Frequently Asked Questions and Answers

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  • I sit on the board of directors for my condominium association and feel our board is getting nowhere with our insurance claim, what can I do?

    Please contact our office for a free consultation. We would be happy to schedule a meeting with the association's board members to discuss the issues surrounding the delay or denial of your insurance claim. We also understand the many personalities involved in working with a condominium association, including the board members, condo owners and contractors and therefore offer the necessary flexibility to get the insurance claim resolved as expeditiously as possible while working with the many role players.

  • I own a condo unit in my condominium and feel my board of directors/association is getting nowhere with the insurance claim necessary to repair the buildings roof, etc. What can I do?

    Please call our office to learn a little more of how we can help your association with their delayed, denied or underpaid insurance claim. Afterwards, you can approach your board of directors and educate them on our services. We are available to travel to your condominium and meet with your board members in order to discuss their insurance claim issues. For a free board of members consultation, please contact our offices to arrange an appointment.

  • Due to damages to my condo unit, I have been forced to move from my condo unit and rent elsewhere. Are these expenses covered?

    Only by our office carefully reviewing your condo unit's insurance policy can we make that determination. However, most policies cover "additional living expenses" while the condo owner is out of the unit. Additional living expenses pay for a hotel or a rental home while necessary repairs are made to your condo unit. Please continue making all condo unit related payments such as mortgage, taxes, condominium association fees, etc. while it is under repair.

  • What can I do to improve my chances of getting my 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.

  • What happens after I file my 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.

  • 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.

  • From the moment I file my disability insurance claim, by when should I 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.

  • My insurer requested to speak to my employer, supervisor and other co-workers about my 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.

  • What information do insurers use to approve or disapprove my 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.

  • If my disability insurance claim is denied, will my 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.

  • My disability insurance company is requesting I 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.

  • If I am approved for disability benefits, until when will my 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.

  • 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.

  • Is there a deadline for filing a long term disability claim once I 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.

  • Can disability insurance companies use my workers compensation benefits to reduce or offset against my 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.

  • 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.

  • My doctor has diagnosed me with a mental and/or nervous disorder, but my disability insurance company has denied my 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.

  • 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.

  • 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.