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Palm Beach

March 2012 Archives

Has your insurance company hired a biased doctor to support a denial or termination of your claim?

Has your insurance company hired a biased doctor to support a denial or termination of your claim? A significant portion of disability insurance litigation is dedicated to the issue of whether insurance companies are repeatedly hiring biased doctors to avoid paying claims. In litigation, evidence of an insurance company's doctor's bias can be gathered during the discovery process and in many cases can mean the difference between winning and losing your claim. If you are able to obtain this information prior to filing suit, it can go a long way to discredit the opinion of the insurance company's doctor. Accordingly, insurance companies vigorously fight to keep this information out of the hands of claimants and their attorneys.

The Importance of Understanding Your Policy's Terms and Limitations

There is a plethora of disability insurance policies on the market and numerous coverage options, coverage limitations, terms, and definitions to consider and understand when applying for disability benefits, filing an appeal, renewing or changing coverage options, or responding to inquiries and requests for information from you insurance company. Failure to recognize and appreciate the terms and limitations within your policy can result in reduced coverage, a shortened benefit period or a denial of benefits. Generally, these are the basic types of disability insurance policies available:

Things You Need To Know Before You Submit To An Interview By Your Disability Insurance Company

Often, insurance companies will require that claimants submit to an interview during the application stage and periodically during the administration of a claim. These interviews can either be in person, called a "Field Interview," or over the telephone. There are several things you need to know before you submit to an interview by your disability insurance company.

What is ERISA?

ERISA stands for the Employee Retirement Income Security Act which was passed by Congress in 1974 and signed into law by President Gerald Ford on Labor Day, September 2, 1974. When the Employee Retirement Income Security Act ("ERISA") became law, it was codified as a part of Title 29 of the United States Code, and is found in multiple sections beginning with Section 1001. There have been a number of important amendments to ERISA since its 1974 enactment, including the COBRA and HIPAA laws. Essentially, the Employee Retirement Income Security Act is a federal law that supersedes state laws and regulates employee benefit plans and determines the rights of beneficiaries under those plans. This includes disability, life, health or long-term care insurance benefits that are provided to employees as a benefit of their employment by employers. The statute defines what is considered to be an employee benefit plan governed by ERISA, who is an ERISA administrator responsible under ERISA for the employee benefit plan, and who is an ERISA participant (employee) and beneficiary covered under ERISA. One of the primary goals in the enactment of ERISA was to promote the interests of employees and their beneficiaries and to assure that employees received promised benefits from their employers - this was expressly written by Congress into the ERISA statute itself. In addition to ERISA setting minimum standards required for ERISA employee benefit plan creation and administration, it requires ERISA administrators to provide participants with certain plan information, it creates fiduciary responsibilities of the ERISA administrator to plan participants, requires ERISA plans to establish a grievance and appeals process for participants to obtain benefits under their plan, and gives participants the right to bring a lawsuit in federal court to pursue plan benefits and breaches of fiduciary duty by the ERISA administrator/plan. The regulations enacted by the United States Department of Labor pursuant to ERISA further provide for very specific strict deadlines, claims procedures, and internal structuring that the ERISA administrator (or insurance company) shall abide by and create to promote fairness and consistency in claim determinations involving ERISA benefits.

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3201 West Commercial Boulevard
Suite 227
Fort Lauderdale, FL 33309

Toll Free: 866-363-3628
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Palm Beach
14255 U.S. Highway One
Suite 235
Juno Beach, FL 33408

Toll Free: 866-363-3628
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Phone: 561-202-9170
Fax: 561-202-9194
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