Frequently Asked Questions and Answers

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  • Who are Company Employee Adjusters and Independent Adjusters?

    Company employee adjusters are employed by the Insurance Company to represent the company in dealing with your loss and damages. The Company Adjusters main responsibility is to protect the interests of the Insurance Company, not your best interests.

    Independent Adjusters are hired as "independent contractors" by the Insurance Company to represent the company in dealing with your loss and damages. The Independent Adjusters main responsibility is to protect the interests of the Insurance Company, not your best interests.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected]s.com.

  • What is a Catastrophe or Emergency Adjuster?

    Florida Statues 626.874, titled "Catastrophe or emergency adjusters," reads as follows:

    (1) In the event of a catastrophe or emergency, the department may issue a license, for the purposes and under the conditions which it shall fix and for the period of emergency as it shall determine, to persons who are residents or nonresidents of this state, who are at least 18 years of age, who are United States citizens or legal aliens who possess work authorization from the United States Bureau of Citizenship and Immigration Services, and who are not licensed adjusters under this part but who have been designated and certified to it as qualified to act as adjusters by independent resident adjusters or by an authorized insurer or by a licensed general lines agent to adjust claims, losses, or damages under policies or contracts of insurance issued by such insurers. The fee for the license shall be as provided in s. 624.501(12)(c).

    (2) If any person not a licensed adjuster who has been permitted to adjust such losses, claims, or damages under the conditions and circumstances set forth in subsection (1), engages in any of the misconduct described in or contemplated by ss. 626.611 and 626.621, the department, without notice and hearing, shall be authorized to issue its order denying such person the privileges granted under this section; and thereafter it shall be unlawful for any such person to adjust any such losses, claims, or damages in this state.

    Catastrophe and emergency adjusters also work for the Insurance Company. Their main responsibility is to protect the interests of the Insurance Company, not your best interests.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • How can you verify if your Public Adjuster is licensed?

    You can verify if a Public Adjuster is licensed by going to the Florida Department of Financial Services.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

     

  • Should you hire a Public Adjuster?

    According to FAPIA's website, you should hire a Public Adjuster if you have just suffered an insurance loss, from a fire, hurricane or some other traumatic event, and you may not feel confident in representing yourself and your interests before an Insurance Company. Consider these three points.

    1. It is up to you to prove the extent of your loss to the Insurance Company.

    A typical insurance policy is dozens of pages long and contains numerous provisions and stipulations written in technical and legal terms. Additionally, it contains various forms and endorsements which are constantly changing from year to year. Most Insureds have difficulty in understanding all of them. To be compensated for your loss, there are certain conditions which must be satisfied. Failure to do so could reduce your settlement amount or even cause your claim to be denied.


    2. No matter how organized you and your documentation is, filing and receiving payment on a claim can be a time consuming and tedious process.

    If you are not sufficiently organized and your loss documented, you may not realize the compensation you have paid for and are entitled to receive.

    3. A Public Adjuster has the experience, knowledge and expertise to obtain your maximum entitlements under your policy.

    Remember that the Insurance Company Adjuster is representing the insurance company. It is not uncommon for the Insurance company to misinterpret their own insurance policy or forget to apply case law or Florida Statutes which supersede their own policy. A Public Adjuster will know current laws as they affect insurance losses and how to best represent you. A Public Adjuster has resources to help you through the maze of estimating, documenting, and filing your insurance claims.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • What can you do to improve your chances of getting your long term disability insurance benefits approved?

    Statistics show that over 70% of long term disability insurance claims are denied.  Statistics also show that hiring an experienced long term disability insurance law firm will increase your approval rating by six (6) fold.    If you decide to go it alone, you can go here to obtain filing tips.  In addition to the filing tips, it would be helpful to keep a daily diary of how your disability is impeding your everyday work life.

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

     

  • What happens after you file your disability insurance claim?

    After you file your disability insurance claim, you will receive either a written or telephonic response confirming your application.  Sometime thereafter, you might receive a call from your assigned "Case Manager."Very few people will ever have to file a long term disability application.  Because of this, it is very easy to give inaccurate responses or explanations to your case manager about your disability and how it affects your occupation.  Please go here to read my blog about dealing with case managers.

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • What is the elimination period on a long term disability insurance policy?

    The elimination period is specified in your disability insurance policy.  Elimination period is the waiting time from when the disability begins and disability benefits are actually paid.  During this waiting period, the claimant must remain disabled.  The elimination period is typically six (6) months, but can vary in length.   

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • From the moment you file your disability insurance claim, by when should you expect the carrier's decision?

    Receiving a denial or approval of your claim can vary from case to case.    A decision may not come as quickly as you would prefer.  However, you can expect to receive requests for additional information which will result in unwelcomed delays. The carrier's decision will be in a written letter to you and should explain if they have approved your claim or if your claim has been denied and the reason why.   

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].
     

  • Your insurer requested to speak to your employer, supervisor and other co-workers about your disability insurance claim. Can the insurer do this?

    As part of their evaluation of your disability claim, insurers may desire to interview your employer, including your supervisor and other co-workers.  The insurer will seek information about your occupation and associated tasks.  This information will be matched with your claimed disability and how it affects your ability to perform the required duties of your occupation. In doing so, insurers may overstep your right to privacy.  Having experienced legal counsel to protect your privacy rights by placing limits on any employer based interviews is highly recommended.

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].
     

  • What information do insurers use to approve or disapprove your disability insurance claim?

    Insurers will use any information at their disposal to disapprove your disability claim.  From an evidentiary standpoint, typical information includes your medical records, vocational evaluations, and statements from your employer, family members, neighbors and third parties.

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • If your disability insurance claim is denied, will your claim end up in trial?

    Not necessarily.  Most disability insurance claims are settled without going to trial.  Nonetheless, our firm handles each disability insurance claim as if the case were going to trial.  Depending on your disability insurance policy or plan, if litigation is necessary, your claim will be processed in either state or federal court.

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].
     

  • Your disability insurance company is requesting you file for Social Security Disability benefits. Is this required?

    Only by reading your disability policy can we determine if this is a requirement.  Many disability policies will offset or deduct your Social Security Disability (SSD) benefits against your disability insurance benefits.  Disability insurance companies are very interested in you obtaining Social Security Disability benefits as this will mean that they will be entitled to pay you less.  On the other hand, if your Social Security Disability benefits are denied, disability insurance companies may want to use this as an example as to why they can also deny your disability claim. 

    With some disability insurance policies, filing for SSD is not required in order to entitle you to receive your full disability insurance benefits in addition to SSD 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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • If you are approved for disability benefits, until when will your benefits continue?

    It depends on your policy provisions. 

    Typically, your disability insurance benefits will continue until:

    • 1. Your disability ceases or improves sufficiently for you to return to your prior job or any other gainful occupation;
    • 2. Your disability insurance policy is exhausted based on age limitations;
    • 3. Your disability insurance benefits are cut-off or terminated for one of several reasons, including failure to continue physician treatment, fraud, etc.

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].
     

  • What is "Waiver of Premiums?"

    Most long term disability policies contain a provision for waiver of premiums in the event your disability benefits are approved.  This means you do not pay disability insurance premiums while you are collecting disability 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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • Is there a deadline for filing a long term disability claim once you stop working?

    If your disability policy was issued through your employer, you will usually be required to file within 30 days from when you stopped working.  Private individual disability policies contain varying deadlines to file your claim.  Please read your policy to ensure that you do not miss this deadline.    

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • Can disability insurance companies use your workers compensation benefits to reduce or offset against your disability insurance benefits?

    Many disability insurance policies contain a provision listing the types of benefits that may be used to offset your monthly disability benefits.  One such benefit that is used to offset or reduce your monthly disability benefits is workers compensation benefits.  For example, if your workers compensation benefit is $1,500 per month and your disability insurance benefit is $2,500 per month, the disability insurance company will reduce or offset your workers compensation benefits from your disability insurance benefits and pay you $1,000 per month.  One other notable benefit that is used to offset against your disability benefits is Social Security Disability 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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • What is the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition?

    This manual is published by the American Psychiatric Association and covers psychiatric or mental disorders of children and adults.  This manual is also known as the DSM-IV.  The manual covers known causes of these disorders, statistics, prognosis and treatment.  Disability insurance companies use this manual to better understand their policyholder's mental illness, treatment and needs as a patient. 

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • Your doctor has diagnosed you with a mental and/or nervous disorder, but your disability insurance company has denied your claim, why?

    Insurance companies refer to the Diagnostic and Statistical Manual of Mental Disorder, Forth Edition, better referred to DSM-IV, to check if the stated mental and/or nervous disorder as diagnosed by your doctors is listed in this manual.  If not, insurance companies will deny your disability claim based on this finding.

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].
     

  • What are the benefit limitations for mental and/or nervous medical conditions?

    Most long term disability insurance policies impose a 12-24 months benefit limitations provision on mental and/or nervous disorders.  This means that if your disability claim is approved, the insurer will pay you benefits for up to this limitation period only.  Your benefits will cease after this limitation period expires.

    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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].

  • 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.

    You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].