The process of applying for long-term disability (LTD) can be confusing and intimidating. It can bring shock to discover that the insurance company is denying something you’ve relied on through years of hard work to secure you and your family if you get injured or sick.
It cannot be stressed enough: it is crucial to get a disability attorney who understands the many tricks insurers use to deny paying benefits. The attorneys at Goldberg & Finnegan can help you at any claim stage to fight for your rights.
Initial level: The task of applying for LTD benefits can be daunting. Insurance companies often use complex application forms to trip up potential applicants. Moreover, claimants sometimes assume that they must simply put in their application and let the insurance company work the claim, gather the evidence and easily be found disabled. Of course, this relies on the trust and goodwill of the insurance companies, which should never be taken for granted in LTD cases. In reality, the insurer will use every technicality and loophole it can to avoid having to pay benefits. It is fundamentally important to have an attorney guide you through the process of putting forth the best application possible. This means understanding the policy thoroughly, gathering the medical evidence you need to prove your case (instead of relying on the insurance company), using the right dates in the application and submitting the documents within the necessary time limits. Our attorneys are skilled in ensuring that the best possible LTD application is filed. Please contact us for a consultation if you need help filing your initial LTD application.
Administrative appeal level: Administrative appeals take place within the internal process of the insurance company. If your initial claim is denied, most likely you will have 180 days to file an appeal. Sometimes there will be multiple levels of appeal within the insurance company. Regardless, it is critical to appeal in a timely fashion and to put forth a winning appeal. If you do not appeal correctly, you will lose the claim and forfeit the right to sue the company in federal court. Filing an appeal also means more than simply submitting the paperwork on time. It requires a detailed brief based on strong legal advocacy and tailored specifically to your claim. Although insurance adjusters can seem heartless, and their bottom line is certainly governed by company finances rather than concern with your disability, they can be persuaded by strong advocacy. They know that dealing with an experienced attorney shifts the power dynamic of the case and that they cannot merely skate by in continually denying your claim.
At Goldberg & Finnegan, we give free evaluations of LTD appeals. If your initial application has been denied, please call us to day so we can help you with your case.
Lawsuit in Federal Court: Most LTD claims that are denied at the insurance company level end up in federal court (as opposed to state court), because most policies are covered by ERISA, a federal law. It is critical to exhaust all “administrative appeals” before this point, because you can be denied benefits for not doing so before filing suit in court.
Appeals at the federal court level can be exceedingly difficult because the law allows LTD policies to include “discretionary clauses,” in which your denial can be reviewed under an “arbitrary and capricious” standard by the judge. This means that, as long as the insurer can show it had any rational basis for denying the claim, the denial will be allowed to stand, even if there is plenty of evidence showing you are disabled. Moreover, claimants are often surprised to find that there is no trial at the federal court level. The suit consists of written appeals, and possibly, oral arguments by the attorneys.
The high stakes involved at the federal court level make it essential to have an experienced long-term disability attorney advocating for you. Please contact our firm at (888) 213-8140 to discuss your LTD claim. Wherever you are in this process, we can help you get the benefits you deserve.