Austin Long-Term Disability Lawyer for LTD Appeals
Austin Long Term Disability Lawyers dedicated to helping you obtain Long-Term Disability.
75 years combined experience helping the disabled
We have the knowledge and proven track record to help you win your LTD claim.
Author: Attorney Lonnie Roach
FREE Long Term Disability Consultation
It has become a common trend for long term disability insurance carriers to deny valid disability benefits claims either initially or after paying for a year or two, asserting that the person’s condition has improved or that the definition of disability has changed.
While their actions would have previously been considered insurance bad faith practices, the insurance companies contend that state insurance bad faith law does not apply to their activities. They argue that they are an employee disability benefits plan immune from state law and are governed solely by federal law favorable to the insurance company. As a result, individuals who have experienced a disabling illness or personal injury often find that their future ability to provide for their families depends on navigating the complexities of federal law.
If your claim has been denied, DON’T GIVE UP.
About 35% of employers provide their employees with Long-Term Disability Insurance. Long Term Disability Insurance (LTD) is private insurance to help support you if you become disabled. If you become unable to work, the LTD will help replace part of your income. Unfortunately, filing an LTD claim can be a difficult process.
If you have been denied long term disability you may still qualify for benefits. Contact an experienced long term disability lawyer at 512-454-4000 for help with your disability appeal.
If you are ready to appeal, don’t go unprepared.
Gather your claim file and medical records. Agencies and individuals who can verify your disability are your allies. If you are collecting Social Security Disability Insurance, then the Social Security Administration has decided you are unable to work. An affidavit from your previous employer is also strong evidence that would support your case. Coherent, comprehensive evidence will go a long way towards winning your appeal.
The Employee Retirement Income Security Act of 1974, also known as ERISA, is the federal law which governs the majority of Long Term Disability (LTD) insurance policies in this country.
For more information regarding ERISA, please click on our ERISA page or our page on ERISA Frequently Asked Questions. If the LTD plan is provided as an employee benefit or purchased as an employment related group plan, it is likely governed by ERISA. Because of the complexity of ERISA, very few lawyers will accept these types of cases. Unfortunately, without experienced legal representation, few claimants will prevail when faced with the seemingly endless resources of the insurance companies. The good news is that the Texas lawyers at Bemis, Roach & Reed have years of experience handling ERISA cases and have amassed an impressive track record of winning these cases for their clients at both the Federal District Court level and in the Federal Court of Appeals. Members of the law firm have also written articles on the subject to guide other legal services professionals.
If you have been denied long term disability benefits, Bemis, Roach & Reed offers a free consultation to determine if we can assist you in obtaining or reinstating those benefits.
When a claimant is denied, there is typically a 180-day period in which to submit an administrative appeal to the insurance company that denied the claim. If this is not done, it may be impossible to later challenge the denial in court. Once you receive a denial letter, it is important to contact an experienced disability lawyer as soon as possible. Cases have been won and lost depending on the quality of the administrative appeal. In most cases, Bemis, Roach & Reed will complete the administrative appeal for you as part of our legal services.
We have successfully handled cases against: Aetna, Cigna, Unum, Hartford, Metlife, Prudential, Standard, Connecticut General Life, Life Insurance Co. of N.A. , Lincoln Financial, Northwestern Mutual, Reliance, Assurant, CNA, Fortis, Liberty Mutual, Paul Revere, and many others, including the U.S. Government.
Bemis, Roach & Reed is a Long Term Disability law firm located in Austin, Texas who fights for maximum LTD benefits for folks just like you.
We represent clients throughout the State of Texas and have won claims against all major LTD carriers and the government. We off FREE Consultations and know what your rights really are. Bemis, Roach & Reed has helped clients who are disabled from a wide variety of medical conditions and will fight for you and your family.
Don’t give up, believe in your claim.
Call 512-454-4000 and get help today.
Don’t delay your FREE consultation, there may be crucial deadlines expiring.
Compassionately helping the disabled throughout Texas
Austin law firm Bemis, Roach & Reed provides legal services to individuals throughout the State of Texas. If you or someone you know is in need of insurance attorneys who specialize in Social Security disability and long term disability, call us toll free at (866) 433-4979.
“After working the same job for 28 years and always carrying LTD insurance. I became unable to work. Tried to deal with the insurance company on my own, but got absolutely nowhere. Found Mr Roach on the internet and after consulting him, I hired him. Not only is he and his wonderful staff completely professional. They also go the extra mile with compassion and truly caring about their clients. I highly recommend Mr Roach.”
Long-Term Disability FAQS
What is long-term disability insurance?
You may think you are not at risk for a disabling illness or injury, but one in four 20-year-olds may become disabled before retirement. Long-term disability insurance is insurance that provides income to an employee who becomes unable to work for a long period of time due to an injury or illness. Some people can get by for a month or two without income, but an illness or injury that stretches out over a long period of time can devastate a person’s finances and ruin their ability to make a living. Long-term insurance provides an income for an employee who is unable to work because of a disabling illness or injury. Some of the events covered under long-term disability include cancer, accidental injuries, heart attacks, mental disorders and accidental injuries.
Why do Long Term Disability carriers require you to apply for SSDI? ->
ERISA : The Summary Plan Description – ->
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How do you get LTD Insurance?
Long-term disability insurance is most often provided in a group plan by an employer or purchased by an employee through an employer. An LTD policy can also be purchased from an insurance carrier by an individual. LTD insurance does not cover work-related illnesses or injuries; those injuries and illnesses are covered by workers compensation insurance. The following are some of the most popular and best-known insurance companies that provide long-term disability insurance:
• Arthritis ->
• Bipolar Disorder ->
• Brain injuries and tumors ->
• Cancer ->
• Cerebral Palsy ->
• COPD ->
• Depression ->
• Diabetes ->
What is short-term disability and how does it differ from long-term disability insurance?
There are two types of disability insurance available to employees: short-term disability insurance and long-term disability insurance. Short-term disability insurance is insurance that will pay a percentage of an employee’s salary if they are temporarily unable to work due to illness or injury. When short-term disability coverage ends – usually after six months – if an employee is still disabled and cannot return to work, long-term disability insurance will take over, paying 50-60% of an employee’s salary. Long-term disability policies are measured in years as opposed to months. Benefits last until the individual can return to work or for the number of years stated in the insurance policy. The benefit period can last 2 years, 5 years, 20 years, or until retirement age. The shorter the benefit period, the cheaper the policy. While the wait period for short-term disability insurance to begin paying benefits is often less than 14 days, the elimination period for long-term disability insurance ranges from 30 days to two years, with the average period being 90 – 180 days. The longer the elimination period (the longer you can go without accessing policy benefits) the cheaper the policy. Disability insurance typically costs 1-3% of an individual’s salary. If purchased with pre-tax dollars (as through an employer), benefits are taxable, but if purchased with after tax dollars, as most private insurance policies, benefits are not taxed.
What is ERISA and why is it important?
The Employment Retirement Income Security act of 1974, or ERISA, is a federal law that sets minimum standards for most private industry retirement and health plans to provide protection for individuals covered under such plans. ERISA protects employees covered under employee benefit plans and ensures employees receive the benefits promised under those plans.
Most group LTD policies are covered by ERISA. As such, ERISA regulates how disability claims are processed, timelines for processing a claim, and an individual’s rights if a claim is denied. When an injured worker files a claim, their employer or the insurance company may try to deny the claim by saying the employee is not disabled, not covered by the policy or some other reason. Long-term disability policies governed by ERISA provide the right to appeal a denial or file a lawsuit. ERISA’s role is to protect employees of private plans; public employee plans may have protections in place.
ERISA provides specific procedures to follow when filing claims and appealing decisions under a group long-term disability policy. Long-term disability policies purchased privately are contracts between an insurance company and the policy holder and governed by state insurance law. Under ERISA, a claimant has the right to appeal any “adverse benefit determination” which includes any denial, reduction in benefits, or failure to provide or make payment in whole or in part of a benefit.
What practices do LTD insurance companies employ to deny claims?
Most long-term insurance policies are purchased through an employer which means the insurance plans are subject to the rules and regulations of The Employee Retirement Income Security Act of 1974 or ERISA. While ERISA requires claimants and respondents to meet specific deadlines for filing claims and appeals, the law allows an insurance company or a plan administrator to have the final say as to whether a claim should be denied or approved. An insurance company will rely on the law to its best advantage. A denial can only be reversed if the claimant can prove that the insurance company’s decision was arbitrary and capricious.
Long-term disability insurance companies will use many strategies to deny your claim. They may refuse to give a claimant a copy of its insurance policy, insisting that the policy can only be obtained from their employer. An insurance company may not disclose whether the medical experts they hire to review cases are employees, independent contractors, or paid reviewers and may refuse to turn over the invoices for services these medical providers perform. These documents are all part of the “administrative record.” The law requires an insurance company to supply a copy of any document the insurance company has considered in denying a disability claim. The administrative record is important because, if a case proceeds to court, it will likely be the only thing a judge will look at in deciding the case. A claimant will not be allowed to call witnesses to testify or introduce exhibits in court that were not submitted to the insurer during the administrative appeal process.
Other tactics an LTD insurance company may employ:
• An insurance company will hire medical providers who are biased to review claims without examining or speaking to a claimant.
• An insurance company will review social media to find anything they can use to prove the claimant is not disabled.
• An insurance company will hire private investigators to follow a claimant and take videos to prove the claimant is capable of working.
• When a policy converts from “own occupation” to “any occupation” (usually after two years) an insurance company will hire a vocational consultant to analyze a claimant’s training, education and work experience. Most of these consultants are employed by the insurance company itself and usually find the claimant is capable of performing some type of work.
How can I avoid a denial of my claim?
There are a number of things you can do to increase your chances of success when submitting a long-term disability claim.
• Do not quit your job; if you quit your employment, your long-term disability coverage may terminate. Instead, as soon as you become disabled inform your employer and insurance provider that you intend to file a claim.
• Read your policy and make sure you understand its definition of “disabled” and its terms and limitations.
• Make sure your doctor provides a supporting opinion that details your limitations. (If your doctor will not provide a statement, find another doctor).
• Provide complete medical records, including results of all tests and procedures.
• Continue prescribed treatments and keep accurate records. All contact with your insurance company and medical providers should be documented in writing.
• Pay attention to all deadlines stated in the denial notice and submit all medical records and documentation as soon as possible.
• Hire a qualified disability attorney to assist you.
What if my claim is Denied?
If your claim is denied, however, then you need to speak with an attorney before you take any additional actions. You will have an opportunity to appeal the denial, but you may only get one chance to do so. An experienced attorney in your corner can make all the difference.
What is the basic appeal process?
ERISA requires a claimant to exhaust all administrative appeals before filing suit. Under ERISA-governed plans, when your claim is denied, you have 180 days from the date notified of the determination to submit an appeal. Once the appeal is submitted, the insurance company or plan administrator has 45 days to decide the appeal. Additionally, the insurance company is permitted to request an extension of 45 days for a total of 90 days. If your appeal is denied, you may file suit in federal court.
Do I need an attorney to file for LTD benefits?
That is the most common question facing an individual filing a claim for long-term disability insurance benefits. The short answer is that we don’t always know. Depending on your disabling condition, the quality of your medical records, the support of your doctors, and the disability insurer itself, you may not need an attorney at the initial claim stage. You should however, consult a long-term disability attorney as soon as you become disabled. If your LTD claim is denied, you will want to hire a long-term disability attorney to prepare your appeal. An ineffective or untimely appeal can cost you an opportunity to pursue your claim in court. The good news is that you can contact Bemis, Roach & Reed and speak with one of our attorneys, even before you file. We will not be able to tell you whether your claim will be approved, but we can often give valuable advice on starting the claim process.
What does an LTD attorney do?
Most LTD group insurance is governed by ERISA which has very specific procedures and time deadlines to follow when filing a claim. Experienced long-term disability attorneys know the rules and procedures set out by ERISA.
An experienced LTD lawyer will:
- Prepare a claim for filing.
- Make sure a claim file contains all relevant medical evidence.
- Work with medical providers to collect opinions to support your claim.
- Know the questions to ask and how to gather all the information needed, instead of relying on forms provided by the insurance company.
- Hire experts to testify regarding the requirements of your job and the overall labor market.
- Acts as your representative, interacting with the LTD carrier or plan administrator.
- Calendars deadlines and files claims and appeals in a timely manner.
- Conducts settlement negotiations and files a lawsuit if necessary.
Why should I hire Lonnie Roach?
In order to defend your claim against an LTD insurance company, you need an attorney experienced in long-term disability claims, especially those subject to ERISA. Disability cases involve volumes of medical records and require a person with the skill to interpret that information. When cases proceed to trial, a claimant needs the skills of an appellate attorney. Lonnie Roach is all these and more. Mr. Roach is a Board Certified Personal Injury lawyer and recognized as an authority in ERISA cases. Admitted to the United States District Courts for the Northern District of Texas, the Southern District of Texas, the Eastern District of Texas, and the Western District of Texas, as well as the United States Court of appeals for the Fifth Circuit, Mr. Roach has successfully overturned denials of disability benefits at trial in U.S. District Court and at the United States Court of Appeals. His published opinions have earned him a place as one of the top attorneys in ERISA law in the state of Texas. Lonnie Roach will consult with you as soon as soon as you become disabled and help you avoid common mistakes.
What is special about Bemis, Roach & Reed?
Bemis, Roach & Reed is a law firm that focuses strictly on representing clients in disability benefits claims, including long-term disability insurance and Social Security Disability Income. While some other firms who specialize in another area of law may represent clients in disability claims as a “sideline,” Bemis, Roach & Reed handles only disability benefits cases. Our friendly and professional staff will treat you with respect and sensitivity and ensure your best chance for winning your claim.
What does an LTD lawyer cost?
Our long-term disability attorneys work on a contingency fee basis, charging a percentage of your past-due benefits. Bemis, Roach & Reed will pay the costs of litigation up front and you do not pay anything if you do not win your case. Additionally, your initial consultation is free.
Don’t Forget Life Insurance Premium Waivers
Most people who rely on Long Term Disability insurance to pay the bills are understandably concerned when their LTD claim is denied. If your coverage is employer-provided, then it is likely governed by The Employee Retirement Income Security Act of 1974, better known as ERISA. If you have employer-provided LTD coverage, then it’s likely that you have an ERISA-governed life insurance policy as well. Typically, your life insurance will continue with premiums waived while you are considered disabled. The denial of LTD benefits, however, will often trigger a denial of the premium waiver for the life insurance policy as well.
Some people don’t worry about the premium waiver because they’re focused on the LTD claim. This is a mistake. If your disability is due to a chronic medical condition, as so many are, then you may find it difficult to find replacement life insurance when you lose your employer-provided coverage. Worse yet, if your chronic condition results in your death, then your loved ones may find themselves with no benefits just when they need them most.
If your premium waiver claim is denied, you must appeal it within 180 days, just like you do your LTD claim. When I submit an LTD appeal for my client, I typically submit an appeal of the denial of a premium waiver claim at the same time. If the LTD appeal is denied and we have to file a lawsuit, we include the premium waiver in the lawsuit filing. Typically, when the LTD appeals are successful, the premium waiver appeal is granted as well. If no premium waiver appeal was sent, however, then the life insurance coverage will likely end and can never be reinstated. Since this is the only life insurance many disabled people will qualify for, it is crucial that the coverage be protected by filing a timely appeal.
Bemis, Roach & Reed has helped clients who are disabled from a wide variety of medical conditions. If you are unable to work due to any of the following conditions and have been denied disability benefits, contact us. We would like to help.
- Acid Reflux
- AIDS / HIV
- Alcohol Dependence
- Amyotrophic Lateral Sclerosis ("ALS")
- Autoimmune Disorder
- Back Pain
- Bipolar Disorder
- Bladder Control
- Blood Disorder
- Brain Aneurysm
- Brain Tumor
- Breast Cancer
- Bulging / Herniated Disc
- Cancer (all kinds)
- Car Accident
- Carpal Tunnel Syndrome
- Cerebral Atrophy
- Cerebral Palsy
- Cervical Disc Disease
- Chronic Fatigue Syndrome
- Chronic Obstructive Pulmonary Diseases (COPD)
- Chronic Pain Syndrome
- Congestive Heart Disease
- Congnitive Dysfunction
- Coronary Dysfunction
- Crohn’s Disease
- Cystic Fibrosis
- Degenerative Disc Disease
- Down Syndrome
- Epstein-Barr Virus
- Essential Tremor
- Falls and disability
- Gastrointestinal Reflux
- Hearing Impairment
- Heart Failure
- Hepatitis C
- Herniated / Bulging Disc
- High Blood Pressure/Hypertension
- Hip Replacement
- Hodgkin’s Disease
- Huntington’s Disease
- Interstitial Cystitis
- Irritable Bowel Syndrome (IBS)
- Ischemic Heart Disease Disability
- Kidney Disease
- Knee Disorder/Replacement
- Liver Cancer
- Liver Disease
- Lumbar Disc Disease
- Lumbar Radiculopathy
- Lung Cancer
- Lyme Disease
- Macular Edema/Degeneration
- Memory Disorder
- Menieres Disease
- Mental Illness
- Multiple Myeloma
- Multiple Sclerosis
- Muscular Dystrophy
- Myofascial Pain Syndrome
- Neurocognitive Disorder
- Parkinsons Disease
- Peripheral Neuropathy
- Post-Traumatic Stress Disorder (“PTSD”)
- Prostate Cancer
- Reflex Sympathetic Dystrophy (“RSD”)
- Rheumatoid Arthritis (RA)
- Seizure Disorder
- Sjorgen's Syndrome
- Skin Cancer
- Sleep Apnea
- Spinal Stenosis
- Systemic Sclerosis
- Temporal Mandibular Joint Dysfunction (TMJ)
- Throat Cancer
- Traumatic Brain Injuries
- Vision Impairment
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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At Bemis, Roach and Reed, if we can't help you, we will try to find the right attorneys for you.
We offer each of our prospective clients a free no obligation one hour phone or office consultation to see if we can help you and if you are comfortable with us. We know how difficult a time like this can be and how hard the decisions are. If we can be of assistance to you and help you find a solution to your issue we will even if that means referring you to another attorney.
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