Pilot
    • John Hancock Insurance Company
    • Liberty Mutual
    • Life Insurance Company of America
    • Lincoln Financial Group
    • Mass Mutual
    • Met Life
    • Metropolitan Life
    • Monarch Life Insurance Company
    • MONY
    • Mutual of Omaha
    • National Life
    • New England Disability and Life
    • New York Life
    • Northwestern Mutual Life
    • Paul Revere
    • Penn Life
    • Penn Mutual
    • Provident
    • Prudential Life Insurance
    • Reassure America
    • Reliance Standard
    • Reliastar
    • Security Mutual
    • Standard Insurance
    • Sun Life Financial
    • Swiss RE
    • The Hartford
    • Trustmark
    • Unum
    • Unum Life
    • UnumProvident
    • UnionMutual
    • Zurich
    • Any Other Disability Insurance Company

    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.

  • I have a short term and a long term disability insurance policy. My short term disability insurance claim has been denied, does this mean my long term disability insurance claim will also be denied?

    Many claimants have their short term and long term disability policies with the same disability insurance company.  If your insurer denied your disability claim under your short term disability policy, they will most certainly deny your long term disability claim.   It is imperative that upon denial of your short term disability claim, you seek experienced legal counsel to represent you in the denial of your claim.  By reversing the denial of your short term disability claim, you will have a much stronger chance of obtaining long term disability benefits as well.

    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 I'm not represented by an experienced disability insurance lawyer, will my disability insurance claim be denied?

    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.  Common reasons for denial and termination of benefits include, but are not limited to:

    • Any occupation clause,
    • Own occupation clause,
    • Fraud,
    • Residual disability,
    • Zero disability,
    • Disability has abated,
    • Pre-existing condition,
    • Many other reasons.

    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.

  • Who is your firm's typical disability insurance claim client?

    The firm represents people from all walks of life.  The firm represents individuals with privately owned long term disability policies to employees covered under employer group long term disability plans (ERISA).   

    Professionals we can assist include:

    • Physicians
    • Dentists
    • Nurses
    • Chiropractors
    • Surgeons
    • Accountants (CPAs)
    • Pharmacists
    • Optometrists
    • Engineers
    • Architects
    • Contractors
    • Real Estate Developers
    • Lawyers
    • Corporate Executives
    • Business Managers
    • Banking and Financial Executives
    • Business Owners
    • Professors
    • Teachers
    • Other Professionals

      Government Employees:

    • City, County, State, or Federal Employees
    • College and University Employees
    • Firefighters,
    • Police Officers,
    • Paramedics,
    • County Teachers,
    • All government employees

    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.

  • What is the difference between an employer group disability policy and a private individual disability policy?

    An individual long term disability policy is simply a privately purchased policy.  You, and not an employer, made the personal effort of shopping for a long term disability policy.  The policy was sold directly to you by either the disability insurance company or through an insurance broker.  As part of your disability insurance application process, you might have undergone a medical evaluation, including blood tests, blood pressure, urine samples, etc.  Your monthly premium is paid directly by you and is not deducted from your employment paycheck.  The policy was not issued through your employer as part of the employer's benefits package.  An employer issued disability policy or group policy is simply a policy provided to employees as part of an employer group benefits plan.  You are enrolled into the plan automatically and all premiums are paid by your employer or premiums are deducted directly from your employee paycheck.  Different variations exist. 

    The main difference between individually purchased vs. employer issued policies are the specific laws and intricacies that govern the wrongful denial, delay or termination of valid claims.  Individual disability policies are governed by state law.  Disability employer group policies are usually governed by ERISA, a federal law enacted 1974. 

    Individually purchased policies have more favorable consumer laws, including a faster appeals process (if any), bringing suit in state court and suing for bad faith.  Trial by jury is allowed.  Employer group disability policies have less favorable consumer laws, have a lengthier appeals process, and suit must be brought in federal court with a federal judge deciding the outcome of the case.  In addition, trial by jury is not allowed and witness and physician testimony may not be allowed.  Furthermore, ERISA is a complicated federal law most attorneys are just not knowledgeable, experienced or skilled at interpreting or handling.   

    Another very notable and important difference is how disability is defined.  With an individual disability policy, one can purchase a policy that provides own-occupation coverage which pays disability benefits even if you are working in another job that was not your own-occupation at the time you became disabled.  Most employer group long term disability insurance policies define disability as your inability to obtain any gainful occupation.  This means that in order to obtain disability benefits you must not only be unable to perform your own occupation, but also any other occupation for which you are qualified by education, training or experience.  This is a much more restrictive and inflexible policy as compared to an individual policy.

    Residual or partial disability is treated differently under both plans.  Under an individual policy, residual disability may be paid up to age 65.  This means that if you are partially disabled, you may still receive disability benefits.  Under an employer group plan, residual disability may not be covered at all and some may pay for up to 2 years only.  Therefore, if you are partially disabled under an employer group plan, you may not be covered at all in the event you are partially disabled. 

    Mental and nervous disabilities are treated differently as well.  With an individual policy you can purchase a plan that covers mental and nervous disabilities like any other disability and are covered without any time restrictions, including for drug and alcohol addictions.  Employer group plans cover mental and nervous disabilities for up to 2 years maximum and usually will cover drug and alcohol addictions for no more than one year.

    Covered income is also treated differently.  An individual policy will cover your earned income as reported on your federal tax return, which will include bonus, commissions, tips and other profit sharing income.  Employer group plans will only cover your base salary, which will not include bonus, commissions, tips and other profit sharing income.  Therefore, if you are a company executive and the majority of your earned income is made up of bonus and stock options income, you may be covered for much less than you think. 

    Even the taxation is treated differently under federal income tax rules.  With an individual policy, any disability benefits received are tax free.  With an employer group plan that pays your policy premiums, any disability benefits received are taxed as ordinary income.  Therefore, if your policy covers up to 60% of your lost income you really earn less when federal tax rates are applied.

    Other differences include portability issues, maximum limits on disability payments received and other important factors.

    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.

  • Can I collect a monthly check on my long term disability policy and continue to work?

    Collecting long term disability benefits while simultaneously working a full time job that affords you the luxury of collecting a paycheck might seem contradictory to the layperson.  It might also seem fraudulent to some.  The truth of the matter is that it is possible and it is totally legal.

    Having the ability to collect both a paycheck and long term disability benefits concurrently will depend on the legal language in your disability policy.  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.  Modified own-occupation and gainful occupation disability policies will usually disallow such a scenario.  A disability policy with own-occupation language may not.

    Own-occupation is the most flexible definition of total disability for an insured.  If the insured is unable to perform the material and substantial duties of his or her occupation at the time of disability, the disability insurance company will pay the claim even if you are working in some other capacity or employment.  However, this new or other occupation must not be identical or even similar to the occupation from which you are claiming disability.  Moreover, some own-occupation policies are not "genuine" own-occupation policies and may prevent you from collecting a paycheck in addition to your long term disability benefits.  Therefore, the disability policy should be read from cover to cover to prevent disability benefits from being terminated.

    In essence, under the terms of an own-occupation disability policy, the inability to perform the material and substantial duties of your occupation will entitle you to long term disability benefits, notwithstanding your ability to work in some other occupation.

    A classic example is when a physician surgeon is unable to perform the material and substantial duties of the surgical procedures and due to sickness or injury files for long term disability benefits.  The claim is approved and the physician surgeon now resorts to physician office work only, such as patient consultations.  In this new line of work, the physician might generate $500,000 during the first year, despite drawing $25,000 per month in long term disability benefits.  There are countless examples of such scenarios that apply to many occupations.

    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 Claims Filing Tips

    Filing for long term disability insurance benefits can be daunting.  Estimates indicate that approximately 70% of long term disability insurance claims are denied.  In addition, those that are approved stand a good chance of being denied down the road.  

    For those individuals who need to apply for long term disability insurance benefits, below are some tips to follow:

    • Read your complete long term disability insurance policy, from cover to cover, including any riders or endorsements.
    • Determine if your long term disability insurance policy is an individual policy or an employer group plan governed by ERISA.
    • Organize and gather all medical records, including lab tests, physician reports and opinions supporting your disability.
    • Know and understand why your disability prevents you from doing your job or any other job.
    • Promptly file your disability claim. Fill out the disability application completely and truthfully. Add additional sheets if necessary. Follow all insurance company requests.
    • Be prepared to file all supporting evidence initially, not later as an amendment.
    • Understand that you may be placed under secret video surveillance.
    • Follow up after filing your claim. Follow up your telephone communications with a written letter. Keep detailed communication records, including person spoken to, date, time, matter discussed, and conclusion of conversation.
    • If your claim is denied, know and understand your appeal rights, including important timeframes and deadlines.
    • Know your insurance company's or employer group plan administrator's deadlines.

    You can reach Miami Long Term Disability Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

  • What Is An Administrative Appeal Under An ERISA Long Term Disability Insurance Policy?

    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 insurance plans are governed by ERISA.   

    Statistics show that over 70% of long term disability insurance claims are denied.  The hiring of an experienced long term disability insurance claims attorney is highly recommended during the appeal stage.  When your long term disability insurance 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.

    You can reach Miami Long Term Disability Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

  • Are Your Long Term Disability Benefits Taxable As Income?

    Talk to your Certified Public Accountant.

    Generally, you must report as income any amount you receive for your disability from a long term disability policy if the plan's premiums were paid for by your employer.  If both you and your employer have paid the premiums for the plan, only the amount you receive for your disability that is due to your employer's payments is reported as income. If you pay the entire cost of your long term disability policy, do not include any amounts you receive for your disability as income on your tax return.  This would include any employer or private individual policy where you paid 100% of the premiums.

    Please consult with your Certified Public Accountant, as rules change frequently.

    You can reach Miami Long Term Disability Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

  • What Should You Do After A Denial Of Your Long Term Disability Insurance Claim?

    Approximately 70% of long term disability insurance benefits are denied.  And of those that are approved, many are subsequently terminated or suspended.  If your long term disability insurance claim has been denied or terminated, you should consult with an experienced long term disability insurance claims lawyer immediately.  With most long term disability insurance policies there will be strict deadlines that will need to be complied with after a denial of your claim in order to perfect an appeal of the claim denial. 

    You can reach Miami Long Term Disability Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

  • Will Your Long Term Disability Insurance Company Investigate You?

    If you have a pending claim with your long term disability insurance company you can count on the insurance company performing an investigation into your life.

    Long term disability insurance companies can suspend or terminate disability insurance benefits after conducting surveillance.  Other reasons that long term disability insurance companies use to take you off of disability insurance benefits include:

    • You have discontinued medical therapy or treatment
    • You are working another job
    • You own and operate a business
    • You are not "totally" disabled anymore
    • The doctor hired by your long term disability insurance company believes that you can return to work

    Long term disability insurance companies will conduct investigations into your life.  They will "Google" your name and search your social media activity.  Investigators will also search public records, including corporate records and business and professional licenses you may have.  Investigators may also follow you and interview you and/or your friends and colleagues.

    You can reach Miami Long Term Disability Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

  • How Is Disability Defined In Long Term Disability Insurance Policies?

    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.   It is also important to understand that policies may change the definition of "disability" after you have received benefits for two (2) years or some other time frame.

    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.

    You can reach Miami Long Term Disability Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].