Unlike social security disability and SSI, long term disability benefits are provided by private LTD insurance companies. Insurance companies are in business to make profit…lots of profit. Logically speaking, paying out on fewer Long Term Disability claims means more profit, and paying out on more claims means less profit. Are LTD disability claims unfairly denied? The answer is YES, without a doubt, many are. In fact, one of the (if not THE) largest, long term disability insurance companies was recently investigated by the Department of Labor and was forced to agree to reconsider 200,000 denied LTD claims.
Frequently Asked Questions
Click on any question to read answer.
Long term disability insurers unfairly deny as many LTD claims as they do because:
- There aren’t enough long term disability attorneys in practice (especially compared to attorneys who handle social security disability and SSI).
- The long term disability carriers know that most claimants who apply for long term disability benefits might not continue to fight them and pursue the benefits to which they are entitled.
- A staggering number of claimants will give up and try to go back to work or apply for Social Security Benefits which lets the LTD insurance companies off the hook.
Having a long term disability attorney with you, can send a strong message to an LTD company that you need to be treated fairly.
Most claimants who show up at a Social Security Disability hearing unrepresented, generally do not win. You must “prove” your entitlement to certain benefits. Dealing with a long term disability claim is very much the same and you should probably consider speaking with an experienced long term disability lawyer before making any decisions.
Having an attorney on a long term disability case can help you improve your chances of winning and motivate an LTD carrier to properly evaluate your claim, giving you proper and fair consideration. Depending on the state in which you live, if the LTD company arbitrarily denies your claim, they may be required to pay your legal expenses and may be assigned to pay punitive damages for having operated in “bad faith”.
While a disability lawyer is not required, your chances of securing disability benefits increases significantly if you are represented by an experienced disability lawyer. The sooner you retain an attorney, the more time the attorney will have to obtain the medical and vocational evidence to prepare your claim. An attorney should help you avoid making statements at interviews and in writing that can be misconstrued, and how to address evidence that may appear to hurt your claim for disability benefits, such as reports from doctors paid by insurance companies and the Social Security Administration (SSA).
It’s best to at least consult with a long term disability lawyer before even applying for LTD benefits, simply to know what you may be up against. Although social security disability claims are similar, a long term disability claim, is handled on the basis of a legal contract entered into by two parties, the LTD carrier and the long term disability claim holder. As we all know, contracts are typically written to favor the writer of the contract. Consulting with a long term disability lawyer can help you better understand both the terms and provisions of your policy and, if you choose to retain representation early in the process, may signal to your insurance company that your claim should receive proper, thorough, and fair consideration.
You should have a copy of your claims file. If your claim is for long term disability benefits, then you can request the records from the insurance company. You should also get your Summary Plan Description from your employer, union or the insurance company. If your claim is for Social Security Disability Indemnity (SSDI) benefits, then you can get a copy of your file from your local Social Security field office, or the Office of Disability Adjudication and Review.
No. Substantive medical evidence, and frequently vocational evidence is invariably required to maximize the likelihood for an appeal to be successful.
Yes, especially since it may be a requirement of your LTD, or long term disability policy. The long term disability carrier is simply hoping to get back payments on disability you are entitled to receive from Social Security Disability or SSI disability. This is not fair because an LTD, or long term disability policy is something you pay for. If you become disabled and are unable to work, you should be entitled to receive your long term disability benefits, because you paid for them, without having to turn over your SSD or SSI back payments, allowing the long term disability carrier to recover their costs.
Unfortunately, this is a provision that long term disability companies have been allowed to insert into their contracts. Fortunately, you can seek the assistance of a long term disability lawyer at any point in this process. This can be done while the LTD claim is being decided, after a claim is denied, or even before a person has been denied for long term disability benefits.
No. Approval of disability benefits by an insurance company or the Social Security
Administration is not binding on the other.
Yes. A so-called “Independent Medical Examination by a physician paid by an insurance company is rarely independent. These physicians know who is paying the bill and they aim to please in order to get more work. Surprisingly, these physicians frequently do not specialize in the area of medicine that is relevant to the claimant’s impairments. Furthermore, because these physicians only get a “snapshot” of your condition from their one examination, they often fail to observe or understand the problems you experience intermittently or in varying degrees of severity.
Most LTD policies put a cap on the amount of time you can receive long term disability benefits for reasons of a mental condition. It has actually been alleged that LTD carriers will attempt to classify some conditions as mental versus physical to avoid having to pay long term disability benefits beyond the typical two-year time frame. This is why it is very important to have an experienced long term disability lawyer on your side. A lawyer can review your policy before you file a long term disability claim, to better understand your plan’s definition of disability so your plan’s requirements for approval have a stronger chance of being met. More importantly, however, a lawyer can work to ensure that your claim receives full and proper consideration. The involvement of an attorney, especially one who specializes in long term disability, may give the insurer the necessary incentive to review the claim properly.
You may be able to sue your long term disability insurance carrier if they act in bad faith and unfairly deny your LTD claim. However, if your long term disability insurance plan is an ERISA plan you will not be able to sue for punitive damages. You will be able to sue for the long term disability benefits that you are owed along with interest, plus a portion of your long term disability lawyer fees.
Regardless of whether your long term disability benefits are derived from an ERISA or non-ERISA plan, the involvement of a long term disability lawyer on your case can serve to send a strong message to the insurance company that your LTD claim should receive full and consideration. It will simply not be worth it to them to escalate their own costs. Hiring a long term disability lawyer can better your chances of receiving benefits.
If your claim is denied and governed by ERISA, you are required by federal law to file at least one appeal. ERISA regulations require that an appeal must be filed within one hundred and eighty (180) days from the date of the insurance company’s denial letter; so it is imperative that you quickly and efficiently take proactive steps to appeal the insurer’s decision.
For both ERISA and private disability claims, the time frame to file a lawsuit is typically governed by state contract law, unless the applicable disability plan requires a disabled claimant to file suit within a shortened period of time. If you are considering filing a lawsuit, it is imperative that you consult a lawyer expeditiously to determine if your claim can be timely filed within the applicable statute of limitations.
If your claim is governed by ERISA, unfortunately neither you nor your physicians will be able to testify in your case. Moreover, with limited exceptions you will not be able to present any additional evidence beyond what was previously submitted to the insurance company.
In a non-ERISA (i.e., private) disability claim, both you and your physicians likely will have an opportunity to testify in front of a jury.
In an ERISA case, a disabled claimant does not have the right to a trial. Cases are typically decided by a federal judge on legal papers (i.e., motions for summary judgment).
In a non-ERISA case, a disabled claimant typically will have a right to present a case to a jury at trial.
Every case is unique on its facts, and the only way to gain a better understanding of the merits of your claim is to request a free, no risk consultation with a competent disability lawyer.
Other than in very unusual circumstance, all matters are handled on a contingent fee. A disabled claimant will not owe any fees or costs unless and until the claim is successfully resolved.
On both ERISA and private disability claims, insurance companies frequently will entertain lump sum settlement discussions in situations where disability benefits are approved and being paid out monthly. Conversely, when a claim is denied and the disabled claimant is venturing through the appeal process, an insurance company typically will not discuss any type of claim settlement. However, if a lawsuit is filed and the contested case goes to court, quite often with the court’s assistance, the parties will work together to reach an amicable settlement of the disputed disability claim.
Yes and no. Many people certainly “can” fight the insurance company without competent legal counsel. However, the disabled claimant should keep in mind she will be fighting against an experienced claims adjuster, a claims supervisor, a nurse case manager, and often times a cadre of physicans; all with the marching orders to justify a claim denial. With such important consequences at stake for the disabled claim, it really is prudent to seek the assistance of a competent and qualified legal representative as soon as possible.
Disability law is a very narrow and focused area of the law. You should certainly strongly consider retaining a disability law specialist. You should also note there is a large distinction between a lawyer specializing in Social Security law, and a lawyer who specializes in Long Term Disability law. When speaking to a prospective lawyer, it is important to ask questions about qualifications, experience, and competency pertaining to ERISA and private disability claims. You should not be afraid to ask questions.
Because they can. They’re not expecting you to fight back. Prove them wrong.