Four Common Policy Provisions Insurers Use To Deny Florida Long-Term Disability Benefits

Do you have long-term disability (LTD) insurance available through an employer? The Bureau of Labor Statistics (BLS) reports over half of all workers are covered. LTD benefits can replace up to two-thirds of your lost income if an accidental injury, illness, or chronic health issue prevents you from working.

Carefully review your policy documents, as insurers use language that makes it harder to get approved. Our Jacksonville long-term disability lawyer protects the rights of clients in filing an appeal and explains four common provisions insurers frequently deny claims.

Insurance Policy Provisions Used To Deny Long-Term Disability Claims In Florida

According to The Centers for Disease Control and Prevention (CDC), over five million Florida residents, or roughly one in four adults, are considered disabled. Employer-provided long-term disability insurance can help make up for lost wages, but be sure to read all policy documents, both when signing up for coverage and when filing a Florida long-term disability claim. Be alert for the following four provisions, which LTD insurers often use to deny people benefits:

Limitations on Pre-Existing Conditions

Pre-existing condition clauses are a common tool insurers use to save money. They prevent insurance companies from having to make payouts on conditions diagnosed prior to when the policy went into effect.

Under the Florida Statutes, long-term disability insurance exclusions for pre-existing conditions can apply to any physical or medical impairment, provided the insurer follows state guidelines regarding look-back periods. These are typically limited to six months or a year, depending on the policy.

Look-Back Periods For Policy Effective Dates

Look-back periods apply well beyond just pre-existing conditions. Insurance companies also use them to determine eligibility for LTD coverage based on when the policy took effect. Look-back periods for employer-provided long-term disability claims in Florida can be up to a year, meaning that benefits can be denied at any point during this time. 

Policy Exclusions

When looking over long-term disability policy documents-which your employer must provide under the Employee Retirement Income Security Act of 1974 (ERISA)-pay close attention to policy exclusions. This is a list of conditions that are not covered, which can include everything from common physical impairments to depression and other mental health issues.

Discretionary Clauses

Insurance companies are for-profit businesses. Long-term disability insurers protect profits by reducing payouts on claims. If none of the above provisions works, they can use a discretionary clause. This basically gives insurers the right to broadly interpret policy terms and deny your claim for any reason, provided they can prove to a judge their decision was ‘reasonable.’

For Help In Filing An Appeal, Contact Our Florida Long-Term Disability Lawyer

Farrell Disability Law protects the rights of people who have been denied long-term disability benefits. We take the legal actions needed to help get your claim approved on appeal. To discuss your case, call or contact our Florida long-term disability lawyer online. Request a consultation today in our Jacksonville or Orlando office.

Sources:

bls.gov/opub/ted/2020/short-term-and-long-term-disability-insurance-for-civilian-workers-in-2020.htm

cdc.gov/ncbddd/disabilityandhealth/impacts/florida.html

leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0627/Sections/0627.6561.html

dol.gov/general/topic/health-plans/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans.