One thing which drives many people into my office is the constant unreasonable demands made by claims representatives about Florida LTD policy claims.
These claims representatives, who are grossly overworked, get behind on their files. Then try to catch up by demanding you provide documentation immediately. Now, your obligation as the claimant is to provide the documentation necessary to substantiate your claim.
However, for a claims representative to make such unreasonable demands only causes you unnecessary stress. That stress only hampers your medical recovery and, in some instances, will make it worse. They are always threatening to “close your file.” It’s an idle threat; the file will be re-opened immediately upon receipt of your documentation.
Artificial Deadlines Can Be Purposeful
The other side of the coin is that perhaps the reason for the unreasonable deadline is not a lack of diligence, but it is specifically intended to stress you out and cause you to be unable to respond. Our experience in Short Term Disability and Long Term Disability claims is that there is no deadline that cannot be extended as long as something in writing is delivered to the insurance company beforehand.
We always demand that they await our response and tell them the date by which we expect to submit documentation. For them to render a benefits determination before that date would likely result in a Court overturning the adverse benefits determination because the failure to await your response renders it “arbitrary and capricious.” This standard applies in cases governed by the federal statute commonly referred to as “ERISA” or the Employee Retirement Income Security Act.
Actual Deadlines You Must Adhere To
There are only two deadlines that a claimant cannot ignore. First, there is a time frame for submitting the application. There can be valid reasons for an untimely submittal, but a claimant does not want to make the timeliness of the application an issue. Second, there are 180 days to submit an Administrative Appeal.
You want to get those appeals in as soon as possible, so you should not let 180 days from the date you receive the denial pass without some type of submittal indicating an intent to appeal.
Artificial Deadlines Are Common Among Insurance Companies
Apparently, this idea of bullying with artificial deadlines is not limited to the Florida LTD policy benefits claims industry. I listened to the topic discussed in detail as it applied to another industry. The underlying purpose of that industry was to get people to become unwilling to pursue a rightful claim, i.e., to get the claimant to abandon the claim as being too complicated.
Or, a claimant may submit a document in too much of a hurry only to later find out it was not completed correctly. Believe me, the insurance company will never let go of such an error.
Let Herbert M. Hill, P.A. Decipher Your Deadlines
If you have any questions along these lines about your Short Term Disability or Long Term Disability claim, please contact Herbert M. Hill, P.A, and we would be glad to answer any questions you may have.
We are a law firm located in Orlando, Florida, with a practice extending throughout Florida. While most cases handled are for Florida LTD policy insurance benefits, areas of practice include employee benefit claims. The firm handles any claims arising under the Employee Retirement Income Security Act (“ERISA”) for disability benefits, medical benefits, retirement benefits of any sort, including pension, 401k, termination agreements, or the like, and claims arising under private disability policies.
