What “Totally Disabled” Actually Means In Your Florida Long-Term Disability Policy
If you are filing for long-term disability benefits in Florida through your employer, you may assume that having a serious medical condition and being unable to work is enough to qualify. However, in most cases, it is not that simple.
Whether you receive benefits depends heavily on how your policy defines the words “totally disabled.” Our experienced Jacksonville long-term disability lawyer explains why it matters and how to protect your rights in a claim. Farrell Disability Law has extensive experience with this.
Total Disability: Two Definitions That Produce Very Different Results
Most employer-provided long-term disability policies use one of two standards to define total disability. An “own-occupation” standard means you can’t perform material and substantial duties associated with your specific job. The “any-occupation” standard means you are unable to perform virtually any job.
Key differences between the two standards include:
- In “any-occupation”, an insurer may identify roles such as consultant, administrator, or case manager and argue that you are capable of performing them, even if those jobs are not available or would represent a significant income reduction.
- The “own-occupation” standard is more common in individual plans; employer-provided group plans most often apply the any-occupation standard or begin with their own occupation and transition to any occupation after 24 months.
- The 24-month transition is when most Florida claimants lose their benefits, often without realizing it was coming.
To determine the standard that applies to your Florida long-term disability claim, review your Summary Plan Description and other policy documents carefully. The Employee Retirement Income Security Act (ERISA) requires employers to provide copies of these documents, free of charge and at your request.
Insurers Use Occupation Standards To Dispute Florida Long-Term Disability Claims
Even when a policy starts with an own-occupation standard, insurers look for ways to use the definition against you. One common tactic is to describe your occupation in the broadest possible terms rather than examine what you actually did.
ERISA gives insurers broad discretion in interpreting policy terms, which increases the risk of denied or disputed benefits. Steps that can help protect your Florida LTD claim include:
- Review your policy’s definition of disability carefully, including any provisions describing how it changes over time.
- Document your actual job duties in specific, concrete terms rather than relying on a generic employer-provided job description.
- Ask your treating physician to address your functional limitations in direct relation to the duties your position requires.
- Request your full claims file from the insurer under ERISA once you file a claim or receive a denial, and review how the insurer has classified your occupation.
Because the administrative appeal is your one opportunity to introduce new evidence before the record closes, acting quickly after a denial is essential.
Contact Our Experienced Jacksonville Long-Term Disability Lawyer
Insurers often use occupation standards to deny or dispute Florida long-term disability benefits. To protect yourself when dealing with these companies, get professional legal representation from Farrell Disability Law.
Our experienced Florida long-term disability can review your policy, explain the terms, and advise you on the options. Contact our Orlando or Jacksonville office to request a consultation today.
Sources:
dol.gov/agencies/ebsa/laws-and-regulations/laws/erisa
dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/publications/filing-a-claim-for-your-disability-benefits.pdf
