Appealing a termination of disability benefits is complicated and confusing and is best done under the guidance of an experienced disability attorney.
If I file a claim for disability benefits do my chances improve with the assistance of an experienced long-term disability lawyer?
Author: Attorney Lonnie Roach
Whether you have a long-term insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance if you become too disabled to work is a complex process. The wording of policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals.
LTD insurance purchased through a private insurance broker is governed by state contract and bad faith law while the Employee Retirement Income Security Act (or ERISA) regulates group LTD policies.
Specific procedures and time limits to file claims are dictated accordingly.
LTD companies are not impartial – unlike the federal government in Social Security disability cases.
The more LTD claims an insurance company approves, the less money the company makes while approving fewer claims means a greater profit for the company. LTD companies rely on an applicant’s inexperience and ignorance of LTD procedures and rules to deny claims unfairly by employing a number of unfair practices:
- Requiring excessive, unnecessary or duplicative information;
- Delaying claims for an unreasonable amount of time;
- Paying lower benefits than stated in a policy;
- Terminating existing insurance payments; and
- Following a claimant and video-taping their activities to prove the claimant is not disabled.
It is easy for a claimant who is unrepresented by an attorney to make serious mistakes and lose their claim. Among the missteps a claimant can inadvertently take are:
- Quitting a job and then filing. Most LTD policies end coverage when employment terminates.
- Taking a less demanding job which can make an “own occupation” claim difficult to prove.
- Taking a job with a lower salary which can reduce LTD benefits.
- Missing a deadline.
- Completing a form incorrectly.
- Giving information to an insurance company the company will use against the claimant.
- Submitting unnecessary information.
An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid these pitfalls and increase their client’s chance of success.
An attorney acts on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you.
If you have been denied disability don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.
If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer.
In a lawsuit, a judge decides the case based on the information that is in the claimant’s file with the insurance company. This is known the administrative record. New evidence cannot be introduced so an attorney will make sure your file contains all medical evidence relevant to your case, working with your physicians and medical providers to include opinions about your employment limitations that support your claim. LTD attorneys know the proper questions to ask doctors and will not rely on forms provided by insurance companies, which may be biased. An LTD attorney can also hire independent experts to testify about the requirements of your job or the job market in general.
When should you consider hiring an LTD attorney?
It’s never too early to contact an LTD attorney to discuss your case, but it’s best to consult an attorney as soon as you are unable to work in order to protect your interests. You may not need attorney representation at the initial stage of your claim. If, however, your claim has been denied, you should strongly consider getting legal representation for the appeals process in order to avoid missing critical deadlines or making other serious mistakes that might harm your case.
Most LTD attorneys handle cases on a contingency-fee basis.
This means you do not pay an attorney’s fee unless the attorney wins your case. Usually, an attorney will pay up front for litigation costs such as medical records and depositions, but will require reimbursement later – sometimes even if you lose. It’s important to ask how much you can expect to pay for expenses and if you will be billed if the claim does not succeed.
There are big differences in how workers compensation claims, Social Security claims and LTD claims are processed and how “disability” is defined.
That is why it’s important to hire an experienced LTD attorney who knows the laws and regulations as well as the insurance companies and their policies. If you are considering filing a claim with your LTD insurance, the attorneys at Bemis, Roach and Reed can help you secure the benefits you deserve.
Disability benefits are an important source of income for those who are unable to work. If you not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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