As you can see from the other articles on this website and across the web, ERISA rules and regulations favor insurance companies and it is easy to make a mistake in appealing a long term disability denial. That is why you should at least consider contacting an attorney early in the appeal process if your claim has been denied or if your benefits have been terminated.
We help disability claimants receive the long term disability (LTD) insurance benefits they are entitled to receive. If you have been denied benefits, we can help prepare and file your administrative appeal with the insurance company in an effort to maximize the chances that your LTD claim will be approved. If your benefits have been cut-off or terminated, we can help prepare the appeal to have your benefits reinstated. If you have exhausted your administrative appeals with the insurance company, we may be able to file a lawsuit against the insurance company.
How Does an Attorney Help in the Long Term Disability Appeal Process?
The Ortiz Law Firm has assisted numerous clients in recovering benefits following a long term disability insurance denial or termination of benefits. We have experience in handling internal administrative appeals directly with insurance companies and we have prosecuted numerous ERISA lawsuits in federal court against LTD insurance companies. We are available to help you anywhere in the country and we will strive to make the process as easy as possible for you.
Mr. Ortiz and his staff offer detailed advice to clients throughout the appeals process. Here are the most important things he will do in your case:
- Understand the reasoning behind your long term disability claim denial.
- Acquire additional medical records and evidence to file the appeal.
- Obtain opinions from your treating doctors concerning your impairments resulting from your injury or illness.
- Complete the appeals paperwork.
- File your LTD claim appeal within the required time limits.
- Filing an ERISA lawsuit in federal court or a breach of contract lawsuit in state court.
- Prepare your case for trial.
Many people wonder what a long term disability attorney will actually do on a claim to earn a fee. The following is a more detailed list of things that an attorney like me may do in your case. Keep in mind that each case is unique and therefore not all of these tasks will be required in every case. Here is a more detailed list of things an attorney may do for you in an LTD claim:
- Conduct the initial interview with the client.
- Advise the client about long term disability claims.
- Gather documentary evidence that may be used in the case, including witness statements, medical records, medical opinions from your doctors, employment information, and vocational assessments.
- Request, review, and analyze the client’s entire claim file to determine what medical and other documentary evidence is in the file.
- Request, review, and analyze the client’s insurance policy to determine the definitions of key terms in the policy and to determine what coverages are available under the policy.
- Conduct a detailed evaluation to determine what must be proven to receive benefits under the LTD insurance policy.
- Analyze the legal issues, such as the burden of proof, and whether state or federal law applies.
- Take a sworn statement from the client’s physicians or treating providers to fully understand the client’s condition, their resulting limitations, and prognosis.
- If litigation is necessary, prepare the lawsuit.
- If a suit is filed, conduct additional discovery against the insurance company.
- Court appearances for status conferences with the judge handling the case and to set a trial date.
- Settlement negotiation during the lawsuit or mediation.
- Prepare for mediation.
- Trial preparation.
- Prepare the exhibits, including medical records and physician opinions, for trial.
- Prepare and organize demonstrative exhibits for trial.
- Prepare briefs and pretrial motions to file with the court to eliminate surprises at trial.
- Take the case to trial, which is usually a bench trial with the judge and not a jury trial.
- Review and analyze the verdict to determine if either side has grounds to appeal the verdict.
- Recommend to the client whether or not to appeal the case.
Who Do We Represent?
We only represent individuals who, due to illness or injury, can no longer continue to engage in full-time employment. We never assist insurance companies in denying claims.
The 3 D’s – Delay, Deny, Defend
Mr. Ortiz has been handling long term disability claims since 2005. He is very familiar with the tactics used by disability insurance companies to wrongfully deny or terminate (cut-off) legitimate claims. Disability insurance companies are most famous for a tactic called “The 3 Ds”—delay, deny and defend. First, the insurance company delays a decision on your claim. Even if they finally decide that you are eligible for benefits, they may delay your payments. Second, the insurance company may outright deny your claim, denying responsibility or coverage according to your policy. After denying your claim, you may have to take the insurance company to court, and the company will use their high-priced lawyers to defend their decisions.
Other tactics used by disability insurance companies include:
- Citing “Insufficient Medical Proof” to support the claim, regardless of how much evidence you send them.
- Placing undue reliance on a Functional Capacity Evaluation (FCE) report ordered by the insurance company.
- Using a “Peer Review” by a physician hired by the insurance company for big bucks—a physician who has never seen or examined you.
- Using a Transitional Skills Analysis, identifying jobs you can purportedly do, but do not actually exist.
- Performing a medical review by a registered nurse who works for the insurance company.
We Don’t Get Paid Unless You Do
Our job is to make the insurance company pay the benefits you are owed and maximize your recovery under your LTD policy. We handle most long term disability claims on a contingency fee basis, meaning that we charge a percentage of the amount recovered. It is contingent in that you owe us nothing if there is no recovery. If your internal administrative appeal is successful, we charge a percentage of the back pay that is owed and a percentage of future monthly benefits for 12 months. We also advance costs and expenses.
What We Do Not Do
We do not handle all types of disability claims. For example, we do not handle the following types of cases:
- Short-term disability, unless the benefit period is for longer than 12 months
- Government-funded disability plans
- State disability plans or retirement systems
- Military retirement
If you have questions about a long term disability claim or if your claim has been denied or terminated, call our office today for a free consultation at (866) 853-4512.