ERISA is a framework of complex federal laws, regulations, and case law that apply to group disability claims. Most attorneys, including those who handle Social Security disability claims, do not have the knowledge or experience to properly handle an ERISA-governed LTD appeal or federal lawsuit. A general practice attorney may miss administrative deadlines or fail to address critical issues in the appeal process. Unrepresented claimants risk making the same mistakes. So our recommendation is yes, you should consult with a lawyer in your LTD claim.
If you have been injured or become ill while working and need to file for long term disability, there is a good chance that without an attorney, you will be denied. Why? Because unlike social security disability adjudicators, long term disability adjusters have an interest in denying your claim. Long-term disability companies are private companies with big profit margins. The more claims they approve, the less profit the company makes. Making it difficult to get your claim approved or denying it altogether is in their best interest.
If you have been denied, it is time to consider using a long-term disability attorney. Here is why it is a good idea to hire a long term disability attorney:
They Recognize Bad Faith
An experienced long term disability attorney will recognize when the insurance company is acting in bad faith. Bad faith is when the insurance company is: delaying your claim for an unreasonable amount of time, requiring excessive documents and multiple copies of the same documents, denying a claim for wrong reasons, or paying out less than the policy states.
They Recognize Discriminatory Evidence Collection
Long term disability companies are notorious for taking evidence out of context to make the claimant look bad. They may use video footage from the surveillance period in court to make the case that the claimant is not truthful. Example: Dottie has a major back injury but was recorded taking out her trash. The insurance company says she isn’t really that injured since she was able to lift her trash bag into the trash can. What the recording doesn’t show, is how much time Dottie had to rest and recover just from taking out her trash. Experienced long-term disability attorneys know how to recognize this and can speak on your behalf in court.
They Know How to Handle a Denied Claim
Unfortunately, most long term disability claims are denied the first time they are submitted. The most common reasons for a claim denial is missing information, incomplete forms, or missing medical records. The insurance company is looking for any reason to deny your claim. For example, if you write “Medical Hospital 234 Main St.” as your doctor’s address but forget to put “Suite 12”, then they may try to deny your claim because you didn’t provide them with the complete address. The LTD companies will also not tell you that before your case goes to court, your administrative file is closed; This means you can no longer add evidence to your file. So if you show up to court with additional evidence, the judge will have to ignore it.
The good news is you can appeal. An experienced long-term disability attorney can help you be more prepared when you submit your appeal, which could greatly increase your chances of being approved.
They Can Help You Before You File Your Claim
If you have not filed a claim yet, you can consult with a long term disability attorney about your claim. Most reputable companies will provide you with a free phone consultation where you can ask any questions you may have. You will have no obligation to use them as well. This free advice is a good place to start before you file your claim. It is also important to note that long term disability attorneys do not get paid until you do. You will have no upfront fees; they will collect their fee once your case is settled with the insurance company.
When Should I Hire A Lawyer?
The most critical stage in an LTD claim for disability insurance benefits is the appeal stage. Once the internal “administrative” appeals directly with the insurance company have been exhausted and a lawsuit has been filed, no new evidence can be introduced to the court. You do not testify. Your doctors do not testify. You cannot introduce any new evidence to the court after your appeals are completed. There are no trials, hearings, or depositions. The court simply reviews the administrative claim file and does so with a legal obligation to defer to the insurance company’s decision. It is essential that an experienced LTD attorney review the claim file at the appeal stage in order to determine what additional medical and/or vocational proof needs to be added to the administrative file and to determine what adverse information needs to be rebutted.
Why Hire the Ortiz Law Firm?
The insurance company will try to find any reason to deny the claim. They may use bad faith tactics, improperly handle your documents, require excessive documents, and deny your claim unfairly. Using an experienced long term disability attorney can help you build a strong administrative file.
The Ortiz Law Firm is dedicated to compassionate client service and outstanding results. Mr. Ortiz has a decade of experience in representing disability claimants in seeking benefits. The Ortiz Law Firm is not a “mill” firm that will represent just anyone that calls. The Ortiz Law Firm accepts approximately one in ten applicants that request legal assistance.
Mr. Ortiz has the support of several paralegals and an office manager, working together to deliver the highest level of legal representation. We represent claimants whose long term disability claim has been wrongfully denied or terminated. If you have questions that are not covered in our “Frequently Asked Questions,” call us at (866) 853-7210.
The Ortiz Law Firm is based in Florida but represents claimants across the country. Receive a free consultation by calling (888) 321-8131 with no obligation. We can help you evaluate your claim to determine how you should move forward with the process.