Our involvement in the long term disability (LTD) process typically begins in one of the following two stages:
- After a claim has been denied and the claimant needs to file an Administrative Appeal directly with the LTD insurance company; or
- When all administrative appeals have been exhausted and the only option left is a lawsuit against the insurance company.
Our office is most commonly contacted to help with the administrative appeal stage of the long-term disability claim process.
Most claimants call us when either: (a) the initial application/claim has been denied or (b) the claim has been wrongfully cut-off (in other words, benefits have stopped). Oftentimes, benefits are terminated after two years when the disability insurance policy switches from evaluating the claim under an “own occupation” standard to an “any occupation” standard.
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 are no longer disabled as you require less medical 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 with “objective medical testing”, 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 our office to schedule your free case evaluation. During your free case evaluation, 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 you and the insurance company. 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, the 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 (such as where we have trouble getting information from a doctor’s office, we are waiting for statements from your various doctors, or 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 issue a decision within the time limits above, we will discuss with you filing a lawsuit against them and whether or not that will strengthen your case.
Your appeal will have one of two outcomes:
- The insurance company will approve your appeal, reinstate your benefits and pay all past-due benefits; or
- They will deny your claim again. If you have another appeal available, you may pursue a second appeal. If all appeals have been exhausted, we will file a lawsuit.
In an ERISA disability claim, a lawsuit cannot be filed until all of the claimant’s administrative remedies have been exhausted. Most LTD policies governed by ERISA require at least one appeal directly with the insurance company or plan administrator before a lawsuit can be filed. A long term disability attorney will:
- Prepare the lawsuit.
- Conduct additional discovery against the insurance company.
- Attend court appearances for status conferences with the judge handling the case and to set a trial date.
- Engage in settlement negotiations during the lawsuit or mediation.
- Prepare for mediation.
- Prepare for trial.
- 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.
Legal Representation in LTD Claims
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, call us at (888) 321-8131 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.