Frequently Asked Questions and Answers
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Does ERISA Apply To Government Employee Long Term Disability Insurance Claims?
As a city, county, state or federal employee you are considered a public employee. 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 not governed by ERISA.
In 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 insurance 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 some cases.
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.
Can A Beneficiary Under A Life Insurance Policy Collect If The Insured Commits Suicide?
Life insurance policies typically contain a suicide clause excluding coverage if the insured commits suicide within two years of the policy's inception. However, since not all life insurance policies are identical, please contact an experienced life insurance claims attorney 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].
Are Low Claim Offers An Act Of Insurance Bad Faith?
Yes."Lowballing" an insured is an act of insurance company bad faith.
What Is Life Insurance?
Life insurance is a contract between a policyholder or insured and an insurance company where the life insurance company agrees to pay money to the insured’s designated beneficiaries in the event of the insured’s death in exchange for premiums paid by the policyholder at certain intervals.
What Is The Most Common Reason For A Life insurance Claim Denial?
The most common reason given by insurance companies for denial of a life insurance claim is that material misrepresentation were made in the application for insurance.
Can Anyone Other Than The Insured Change The Beneficiary On A Life Insurance Policy?
Yes, if the person making the change holds a power of attorney (POA) authorizing such changes or is listed in the insurance policy as having this right or otherwise has legal standing to do so.
What Is Disability Insurance?
Disability insurance protects you in the case that you are unable to work as a result of being injured or sick. The disability policy pays you a percentage of your lost wages.
What is an Independent Medical Examination (IME) and Functional Capacity Evaluation (FCE)?
Long term disability insurance policies typically contain insurance provisions allowing your insurance company the right to physically exam you by a doctor of their choice. This is referred to as an "independent medical examination" or an "IME". During this physician examination, you may be instructed to participate in a "functional capacity evaluation" or "FCE" which will tests your body’s functional abilities. But make no mistake about it, there is nothing "independent" about the doctors that insurance companies use for these evaluations. Insurance companies pay these doctors a lot of money. As such, you should prepare for these examinations accordingly as everything that you say or do at these examinations may be used to support a denial of your long term disability insurance claim.
What Should You Do When Your Long Term Disability Insurance Company Asks You For An Interview?
Your insurance company has a right to investigate your long term disability insurance claim. This includes taking a recorded statement or interview from you. You must prepare for this statement. Whatever you say during these statements can be used to support a denial of your claim. Prepare, prepare, and tell the truth. Get help of an experienced long term disability insurance claims lawyer prior to providing any statements to your insurance company, if necessary.
Will Your Long Term Disability Insurance Company Place You Under Surveillance?
Absolutely. If you have an ongoing long term disability insurance claim, your insurance company will place you under video surveillance. Surveillance is admissible in court. Video recordings of your day-to-day activities are used by insurance companies to substantiate denial or underpayment of your long term disability benefits claim. An experienced long term disability insurance claims lawyer working on your behalf will help debunk what the insurance company claims that the video purports to show.You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].
Can We Help You With Your Long Term Disability Insurance Claim?
Yes.We can help you with the denial or suspension of your long term disability insurance claim including representing you during your insurance company's internal appeals process and prosecution of your lawsuit to enforce your rights under the insurance policy.
What Are Some Examples Of Insurance Bad Faith?
An insurance policy is a contract. In exchange for your premiums, the insurance company promises to pay your valid insurance claims. When the insurance company fails to meet its obligations and act in good faith according to the insurance policy and Florida law, insurance bad faith is said to exist. If insurance bad faith can be proven, Florida law allows the insured to collect damages, attorney fees and costs, and in some cases punitive damages.
Some examples of Insurance Bad Faith conduct include:
- Insurance company denies your valid claim
- Insurance company ignores or delays paying your claim
- Insurance company underpays or lowballs your claim
- Insurance company unjustifiably suspends or cuts-off payments on your previously approved claim
- Insurance company interprets ambiguous language in your policy in its favor to avoid paying your claim
- Insurance company purposely conceals or misrepresents benefits that you are entitled to under your insurance policy
- Insurance company attempts to dissuade you from filing your legitimate claim
- Insurance company engages in insurance fraud
- Insurance company engages in other malicious and dishonest conduct
Your Insurance Claim Was Denied - Do You Have A Bad Faith Claim?
Maybe. But not all insurance claim denials are made in bad faith. Your insurance company, however, may have an invalid basis for denying your insurance claim. Whether you are the victim of bad faith should be determined by a lawyer experienced in handling bad faith insurance claims after review of the specific facts of your case.
What Does Insurance Bad Faith Look Like?
Insurance bad faith comes in all shapes and sizes. Insurance companies have been found liable for insurance bad faith for unreasonably denying claims, interpreting policy language to their benefit, not investigating insurance claims adequately or within a reasonable time frame, misrepresenting facts or coverages, underpaying claims, failing to protect their insureds, etc. We can go on. You should consult the individual facts of your situation with an experienced bad faith insurance claims lawyer.
What Are The Conditions In Florida For Bringing A First Party Insurance Bad Faith Lawsuit?
In the State of Florida, before proceeding with a first party insurance bad faith lawsuit, you must meet the following conditions:
- File a Civil Remedy Notice of Insurer Violation with the Florida Department of Financial Services which triggers a 60 day period in which the insurance company has to "cure" its bad faith conduct.
- Receive an award in your underlying contract claim for insurance coverage.
How Much Will It Cost You To Hire Attorney J.P. Gonzalez-Sirgo?
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 confidential consultation. In the vast majority of cases, if we decide to accept 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 attorney's fees for our services . Furthermore, under certain circumstances your insurance company will become responsible for paying your attorney’s fees. Since not all insurance claim cases are alike, please contact our office to discuss your case in more detail.
How Do You Locate A Missing Life Insurance Policy?
When a loved one passes away, the last thing you want to spend your time doing is looking for the life insurance policy. It is not uncommon for the surviving family members to be unaware of the details regarding the life insurance policy, including the company who issued it. However, it is worth the effort to try to locate the missing life insurance policy, as the settlement can help pay funeral expenses, medical bills, and household expenses.
Before you start your search, you should consider what company may have sold the policy. For example, is there a particular insurance agent you work with for your insurance needs? Is it possible that this insurance agent also sold the policy to your loved one? Employers, trade associations, and unions also frequently offer life insurance to their members, so you should also check with these resources.
If you are still not sure what company issued the policy, you may want to look through your loved one’s file cabinets, storage boxes, and bank safe deposit boxes, if applicable. An address book may even be helpful as it could list the name of an insurance agency. You might consider calling professionals you have worked with in the past, such as accountants, attorneys, insurance agents, and financial advisors.
While there is no central database to locate life insurance policies, you can employ a private service to help you find the policy information. These companies will search for lost insurance policies for a fee.
Another great source is the National Association of Insurance Commissioners, which can provide you with contact information for state insurance personnel who can help identify possible insurers that may have issued the policy. Florida’s Bureau of Unclaimed Property is also worth looking into. If the life insurance company is aware of your loved one’s death, but can’t locate the beneficiaries, then it may have forwarded the death benefit to the State.
The article, Locating a Lost Life Insurance Policy, has more information and strategies regarding finding missing policies.You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].
How Do You File A Life Insurance Claim In Florida?
The first step is notifying the life insurance company of your claim.
Following the death of a loved one, the last thing you want to deal with is the life insurance company. However, a life insurance settlement can provide the necessary money to cover funeral costs and medical expenses and can act as an income supplement for you and your family. It is important to understand what is involved in filing a life insurance claim, so that you can avoid a delay in the process and denial of your life insurance claim.
You should review the details of the policy to become familiar with the benefits. If you cannot locate the policy, contact the life insurance agent or life insurance company for a copy of the life insurance policy. They will also be able to explain the benefits under the policy and provide information on how to file the life insurance claim with that particular life insurance company.
There will be forms that you will need to complete. Each adult beneficiary is generally required to fill out a proof of death form. Other supporting documents will be required by the life insurance company, such as a certified copy of the death certificate and a certified copy of the marriage certificate, if applicable. A funeral director can provide the death certificate. Once all of the forms are completed and the necessary paperwork is gathered, you will need to submit everything to the life insurance company.
The life insurance company will begin to review the claim upon the opening of the claim.
Our article, Top 4 Things You Need to Do to File a Life Insurance Claim, has additional helpful information regarding the filing of a life insurance claim.