Long Term Disability Process with Our Firm

The Process That We Use to Help You Get Your Long Term Disability Benefits

Our involvement in the long term disability process typically begins at one of the following three stages:

  1. After a claim has been denied and the claimant needs to file an Administrative Appeal directly with the LTD insurance company; or
  2. When all administrative appeals have been exhausted and the only option left is a lawsuit against the insurance company.

Administrative Appeals

Our office is most commonly contacted at this stage of the long-term disability claim process.

We may get involved when you contact us about your wrongful termination of benefits, or your initial claim was denied. Oftentimes, benefits are terminated after two years when the policy definition switches from “own” to “any” occupation. Read more about the difference here.

There are many reasons why an insurance company will terminate benefits. They may have discovered that you have missed doctors’ appointments, and think that you no longer need treatment. They may put you under surveillance and think they have enough evidence to stop benefits. Your disability could be one that is hard to prove such as depression and anxiety. The best thing to do is to allow our firm to help you navigate the appeal process.

The first thing to do is to contact us online, by phone at 850-308-7833 or email. You will speak to a licensed attorney with substantial experience with long-term disability claims and appeals. There is no charge for this call. You will not be obligated to hire us. During the call, you can ask any questions you have regarding long-term disability, and we will answer them.

After we have discussed your situation, if you feel that we can help you and we feel that you have a case, we will move forward to signing a contingency fee contract. A contingency fee is not paid upfront. We only get paid if the case is won. You will also need to sign an authorization form for us to obtain your claim file from the insurance company.

After you sign and return the contract and forms, we will contact the insurance company and request a copy of your claim file. This file is called an administrative file. Your administrative file contains all the information regarding your case including medical reports, your disability policy, claim notes, and correspondence between the insurance company and you. This is the only file that is used in court so it must be complete.

After the insurance company receives our request, it takes between three and four weeks for them to copy and send us your file. Once our team receives your file, we start working on inputting the information into our system. This process usually takes a week. After that, an attorney will review your claim and contact you to discuss your case. Our attorney will outline the plan for an appeal, and you will provide your input. When you agree with what the plan is, we will start the appeal process.

The appeal plan can take up to 8-12 weeks but sometimes longer we have trouble getting information from a doctors office and if the insurance company requests an independent medical examination. The appeal is then filed with the updated supporting documentation.

From that point, the insurance company has 45 days after receiving the appeal letter to make a decision. The insurance company can extend the decision process by another 45 days if they request it in writing before the end of the first 45 days. By law, the insurance company must reach a decision within the 90 day period.

It is rare, but if the insurance company fails to do so, we will discuss filing a lawsuit against them with you and whether or not that will strengthen your case.

Your appeal will only have two outcomes:

  1. The insurance company will approve your appeal, reinstate your benefits and pay all past-due benefits or
  2. They will deny your claim again, and we will file a lawsuit.

We understand that this process can be a long and tedious process with long waiting periods to receive updates on your case. If at any time you have any questions, feel free to reach out to us, and we will give you an update on your case.

Just to reiterate this point, your Long-Term Disability attorney does not get paid until you do so that you can proceed with your case without fear of upfront legal bills or costs.

Although based in Florida, the Ortiz Law Firm represents claimants across the United States.

If you’d like to speak to one of our Pensacola Long-Term Disability Insurance Attorneys about your denied claim, contact us at (850) 308-7833 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access Long-Term Disability Benefits and how to move forward with the process.