When a person becomes disabled and cannot work due to an injury or illness, the strain on the disabled victim is tremendous. Unfortunately, disabled individuals with long-term disability (LTD) insurance are often shocked when their insurance company refuses to pay benefits. If you need to file a long-term disability claim or if your LTD benefits were denied or terminated and you don't know where to turn, you need an experienced long-term disability lawyer like J. Price McNamara on your side, fighting for you.
Long-term disability insurance claims are often denied — unfairly and without good reason. A respected federal judge who hears long-term disability benefits cases once said: “WHEN YOU BUY AN INSURANCE POLICY LIKE THIS, YOU ARE PURCHASING AN INVITATION TO A LEGAL RITUAL... AND YOU WILL BE DENIED BENEFITS.”
In other words, most disability insurance policies inherently favor the insurer. The applicable law is, likewise, unfavorable to the insured. However, an experienced disability attorney can successfully fight and often reverse an unfair disability claim.
At J. Price McNamara ERISA Insurance Claim Attorney, we have been fighting for disabled individuals for over a decade, winning successful trial verdicts and settlements for our clients.
Fighting Your Long Term Disability Insurance Company
Long-term disability insurance companies are corporations whose goal is to maximize financial profit. After they receive insurance premiums from their insureds, they increase their profits by minimizing what they pay in claims. The more they pay, the less they profit. After collecting premium payments for years, they often refuse to uphold their end of the policy when an insured becomes disabled.
Thus, the disability insurance company collects premiums from you as long as possible, then will often deny your claim no matter how legitimate it may be once you become disabled and need benefits. They may even initially approve you for short-term disability (STD) or long-term disability (LTD) only to buy time while gathering information in an effort to later deny your claim for disability insurance benefits.
In many cases, policyholders do not fight back despite being unfairly denied their benefits. They believe that the fight may be too costly and likely unsuccessful. However, when those disabled do fight back, many will win.
Long-Term Disability Insurance Policy Definitions
In order to be entitled to disability benefits, you must meet the insurance company's policy definition of “disability.” The definition of “disability” varies from policy to policy. You will need to consult a long-term disability lawyer to find out if you have a case. Even if you are found to be totally and permanently disabled in a Social Security Disability claim, this does not automatically mean that you meet the disability insurance company's definition of “disability.”
Also, many of these billion-dollar insurance companies distinguish between benefits in the category "own occupation" (short term benefits) versus "any occupation" (long term disability benefits). The phrase "own occupation" refers to the work you were doing when you became disabled. "Any occupation" refers to other work you could do based on your education, training, and experience.
Basically, you may qualify for and receive short-term disability benefits if you are unable to perform the work required for your prior job. However, these monthly disability benefits may end after a period of time if the insurer believes you could eventually work in another job. If you cannot do any type of work that falls under your prior education, training, or experience, you may qualify for LTD benefits. A qualified disability insurance lawyer can explain your rights under your particular circumstances.
What is ERISA?
The Employee Retirement Income Security Act of 1974, commonly known as ERISA, is a federal law that often controls long-term disability claims when long-term disability coverage is provided by an employer to its employees. If you have private individual disability insurance coverage or work for a church or government office, the ERISA rules do not apply to your long-term disability claim.
When ERISA controls a disabled person's claim, that claimant is at a disadvantage while the insurance company benefits. For example, if your employer's long-term disability insurers deny your claim and you need to bring legal action, you must file your case in federal court. Also, no matter how egregious the insurer's actions are, you cannot request punitive damages, and you cannot request payment of your long-term disability lawyer's fees from the insurance company.
The Long-Term Disability Claims Process
Disability insurance companies may deny claims based on technicalities. The insurance companies will use their paid medical consultants to provide input despite never meeting you. These insurance company medical consultants will often disagree with your own treating physician who sees you on a regular basis. Then, the insurance company may accept its own medical consultant's opinion regarding disability and disregard the opinion of your treating physician completely.
The insurance company will also ask you to sign forms authorizing the collection of personal information. They will even hire private investigators to investigate, follow, and take videos of you to destroy your disability claim. The disability insurers will often use your signed authorization forms to collect medical records and other personal records dating back several years prior to your disability to support any conceivable argument to deny your claim. They may invade your personal privacy and expose background information that is absolutely unrelated to your disability. If this happens, you should hire an ERISA attorney as soon as possible.
Even if you know without question that you cannot continue working, the disability insurance company will consider your opinion worthless. As noted above, they will even disregard your physician's opinions regarding your disability in favor of their own hired consultants. The insurance company's decision to deny your claim often depends on a claims examiner with no formal medical training whatsoever.
Related Read: 11 Steps to Effectively Apply for Long Term Disability in 2021
Why You Should Work With A Long Term Disability Attorney Throughout the Disability Benefit Claims Process
After you have suffered a disability, your first priority should be receiving the medical treatment necessary to recover. Next, if you have disability insurance coverage, you can file a claim for benefits with your long-term disability insurance company. My law firm can provide legal help at any time throughout the claim process, but having an experienced LTD attorney can be critical at these times:
Before You File Your Initial Claim
You should meet with a long-term disability attorney before you file your claim to avoid making a mistake in your claim forms. We can also explain your disability policy, the LTD claim process, and the benefits you can expect. Our goal is to protect your benefit rights and ensure you are treated fairly by your disability insurance carrier.
If You Have Already Filed a Claim and Your Application Was Denied
If you receive a denial letter after filing your application, it's imperative that you consult a long-term disability lawyer to understand why your benefits were denied and whether you can dispute the denial. You may have the right to appeal the insurance company's decision or take other legal steps to obtain the benefits you deserve.
Your Short-Term Disability Benefits Were Terminated
If you were granted short-term disability benefits but the insurer terminated those benefits, you may have the right to long-term disability benefits under the terms of your LTD policy. Our experienced legal team can review your unique circumstances and explain your options at this time.
Related Read: How to Appeal a Denial for Long-Term Disability Insurance [Step-by-Step]
The Many Ways Long-Term Disability Lawyers Can Help
Depending on which part of the disability benefits process you are facing, a long term disability lawyer can provide valuable services to help you recover the benefits you deserve. While each situation is different, a seasoned disability lawyer can:
- Gather relevant medical records from the doctors who have treated you and are currently providing treatment,
- Connect you with a medical specialist if your insurer requests additional reports or challenges the extent of your disability,
- Work with experts to create an expert opinion report describing your ability or inability to work,
- Negotiate with your disability insurer to reopen a denied disability benefits application,
- Request the extension or waiver of a deadline to allow you to prepare your claim or appeal,
- Issue subpoenas to ensure all important witnesses and documents are available and present during any hearings,
- Personally prepare you for any hearings, answer your questions, and explain what to expect when you testify at a hearing,
- Protect your legal rights during the hearing by objecting to irrelevant, inappropriate, or unwarranted procedures or evidence,
- Cross-examine witnesses and challenge evidence when necessary,
- Deliver a persuasive closing argument at the end of a hearing to explain why you deserve benefits,
- Verify your benefits are calculated correctly when you prevail, and
- Appeal a negative decision or ruling if you decide to continue fighting.
Related Read: How to Appeal a Denial for Long-Term Disability Insurance [Step-by-Step]
Our Fees
We are here to answer any questions you have during a free consultation. Our firm welcomes telephone calls or the opportunity to visit with you in person during a Free Denial Review, where we can learn about your situation, review your long-term disability policy, and explain the complexities of disability law.
There is no obligation whatsoever to hire us as your long term disability lawyer. If you ultimately decide to hire us for your disability insurance claim, we will handle your case on a contingent fee basis. We receive compensation only if you win your case. In other words, you will owe us nothing — no attorney's fee and no reimbursement of our advanced litigation costs unless we recover disability benefits for you.
Mr. McNamara holds the highest possible peer review rating of “AV” (“Very High to Pre-Eminent”) for professional excellence and ethical standards. Trust us to protect your rights.
