If you’re considering filing a claim for long-term disability (LTD) benefits, either through a private IDI policy or group LTD (ERISA) policy, you may be wondering whether it’s necessary to retain a lawyer to assist with the process. The short answer is: yes. Retaining an attorney who focuses their practice on long-term disability insurance will be immensely beneficial. Navigating the complexities of disability claims—whether through a private policy or an ERISA plan—is daunting, even more so when you are too sick to work. A skilled LTD insurance lawyer can help you avoid common pitfalls and increase your chances of receiving the benefits you’re entitled to.
Let’s break down the reasons why you might want to retain a lawyer, and how an experienced attorney can assist you throughout the claims process.
The Claims Process Is Complex and Loaded with Potential Errors
The process of filing a disability claim is far from straightforward. Both private and ERISA disability insurance policies have their own sets of rules, regulations, and deadlines. While it may seem like a simple matter of submitting a claim and waiting for approval, insurance companies often make the process more complicated by requesting extensive medical documentation, imposing strict deadlines, and setting up rigid criteria for evaluating whether you qualify for benefits.
A long-term disability insurance lawyer understands the intricacies of the insurance company’s procedures and the nuances of the disability insurance claim process, and can help ensure you provide the correct documentation, meet all necessary deadlines, and submit a claim that maximizes your chances of success. They can help you craft a compelling case and make sure that all required information is included from the outset—reducing the risk of errors or omissions that could result in a claim denial. They can spot issues, before they arise as problems, and thus, prevent spills, to avoid cleaning messes that may occur.
Insurance Companies Often Deny Claims or Delay Payments
Insurance companies are reluctant to pay out large claims, and they have teams of adjusters, doctors, economists, actuaries, and lawyers working to minimize their liability. They may deny claims for a variety of reasons—not all of them legitimate. Whether it’s a deliberate misunderstanding of the medical evidence, an incorrect application of the policy’s terms, or even a simple attempt to avoid payment, your claim is too important to leave unprotected.
If your claim is denied, having a lawyer who specializes in long-term disability insurance can make a significant difference. An experienced LTD lawyer knows how to carefully review the denial letter, assess the reasons for the denial, and determine if it was based on faulty reasoning, incomplete information, or improper interpretation of the policy terms. More importantly, they can help you file an effective appeal, as well as represent you in court if necessary. This is not a simple matter, and it requires the skillful handling of an experienced disability insurance claims attorney.
What is the Difference Between “Own Occupation” vs. “Any Occupation”
One of the most critical factors in determining whether you’ll qualify for long-term disability benefits is the definition of “disability” used in your policy. Some policies define disability based on your inability to perform your own occupation (the specific job you held before becoming disabled), while others use the broader “any occupation” standard (meaning you’re unable to work in any job for which you’re qualified).
Understanding which standard applies to your policy is essential, as it affects both the eligibility for benefits and the duration of payments. Jason Newfield offers a free evaluation and will evaluate your policy’s language to determine what you’re up against. He makes sure his clients’ claims are presented in a way that aligns with the specific terms and definitions that apply to your situation. Because of his representation, client’s claims are presented in a manner that aligns with these definitions, increasing your chances of securing benefits.
ERISA Claims Have Unique Legal Considerations
If your disability coverage is governed by the Employee Retirement Income Security Act (ERISA)—as is often the case with employer-sponsored plans—special legal rules apply that are not typically present in private disability claims. ERISA provides a more complex framework for managing claims and appeals, including specific rules governing deadlines, the appeal process, and the standard of review in litigation, as well as the litigation protocols, which are unlike the typical court proceedings.
When dealing with ERISA claims, having an attorney experienced with ERISA disability insurance law is particularly important. ERISA’s regulations are highly specific and can be difficult to navigate without specialized knowledge. For instance, if you file an appeal under ERISA and the claim is ultimately denied, the judge will often review the case under the “arbitrary and capricious” standard, which is difficult to overcome without a well-documented and thoroughly supported case. An attorney with expertise in ERISA can help ensure that your claim is properly handled, and that the appeal process is correctly followed, significantly improving the likelihood of a favorable outcome.
Gathering and Presenting Medical Evidence is Not as Simple as You Think
Disability claims hinge on medical evidence. If your disability is not immediately obvious, such as in cases of chronic pain, mental health disorders, or autoimmune diseases, the insurer may require extensive documentation to prove that you are unable to work. This can include medical records, statements from doctors, vocational assessments, and sometimes even testimony from expert witnesses.
Jason Newfield has worked with many claimants when the medical evidence from their treatment is not sufficient to demonstrate the disabling condition of their claim. In these cases, he has access to a network of medical and occupational experts who are able to provide the proof of disability, in many times tests even their own doctors were not aware of. The standard of proof is not the same as you might think.
A long-term disability insurance lawyer can help you gather the appropriate medical evidence to support your claim. They can work with your treating physicians and medical experts to ensure that all documentation is properly formatted, complete, and persuasive. Furthermore, they know how to frame the evidence in a way that clearly demonstrates that your condition prevents you from being able to work.
Preparing an Appeal is Complex and Must Address the Possibility of Litigation
If your claim is denied, an attorney will be needed to manage the appeals process or, if necessary, if you need to take your case to court. Appeals are typically an essential step in obtaining benefits, and many policies require you to exhaust administrative remedies before taking the case to court. In these situations, having legal representation can significantly strengthen your case, especially since insurance companies are often more likely to take a claim seriously if it’s being handled by a knowledgeable attorney.
Moreover, if your case reaches court, the stakes are high. A skilled long term disability insurance lawyer can build your case for trial, making arguments that maximize your chances of success in court. In some cases, they can cross-examine witnesses, challenge the insurer’s evidence, and present a compelling case on your behalf. In others, they can develop and argue the record that has been created.
Finally, it’s important to recognize that filing a disability claim can be an emotionally and physically taxing experience, especially if you’re dealing with a serious illness or injury. Navigating the complexities of insurance policies, documentation, deadlines, and legal procedures can add unnecessary stress to an already challenging situation.
By retaining an LTD lawyer, you can focus on your health and recovery, while leaving the legal complexities to a professional. An attorney will handle the details of your claim and ensure that it is pursued in the most efficient and effective manner possible, giving you peace of mind that your case is in good hands.
