Long-Term Disability Insurance FAQ
We’ve been representing claimants in long-term disability appeals and federal court litigation since 1999. Our takeaway: disability claims are complicated! Here are some of the questions we get most often
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If you have appealed and lost, your next step is most likely litigation in federal court.
Here's where it's important that you or your lawyer raised all the factual, medical, and legal arguments that should have been raised in the appeal. It's too late to add new evidence to your file (there is no calling witnesses in these cases).
We will review both your initial denial letter and your appeal denial letter for free to see what evidence was added during the appeal. We have won and settled many cases where the appeal was not ideal but was either "good enough" or was mishandled by the insurance company.
If you have appealed and lost, you may have a second "voluntary appeal." Check your final denial letter. If you do have a voluntary appeal, then treat that as your first appeal and let us have a look at both of your denial letters. We will give you a detailed personalized strategy for winning your appeal. Again, this is free.
If you have already appealed but the insurance company has not yet made a decision on your claim there may still be time to improve your claim.
Some insurance companies will allow you to "withdraw" your appeal and start a new one as long as the new appeal is started within 180 days of the original denial letter. Other insurance companies won't allow this, but they may allow you to submit additional information now in support of the appeal that has already been filed.
In either case, we are happy to talk to you. You should get us your denial letter and any information that has come back from the insurance company before today. We will review this for free and give you our ideas for how best to move forward.
Obviously, time is of the essence.
What if I've gotten a letter saying the insurance company is going to deny my claim but wants my doctors to respond to a "peer review"?
“Peer review” is insurance talk for a bank of so-called “independent” experts who make their money justifying claim denials. Due to a recent change in the disability insurance regulations, insurance companies are now required to let you know if they have hired an expert who is ready to give them the ammunition to deny your claim.
You should not ignore this letter. If you do, the insurance company gets the last word, and the last word is sure to be "denied."
You also should not just pass on this letter to your doctors and ask them to read and respond because they are doctors, not lawyers. While meaning well, they may say or do something that will legally impair your claim. (For example, did you know that "no restrictions on sitting" is often insurance company-speak for "able to work full-time in a sedentary job?")
We will review your letter for free and give you a recommendation for how to respond.
Yes, of course. We speak to many people each week who are on the claim but who have questions. Some want to know about the best strategy to return to work without impairing their benefits. Some want to make sure that their benefits are being calculated correctly. Some people simply want to know and understand more about their policy. If you are on claim and have questions reach out to us. Simple questions can be answered with an email. Other questions will require a paid consultation, especially if we need to review documents or medical records. We will tell you up front how much a consultation will be. No surprise fees!
Call us at the number at the top of this page or go to the contact page and fill out a form to get started.
We can and we should! The absolute best time to speak to an experienced disability attorney is before you file for benefits.
It is really important that at the time you file for long-term disability benefits your medical records fully support your claim. Once you file there will be forms to fill out and an interview process with the disability insurance company. It is important to understand how to handle this step of the process, especially if your disability is complicated or, experience tells us, if you are a high wage earner.
Insurance companies know that once they approve a claim, they will have a harder time arguing that the person they once said is disabled has improved to the point where they can return to work. They have a high standard of proof for claims that are likely to be expensive for them.
It's also important to understand how receiving disability income will affect your financially. We represent a lot of doctors, dentists, lawyers, CEOs, CFOs, and other business owners or self-employed individuals. These claimants typically have complex tax and business issues that can affect their disability benefits claim and in particular the calculation of benefits. For these claimants, it is imperative that they speak to an attorney before filing their claim.
Simple questions can be answered with an email. Other questions will require a paid consultation, especially if we need to review documents or medical records. We will tell you up front how much a consultation will be. No surprise fees!
For consultations not related to a denial letter (i.e. you are thinking about going out on a claim, or you are on claim and you have questions) we charge a flat fee. This fee is later credited to you if your claim is terminated and we represent you in the appeal and/or the lawsuit.
For most appeals and lawsuits, we represent you on a contingent fee basis. This means you pay us nothing up front, and if we are not successful in recovering benefits for you from the insurance company, there is no fee. Our fee is one-third of the benefits recovered.
If your case is litigated in federal court, and you win the litigation, the court may order the insurance company to pay all or a portion of your legal fees. This is discretionary with the court and depends on a number of issues. The insurance company does not pay your legal fee if you win your appeal.
Before you hire us to represent you, we will fully advise you of how fees and costs work, in writing. There are never any surprises with us.
ERISA is the Employee Retirement Income Security Act of 1974. It is a federal law that governs most group disability insurance benefits (it governs a lot of other employee benefits that are not relevant to this discussion, too).
There are two things very important to your claim: the language of the disability insurance policy that your employer purchased, and ERISA and its rules and regulations. An insurance company must comply both with the terms of your employer's disability insurance policy and ERISA's rules and regulations.
A note of caution: some lawyers will tell you that they will write your appeal to the insurance company but they "don't do lawsuits." What they are really doing is gambling with your claim. ERISA says that no new evidence can be added to your case after the appeal is decided. In most cases, a judge isn't deciding whether the insurance company was right or wrong to deny your claim - they are only deciding whether the insurance company's decision was reasonable given the information it had at the time. In our experience, the "I only do appeals" lawyer either doesn't fully understand this or doesn't care, since they are not going to be the one trying to piece together a litigation case based on an incomplete record.
Always ask anyone who represents you, "what happens of we lose the appeal?"
The vast majority of our clients, because they are disabled and many live hundreds if not thousands of miles away, never come to our office. We are located in a terrific building near George Mason University in Fairfax County, Virginia, just outside of Washington, D.C. The nearest airports are Dulles International Airport and Reagan National Airport. Today, most of our work is done by phone, fax, email, and video conference. Court filings are made electronically, and many court hearings are being held by telephone. In short, you will likely never have to come and visit us at our offices.
That's why we made this video. Virtual Tour Page
ERISA's regulations permit you to appoint out of state attorneys to submit an appeal on your behalf. In the event that your case must be filed in court, we will work with an attorney who is admitted to the federal court where your case is filed. This is common practice in our industry and this process is transparent to you. There is no additional cost or attorney fees.
Over 99 percent of our long-term disability clients never actually set foot in our office. Besides being located hundreds or even thousands of miles away from us most are disabled to the point where even a visit to an attorney's office is challenging or impossible.
There is never a need for an in-person appointment as our work can be done by email, telephone, and video chat.
You can take virtual video tour of our office here. Virtual Tour Page
If you are more comfortable dealing with an attorney that you can visit live and in person and if there is an ERISA disability qualified attorney near you, we will be more than happy to make the introduction for you. We know who the top long-term disability attorneys are around the country.
What's the number one question I should ask before hiring a lawyer to do my appeal or my litigation?
You need to make sure that lawyer has experience in actually litigating these cases. Litigation experience is very important even to appeals because litigation will only be as good as the appeal that was done. Lawyers who do appeals only and never litigate do not have the incentive to get the appeal done "just right."
The number one question you should ask a lawyer is how many federal lawsuits they have filed on behalf of claimants under ERISA? Contact us, and we'll send you our list. Sadly, many lawyers advertising that "we do long term disability appeals" have no such list.