Many people in Florida and elsewhere in the country have faced serious hardship after their applications for disability benefits were denied by their insurance companies. One firm, Life Insurance Co. of North America, was found to be liable in its treatment of a woman with chronic pain to whom it denied disability benefits. The insurer is a subsidiary of Cigna, a larger life and health insurance firm with customers across the country. A U.S. Court of Appeals for the 6th Circuit decision ordered the company to pay the woman's attorney's fees after she was wrongfully denied benefits.
A professional may face difficulties when attempting to bring a claim to a disability insurer. Doctors, lawyers, business owners, and other skilled professionals work hard and spend significant sums of money to make sure they have disability insurance policies that will protect their family and financial well being should an injry or illness prevent them from being able to work. Despite timely paying premiums, when the time comes to file a claim after an accident, injury or significant health event, the insured too often faces delays, ongoing requests for information, and a denial of claim. Disability insurance companies, while happy to take premium payments, look for reasons to deny benefits, especially for high-earning professionals.
As more people are becoming accepting of transgender surgery, insurance companies are changing policies. In this vein, a major disability carrier recently did so after initially denying a claim. This is good news for the transgender community in Florida as many are hoping other carriers follow suit.
There is a great disparity in how people think about insurance. Many Florida residents think of it as a necessary evil and purchase the minimum required for specific purposes, while others seek to protect themselves against risk by acquiring upgraded and broader coverage. For example, it is not uncommon for relatively young individuals to buy life insurance, yet, statistically, a disabling injury or illness is far more likely than an early death. However, when it comes to collecting on a filed claim, disability insurers often delay, offer low settlements, or deny the claim altogether.
Having insurance coverage can provide peace of mind. The hope, of course, is to never have reason to file a claim, but the expectation is that if a loss occurs, the insurance company will respond in a timely manner, address the issue professionally and pay an appropriate settlement amount to cover the damages incurred. However, when it comes to disability insurance claims, many Florida claimants find that the reality of how the insurance company handles the matter is far different from their expectations.
If you are a private insurance policyholder in Florida, you have a right to file a valid claim should you need insurance benefits for a specific purpose related to your policy - e.g., a car accident, flood or theft. But if you have a claim that's denied, you have a legal right to attempt to collect payments you believe you are entitled to receive. This process involves filing a breach of contract claim against your insurance company. Before this step is taken, however, many insurance policies and state insurance laws require policyholders to make a demand for payment directly to the insurance company.
In many instances, insurances companies in Florida and other states make an effort to meet the needs of families and individuals with unique care requirements. But one mother has experienced unexpected difficulties with her insurance provider about a request for a new, safer wheelchair for her 19-year-old son. The young man, who has cerebral palsy, has been using a wheelchair practically all of his life, but it recently fell into disrepair. While he has been using a donated scooter to get around, it presents some mobility challenges for the man.
Individuals in Florida and throughout the country are eligible to buy health insurance through the Affordable Care Act (ACA). About 80 percent of those who buy policies through the ACA receive subsidies to make their policies more affordable. As part of changes to the system announced in August 2018, it is now possible to buy short-term policies that last for up to 364 days.
People in Florida typically seek out medical care at emergency rooms for acute and worrisome conditions and injuries. To discourage the use of emergency care, the insurance company Anthem launched a policy of reviewing emergency charges and denying coverage if the company deemed the emergency care inappropriate. Researchers who analyzed the outcomes of this policy determined that the insurer could not reliably identify nonessential emergency visits.