The services a long-term disability insurance lawyer can provide you depends on where you are in the claim process.
Every case is different. Some disabled workers have little difficulty substantiating their disability claims, so the insurance adjuster accepts the claim application and begins processing it quickly. In other instances, that may not be the case. Below is an overview of some possible scenarios in which a long-term disability insurance lawyer can help you with your claim.
Making The Initial LTD Claim
Most long-term disability insurance claim packets have the same basic forms and claim requirements, known in insurance parlance as “proof of claim”. They typically include questionnaires for the disabled worker to complete, a questionnaire for his or her employer, and one for his or her physician or physicians. They also require submission of medical records to document the disability. If the records are not in the claimant’s possession, then an authorization to release those records to the insurance company is usually required.
Most of the time the initial claim process goes off without a hitch. Sometimes, however, the claimant/disabled worker will get the feeling that he or she is getting the runaround from the insurance adjuster. If you start to feel like the insurance adjuster is asking for the same information and documentation over and over, and you’re getting nowhere with your claim it’s probably time to contact a long-term disability insurance attorney.
At this stage of the process your attorney will “quarterback” your claim by making sure all the necessary questionnaires and documents are completed, medical records are assembled, any additional statements or documentation that may be helpful to your claim is obtained and it is all timely submitted to the insurance company. An experienced long-term disability lawyer will be familiar with the claim forms and will know precisely what information and documentation the insurance company needs to process your claim. An experienced long-term disability insurance lawyer will also be familiar with the federal regulations that impose deadlines on insurance companies for making a decision on a disability insurance claim, and will be able to hold the insurance company to those deadlines.
The Initial Claim is Denied (Filing An Administrative Appeal)
If you haven’t contacted a long-term disability lawyer yet, now is definitely the time to do so. In an ERISA disability insurance case this stage of the process, called the administrative appeal, is the best opportunity you will have to get your claim approved. It is, therefore, very important that you not try to handle the appeal without legal help. And don’t delay. In almost all cases you have no more than 180 days to file your appeal with the insurance company.
The first thing your long-term disability lawyer will do is notify the insurance adjuster that you are represented by legal counsel. He or she will then request all the records the adjuster has in your claim file to see exactly what was relied upon by the insurance company to deny your claim. He or she will also study the claim file to determine if the reasons the insurance company gave for denying your claim are corroborated by the records in the claim file.
If you haven’t already received it from the insurance company or your employer, your long-term disability insurance attorney will obtain a copy of the long-term disability insurance policy. The policy contains critical information necessary to evaluate your claim, such as the monthly benefit amount, how long benefits are potentially payable, and what time limitations apply to disabilities caused by certain illnesses.
Your lawyer will then start the process of obtaining whatever records he or she determines are necessary to prove your disability claim. Usually these are medical records, but in some cases the attorney may need to draft questionnaires for your doctors to fill out so that the attorney will have all the information necessary to substantiate your claim.
In some cases it may be necessary to retain an expert vocational counselor to render an opinion regarding a disabled worker’s ability to perform job functions. If your long-term disability insurance attorney deems this necessary he or she will know a reliable expert to work with.
Once all the documentation has been received by the attorney, he or she will then draft the appeal and submit it to the long-term disability insurance company, along with all of the medical records, questionnaires, and reports to substantiate your claim for long-term disability insurance benefits.
At this point the insurance company has three options: It can either reverse the denial of benefits and initiate payment, stand by its earlier denial and give you the option to file a second appeal, or stand by its earlier denial without the option of a second appeal. If a second appeal is an available option your long-term disability insurance attorney will be able to determine if it is to your advantage to go forward with the second appeal, or not. If a second appeal is not in your best interest, or if the long-term disability insurance company does not offer the option of filig one, then the next step, and only remaining option, is to file a lawsuit.
Filing A Lawsuit
If your administrative appeals were not successful, the only remaining avenue of relief is to file a lawsuit against the long-term disability insurance company.
As is true with all other aspects of a long-term disability insurance case, if you find yourself having to file a lawsuit is imperative that you have a lawyer experienced in litigating this type of insurance dispute. An experienced long-term disability insurance lawyer will know what types of claims you can bring against the insurer, which matter, and he or she will know the best strategies for maximizing a recovery on your behalf.
If you are searching for a lawyer to represent you, make sure you ask the attorneys you speak with if they have specific experience litigating long-term insurance disability denials. If not, ask him or her for a referral, or keep looking.