If your employer-sponsored long-term disability benefits have been denied, your first instinct may be to appeal right away, potentially without a lawyer, in the hopes that your benefits will be reinstated as quickly as possible. Your disability plan administrator may even try to deceive you into thinking it’s easy, by encouraging you to submit the one-page “Appeal Request Form” included with the denial letter, or by telling you over the phone that “all you need to do is fax a letter stating, ‘I appeal.’”
While it is technically true that you don’t need a lawyer to challenge a denial of long-term disability benefits, and some claimants do appeal on their own with success, you are better off finding a lawyer with expertise in this area to represent you in your appeal. The insurance company is sophisticated and has likely spent weeks, if not months, building its case against you. An experienced ERISA and long-term disability lawyer will recognize the traps that have been laid and know how to overcome them.
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Common Mistakes of Going It Alone
As part of our practice, we often review claim files for litigation where the claimant has exhausted appeals on his or her own, without a lawyer. Here are some of the mistakes we commonly see when claimants are unrepresented:
- Not taking your time: In general, you have six months (180 days) to appeal a denial of long-term disability benefits. It can take that long to build an effective appeal. By appealing right away, without gathering supporting evidence, you are giving away one of your chief advantages, which is time, and allowing the insurance company to dictate what evidence is contained in the claim file.
- Not requesting the claim file: One of the most important protections under ERISA is the right to obtain, free of charge, a copy of your claim file, including all the evidence relevant to your claim for benefits. The claim file will help you to determine what additional evidence and argument is necessary to win your appeal.
- Not submitting new medical and opinion evidence: Oftentimes, the medical records obtained by the insurance company are incomplete. Perhaps they don’t include all your doctors, or they don’t go back far enough in time to adequately capture the nature of your disability. Once you have obtained the claim file (see above), review it to determine what medical records are missing. Also, ask your doctors to prepare letters or complete questionnaires documenting your restrictions and limitations.
- Nitpicking over the evidence: Self-represented claimants sometimes devote their entire appeal letters to pointing out errors in the denial letter, while losing sight of the bigger picture. A more effective strategy is to tell your side of the story, explaining why you can no longer work, with reference to concrete restrictions and limitations. Still, even the most eloquent appeal letters can overlook critical vocational evidence and arguments that can make or break the case – hence, why hiring a lawyer is a good idea.
Why Should I Hire a Disability Insurance Lawyer?
You may be deterred by the cost of hiring a lawyer. However, most, if not all, lawyers who practice in this area handle such appeals on a contingency basis. Thus, there is little risk to you if your appeal is unsuccessful. If your appeal is successful, the fees paid to your lawyer will have been a worthwhile investment.
You may also be deterred by the time involved in hiring a lawyer. A lawyer will likely require one to three months, and possibly as many as six months, to gather the documents and evidence necessary to perfect your appeal. Then, the insurance company typically takes one to three months to decide the appeal. All told, the process can take up to nine months or more.
While nine months is a long time to go without benefits, there is no point to rushing through the process only for your benefits to be denied. And, depending on the ERISA standard of review, you may not have an opportunity to supplement the record later in litigation. Thus, the prudent approach is to hire a lawyer and allow the lawyer to take the time necessary to build a robust appeal.
How Do I Find a Long-Term Disability Lawyer?
The practice of law has become very specialized, and long-term disability appeals are no exception. While hiring a general practitioner is preferable to going it alone, ideally your lawyer will be one who concentrates his or her practice in long term disability appeals and litigation and have years of experience doing so. If you are unsure where to start, ask the lawyers in your personal network who they would hire for such a matter. Your local bar association may also have a lawyer referral service for this purpose.
You may find there are no lawyers in your city or town who handle such matters, in which case you should consider hiring a long-term disability lawyer with a national practice. A lawyer need not be located in the same city or state as you to provide effective representation. DeBofsky Sherman Casciari Reynolds P.C. has offices in Chicago, Illinois and Seattle, Washington and has represented clients in over 38 states with a proven record of success. We encourage you to contact us today for a case evaluation.
What If I Can’t Find a Lawyer?
There are many reasons a lawyer may be unable to accept your case for representation that have nothing to do with the merits of your disability claim. For instance, if you are receiving Social Security disability benefits or another source of income that is subject to deduction under your LTD policy, your case may not be economically viable on a contingency basis.
If a lawyer won’t accept your case, don’t despair. Even if you are unable to obtain counsel, you should appeal the denial of benefits on your own, as failure to submit a timely appeal could bar you from later bringing a lawsuit. Before you appeal, be sure to first request a copy of your claim file and long-term disability plan document from the insurance company and/or your employer to see what additional evidence, if any, is needed to perfect your appeal. Submit the appeal letter, along with supporting medical and opinion evidence, within the timeframe specified in the denial letter. For additional insights, visit the “Articles” section of our website –
and, in particular, my colleague Matthew Maloney’s post, “Five Common Mistakes When Appealing a Denial of Long Term Disability Benefits.”