Are you struggling to obtain long-term disability (LTD) insurance benefits? Have you exhausted your appeal rights with your disability insurance carrier? You are not alone, and help is available.
At Ortiz Law Firm, we are committed to providing expert legal services and maximizing your recovery. Our team has an impressive track record in handling all aspects of long-term disability lawsuits. We understand the nuances and strategies insurance companies employ to deny claims. Armed with this knowledge, we effectively counter these tactics and fight tirelessly for the benefits you deserve.
Long-term disability attorney Nick Ortiz will take the time to understand your case deeply, listen to your needs, and develop a customized legal strategy that best fits your situation. We will educate you on your rights and ensure you are fully equipped to make informed decisions about your claim. Then, we will prepare the lawsuit and appeal your case to federal or state court.
What Will a Long-Term Disability Attorney Do For You?
- Prepare the lawsuit.
- Conduct additional discovery against the insurance company.
- Attend court appearances for status conferences with the judge handling the case and 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, usually a bench trial with the judge, not a jury trial.
- Review and analyze the verdict to determine if either side has grounds to appeal the ruling.
When Can I File a Lawsuit?
One of the questions we hear often is, “When can I sue for a denied claim?” If you have a group LTD insurance policy, your claim is governed by the Employee Retirement Income Security Act (ERISA). In an ERISA disability claim, a lawsuit cannot be filed until all of the claimant’s administrative remedies have been exhausted. Most policies require at least one appeal to be filed directly with the insurance company or plan administrator before you can proceed to litigation. Litigation means taking legal action or filing a lawsuit to protect your legal rights.
How Does the Judge Make a Decision?
Federal judges use two methods, or standards of review, to decide ERISA claims. Which one the judge uses depends on the wording of your disability policy. These are
- The de-novo review standard.
- The arbitrary and capricious standard (or the “abuse of discretion” standard).
With de-novo review, the judge independently looks at all the details of your claim file and decides if you qualify for benefits under your group disability insurance policy. It’s generally better for the policyholder.
The arbitrary and capricious standard is used when the policy allows the insurance company to interpret it. In this case, the judge has to find that the insurance company was wrong to deny benefits, meaning they had no good reason for their decision, and that it was “arbitrary and capricious.”
While some states tried to stop these discretionary clauses in disability policies, most employers’ long-term disability ERISA policies still have them. Federal courts, including those in Florida and nationwide, often use the arbitrary and capricious standard.
Group ERISA Lawsuits vs. Individual State Law Lawsuits
There are numerous differences between a lawsuit filed in connection with a group LTD plan governed by ERISA versus an individual disability insurance plan. The claimant is entitled to a jury trial in state court with an individual policy. However, an ERISA claimant is not entitled to a jury trial. A federal judge will decide on an ERISA disability lawsuit. The decision is usually made after the parties have filed written briefs supporting cross-motions for summary judgment. Another disadvantage to ERISA lawsuits is that it is challenging to receive an award of attorney fees for the winning party in an ERISA disability case in most federal circuits.
Moreover, in a lawsuit in state court for the wrongful denial of benefits under an individual disability policy, the claimant may seek extra-contractual damages such as the insurance company’s bad faith. Unfortunately, ERISA regulations do not allow any claims for bad faith or punitive damages for an insurance company’s wrongful denial of long-term disability benefits in a group plan ERISA claim. If the federal court rules in favor of the claimant in a federal ERISA lawsuit, the disability insurance company’s only potential damages are the payment of the claimant’s past-due benefits and possibly interest and attorney fees.
Because you may not be familiar with some of the deadlines that may apply to your claim, you should seriously consider consulting with an attorney to discuss your rights. The legal team at Ortiz Law Firm can help you cut through the red tape and fight for your disability benefits no matter where you live in the United States. We never charge attorney fees or costs unless we recover benefits for you. Call us today at (888) 321-8131 to discuss your claim.
