Long Term Disability Insurance Claims For EMS Workers And First Responders

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

What are some common ways of getting injured on the job as an EMS worker or first responder?

EMS workers are tasked with a difficult job. A typical day in the life of one of these workers may include responding to medical emergencies such as heart attacks, gunshot wounds, car accidents, childbirths, etc. To ensure a prompt response to whatever the emergency may be, EMS workers, and First Responders in general, often have to weave through busy streets, and speed through dangerous intersections. This is all while operating a heavy vehicle, typically loaded with large pieces of equipment and machinery, while ensuring the safety of the individuals travelling in the vehicle and on the streets. Amongst other things, this career necessarily requires lifting heavy objects, kneeling, running, and the ability to operate effectively under high levels of pressure and stress.

The very nature of this career exposes EMT’s and First Responders to much higher risks of job-related injury and illness than most other occupations. It is not uncommon for these workers to become involved in car collisions, slip and falls, or to suffer from knee injuries, back injuries, PTSD, etc. Moreover, many of the patients are unstable and combative, and often threaten the safety of these workers. Additionally, the constant contact with patients under these circumstances exposes these workers to a much higher risk of contracting contagious diseases and viruses, than those involved in other occupations.

What is the communicable disease statute, and how does it affect your long term disability benefits?

Florida worker’s compensation laws provide that when an individual suffers from a work-related injury or sickness, the individual will be entitled to receive certain benefits that provide for you during your time of need. In addition, disability insurance may cover the loss of income that results from your injury or sickness, provided that you are “disabled” pursuant the terms of your policy.

A certain piece of Florida legislation was enacted to provide added protection for First Responders who have contracted a disease transmitted through bodily fluids that resulted in death or disability. The statute creates a presumption in favor of the First Responder that the cause of such illness was work-related. However, the presumption can be defeated under several circumstances. For example, a showing that the First Responder never took a pre-employment physical that would have revealed such a disease or that such physical was taken and the disease was revealed, would render the presumption inapplicable and the First Responder would not be entitled to recover worker’s compensation benefits. The statute also provides for strict guidelines for filing a claim. If you do not follow these guidelines, you risk losing these benefits forever. Moreover, the statute provides a catch-all that eliminates the presumption if the First Responder has engaged in certain types of “high-risk behavior.” This may include evidence of unprotected sex, tattoos, piercings, etc.

What is long-term disability insurance?

So what exactly is long-term disability insurance? It is a contractual arrangement between you and your long term disability insurance company, in which your insurance company agrees to cover a certain percentage of your lost income, in the event that you become “disabled,” permanently or for an extended amount of time. Typically, long-term disability insurance will require the disability to persist for at least 180 days before you will be entitled to receive anything. Moreover, whether you are considered to be “disabled” will depend on the specific terms of your insurance policy. For example, some policies provide for what is commonly referred to as “own occupation” terms. Under an “own occupation” policy, you will be entitled to disability benefits if you cannot materially and substantially perform the duties of your particular occupation. For EMS workers, and First Responders, this may mean that you no longer have the mobility, the eye-sight, the mental conditioning, or any other necessary condition required for you to carry out the duties for this career. Alternatively, some policies have a tendency to be more insurer friendly, resulting in a greater chance of your claim being denied. These types of policies are typically referred to as “any occupation” policies. Under these policies, you will only be considered to be “disabled” if you do not have the capacity to perform any occupation for which you are qualified for. It is necessary to review the terms of your policy to understand the extent of your protection.

Which laws will govern your disability claim, and why does it matter?

The type of coverage you carry may affect your rights under your policy, and the process you must follow to enforce those rights. If you carry individual insurance coverage or you are employed by a government entity, then your claim will likely be governed by Florida law. Typically, this will be in the form of a breach of contract action, and you will have to demonstrate that you had a contractual right to receive the long term disability benefits under the terms of your particular policy. On the other hand, if your disability coverage is provided by a private employer, then you probably have group coverage. If you have group coverage, then your claim will typically be governed by ERISA, a complicated federal law that provides for a strict procedural framework. Amongst other things, ERISA requires the insured to appeal their claim through their insurer before bringing suit. There is a window of opportunity to file this appeal, and failure to do so may bar your claim altogether. Additionally, the record produced during this window typically cannot be altered once the appeals process is over. This makes this time period very important because if your insurer denies your claim after your appeal, then you will have to base the merits of your action on the record produced during this time period.

If your claim has been denied, you should contact an experienced attorney as soon as possible. Many of these laws require strict adherence to complex procedures, and the failure to abide can result in the permanent denial of your disability benefits.

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].

Sources

https://www.bls.gov/ooh/healthcare/emts-and-paramedics.htm#tab-3

FL. Stat. §112.181

29 U.S. Code Chapter 18 - EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM