{"id":3305,"date":"2020-07-15T13:59:43","date_gmt":"2020-07-15T13:59:43","guid":{"rendered":"https:\/\/nolfinal.wpengine.com\/?p=3305"},"modified":"2024-03-06T11:40:33","modified_gmt":"2024-03-06T16:40:33","slug":"why-is-it-so-hard-to-win-an-ltd-claim-video","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/why-is-it-so-hard-to-win-an-ltd-claim-video\/","title":{"rendered":"Why Is It So Hard To Win a Long-Term Disability Lawsuit? [Video]"},"content":{"rendered":"\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube youtube-embed wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Long Term Disability Insurance Claim - Why Is It so Hard to Win?\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/Q6Rc948MtxM?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>Transcript: When you\u2019re denied&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/\">long-term disability<\/a>&nbsp;benefits, you must go through the&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/appeals\/\" data-type=\"page\" data-id=\"77\">administrative review&nbsp;process<\/a>. If your appeals are unsuccessful, the next step is to <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/lawsuits\/\" data-type=\"page\" data-id=\"842\">go to court<\/a>.&nbsp;Winning an LTD claim in court can often feel like an uphill battle. In this post, we&#8217;ll delve into the reasons why winning an LTD claim in court is so challenging.<\/p>\n\n\n\n<p>When you go to court, the court typically applies a six-step review process in evaluating long-term disability claims. For example, here in the&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/eleventh-circuit\/\" data-type=\"post\" data-id=\"3222\">11th Circuit<\/a>, there is a six-step process, the most important of which are the first three. When you look through the first three steps, you\u2019ll see why it is so difficult to win a long-term disability claim.<\/p>\n\n\n\n<p><strong>Step 1<\/strong>: The court has to apply the de novo <a href=\"https:\/\/www.nickortizlaw.com\/the-standard-of-review-in-erisa-long-term-disability-lawsuits\/\" data-type=\"post\" data-id=\"7392\">standard of review<\/a> to determine whether the claim administrator\u2019s benefits-denial decision was wrong. In other words, the court has to determine whether they disagree with the administrator\u2019s decision. If the court agrees that you\u2019re not disabled, then that\u2019s pretty much the end of the case. <\/p>\n\n\n\n<p>However, if the court disagrees with the insurance company\u2019s decision and thinks you\u2019re disabled, that\u2019s still just Step 1, and that is what most people have a hard time understanding. If the court disagrees with the insurance company\u2019s decision on this de novo review, then they move on to Step 2 of the six-step process.<\/p>\n\n\n\n<p><strong>Step 2<\/strong>: If the administrator\u2019s decision is, in fact, \u201cde novo wrong,\u201d then the court must determine whether the administrator was vested with discretion in reviewing claims. <\/p>\n\n\n\n<p>So, what does it mean to be \u201cvested with discretion?\u201d Under most policies, an insurance company has discretionary authority to determine whether and to what extent eligible employees and beneficiaries are entitled to benefits and construe any disputed or doubtful policy terms. <\/p>\n\n\n\n<p>That means they get to determine for themselves whether or not you\u2019re disabled under the policy. The insurance company is the one that makes the very decision. I can guarantee that most policies have discretionary language these days, which means the case then moves on to Step 3. Step 3 is the most difficult step in a long-term disability claim.<\/p>\n\n\n\n<p><strong>Step 3<\/strong>: If the administrator\u2019s decision is \u201cde novo wrong\u201d and they were vested with discretion in reviewing claims, then determine whether reasonable grounds supported the decision. Hence, review their decision under the more deferential arbitrary and capricious standard.<\/p>\n\n\n\n<p>This is where most cases are lost. If the insurance company can show any reasonable basis, then the court will allow them to win the case. Reasonableness may be that they sent your file for&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/peer-review-report\/\" data-type=\"post\" data-id=\"3219\">review by one of their doctors<\/a>,&nbsp;who indicated that you don\u2019t have enough limitations to be disabled, and they relied on that. It was reasonable for them to rely on that. <\/p>\n\n\n\n<p>Another example would be if there were conflicting evidence in the file, such as a&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/types-of-surveillance\/\">surveillance video<\/a> that shows that maybe your daily activities aren\u2019t as limited as they are made out to be in the medical records. A court may say it was reasonable to review that surveillance, determine that the symptoms aren\u2019t as bad as represented in the medical records, and it was reasonable for the insurance company to deny the claim.<\/p>\n\n\n\n<p>What I\u2019m trying to point out to you is that even if you show at Step 1 that, under a de novo fresh look at the case, you are disabled, and even if the court agrees with that, you can still be denied at Step 3 if the court says, \u201cThey had enough evidence and it was reasonable enough for them to deny your claim.\u201d That is why it\u2019s so hard to win LTD claims.&nbsp;<\/p>\n\n\n\n<p>Even in this structure that\u2019s stacked very heavily against the claimant, our goal is to prove <a href=\"https:\/\/www.nickortizlaw.com\/testimonials\/\" data-type=\"page\" data-id=\"1073\">our client\u2019s cases<\/a> and get them awarded benefits. If you\u2019d like to talk to an experienced attorney, please call our office at\u00a0<strong><a href=\"tel:8883218131\">(888) 321-8131<\/a><\/strong> for a free case review. We look forward to hearing from you.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Transcript: When you\u2019re denied&nbsp;long-term disability&nbsp;benefits, you must go through the&nbsp;administrative review&nbsp;process. If your appeals are unsuccessful, the next step is to go to court.&nbsp;Winning an LTD claim in court can often feel like an uphill battle. In this post, we&#8217;ll delve into the reasons why winning an LTD claim in court is so challenging. When &hellip;<\/p>\n","protected":false},"author":2,"featured_media":5496,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[207,211],"tags":[],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/3305"}],"collection":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/comments?post=3305"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/3305\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media\/5496"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=3305"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=3305"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=3305"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}