Long Term Disability Insurance Claims For Firefighters

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

What are some common ways of getting injured on the job as a firefighter?

During emergencies, Firefighters are often the first line of defense for individuals and property. While the common conception of a Firefighter is that they put out fires, Firefighters are often called upon to protect the public from a number of different emergencies. This can include anything from providing first aid, responding to car accidents, assisting with oil spills and other chemical disasters, and assisting people during severe floods. In many counties, the traditional firefighter career and EMT career have been consolidated, placing even greater responsibilities on the individual that elects to pursue this career. Many of the typical functions associated with this career demand the ability to carry large objects, to run, to have great eyesight, to be mentally stable, to be able to withstand enormous amounts of pressure and stress, etc.

Despite what appears to be an unparalleled resilience to injury, the Bureau of Labor and Statistics estimates that in 2013, approximately 14,700 Firefighters suffered some form of non-fatal work-related injury that resulted in time away from work. In 2011, the Bureau estimates that the most common form of non-fatal work-related injuries experienced by firefighters involved some form of overexertion to the body. The second most common form of non-fatal work-related injury or illness had to do with Firefighters coming into contact with certain objects and equipment, such as heavy machinery or chemical contact. The third most common non-fatal work-related injury had to do with slips, falls, and trips.

What is the Heart/Lung Bill, and how does it affect your worker’s compensation benefits?

A piece of Florida legislation, commonly referred to as the “Heart/Lung Bill,” is designed to provide added protection to Firefighters in the event that they develop tuberculosis, heart disease, or hypertension that results in death or disability. The effect of the statute is to create a presumption in favor of the Firefighter that such illness was caused by work-related events. However, the statute provides that the presumption can be rebutted if it can be demonstrated by competent evidence that the cause of such illness was not work-related. If you can offer evidence that your illness was indeed work-related then your employer must meet a higher burden to rebut the presumption. The effect of the statute’s protection has been weakened by subsequent amendments. A recent amendment states that if a Firefighter has materially departed from his or her physician’s prescribed course of treatment, then the statute will not apply. For example, if your physician has prescribed a certain diet, and you have deviated from this diet, then the presumption will not apply and your worker’s compensation claim may be denied.

The Heart/Lung bill matters. If you’re injury or sickness is considered to be work-related, then worker’s compensation laws kick in and you can recover benefits whether or not you carried long-term disability insurance. If you did not satisfy the eligibility requirements under the Heart/Lung Bill, then disability insurance may be your only alternative to recovering loss of income. If you did carry long-term disability protection, then your policy likely has a clause that would allow your insurer to offset your long-term disability benefits with benefits you have received through worker’s compensation.

What is long-term disability insurance?

Long-term disability insurance is a contractual agreement that provides you with income protection and benefits in the event that you become disabled and can no longer work, either permanently or for an extensive amount of time. Usually, these benefits will kick in only if your disability has persisted for more than 6 months. A typical long-term disability policy provides that the insured will be paid a certain percentage of his or her pre-disability income in the event that the insured becomes “disabled.” The specific terms in the policy will govern the insured’s right to receive disability benefits. Generally, these policies can be broken down into two main categories: “own occupation” and “any occupation” policies. The “own occupation” policy is considered to provide the insured with the most protection because the insured will be entitled to collect disability benefits if he or she cannot substantially and materially perform the duties of his or her current occupation. For example, for firefighters this could mean that you no longer have the ability to run, or carry heavy objects, or that you have developed poor eyesight, or you no longer have the mental conditioning to withstand the pressure that the job demands. On the other hand, the “any occupation” policy would only provide you with disability benefits if you no longer possess the capacity to perform any occupation for which you are qualified for. It is easy to see why the latter policy is more likely to result in a denial of your claim.

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

As a Firefighter you are employed by a government entity and you are likely insured for long term disability benefits under a group plan.  Normally, the effect of being insured under a group plan is that your claim would be governed by an anti-consumer and complicated federal law, known as ERISA. However, ERISA does not apply to government employees.  As such, a denial will be governed by Florida law. Typically this will be under a breach of contract theory, or the like, and you can generally file a lawsuit to enforce your rights under the contract at any time.

If your long term disability benefits have been denied, then it is critical that you call a an experienced long term disability attorney as soon as possible. It can mean the difference between receiving benefits, and not receiving anything at all.

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/iif/oshwc/cfoi/osar0017.htm

FL. Stat. §112.18

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