Everything You Need To Know About Permanent Total Disability

What Is Permanent Total Disability?

A permanent total disability in the State of Florida requires an employee to demonstrate that they are unable to work even a sedentary or seated job (such as a job working at a computer or a desk) on a full-time basis. Examples of such disabilities might include a spinal cord injury and paralysis, a severe neurological disorder such as chronic seizures, or severe loss of vision.

Who Determines If My Injury Is A Permanent Total Disability?

An adjuster assigned to your case would make the initial decision as to whether or not an insurance carrier would agree to pay permanent disability benefits. While there are certainly times when both the injured worker and the carriers agree that the injury qualifies as a total disability, sometimes there are disagreements.

What happens then? Should the carrier assigned to your case disagree that you are permanently and totally disabled, the next step would be for a consultation with us to review your case. After we determine that there are sound reasons to move forward, we would then present your case before a judge of compensation claims in a formal legal proceeding.

This process ensures that you have every professional and fair chance to make the case for a total and permanent disability, and the benefits that would come with this designation.

What Benefits Are Available Under Permanent Total Disability?

In the state of Florida, workers who are determined to be permanently and totally disabled are entitled to two thirds of their average weekly wage to be paid through and including age 75 in the timeframe of 1-5 months. For example, if your average weekly wages prior to disability were $900, you should expect to receive the equivalent of a $600 weekly wage through permanent total disability benefits until you reach the age of 76, and include an annual cost of living increase.

Should you suffer an injury that leaves you totally disabled between the ages of 70 and 75, however, these benefits can be paid out five years from the time of injury, and include an annual cost of living increase.

What Evidence Do You Need To Prove Total Permanent Disability?

To prove permanent and total disability in the State of Florida, expert advice from both medical professionals and from vocational professionals are typically needed as evidence. A medical professional (such as a family doctor) will need to be able to testify that your physical condition makes even sedentary full-time work impossible.

A vocational expert would be a professional with knowledge of the physical working conditions in various jobs. They would give testimony about the real-life physical demands of various fields of work available, and their testimony would help determine what kind of work you would be capable or incapable of doing in various settings.

The judge reviewing your case would take both the medical testimony and the vocational testimony into consideration when determining whether you qualify for permanent total disability, as your medical limitations and the real-life requirements of available work options would be considered together.

What Are The Most Common Reasons Permanent Total Disability Claims Are Denied?

The most common reason that permanent total disability claims are denied are when the carrier determines that an employee should be able to physically manage at least a sedentary job. A sedentary job in this case means that the employee would not have to lift more than 10 lbs., and would be able to sit to perform the job.

The carrier may also determine that the employee’s workplace would reasonably accommodate these restrictions, and will thus deny the claim on the basis of modified full-time employment still being possible.

It’s important to remember that even if you were physically able to perform your job in the past, the State of Florida does not heavily weigh past ability, but rather looks at current ability to determine disability benefits. If sedentary full-time work is determined to be medically impossible, the State will take this into consideration no matter what your past physical abilities were.

How Soon After Applying Will I Know If My Permanent Total Disability Claim Is Approved Or Denied?

Once you have submitted a permanent total disability claim with an insurer, expect anywhere from 3 to 5 months on average for a response. This time period varies, and may depend on the complexity of your case and how much medical documentation is requested. If you do receive a notice of denial, the next step is to reach out to a knowledgeable and dedicated lawyer with experience in handling disability claims as soon as you can.

When a carrier does not communicate or respond to a claim within the initial request period, we generally take that as a denial of the claim, and can then proceed to litigation in front of a judge.

Should your case move forward with litigation, this process typically moves quicker. Once your claim is filed before a judge, the carrier will typically respond within days.

If Denied, Will I Know The Exact Reason?

Most of the time, a carrier will explain why they have determined that you do not qualify for permanent total disability. The discovery process, or the period of time wherein the carrier determines or verifies your physical limitations and workplace options, can lead to opinions that are usually explained by the carrier.

It’s important to know what these opinions are and how they were formed, as this helps us move forward better equipped and prepared to present a case. However, even in cases where a carrier does not respond or does not give an explanation, cases may still move forward legally.

For more information on Permanent Total Disability Claims In Florida, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (386) 388-6260 today.