People often ask, “What are my chances of winning an administrative appeal directly with an insurance company in a long term disability claim? What are my chances of winning a lawsuit in a long term disability claim?”
This is an impossible question to answer with certainty because of the number of factors that go into the decision, but the following is based on our firm’s own experience:
Administrative Appeals
Recently I attended a disability conference with a lot of disability attorneys. One of the featured speakers handled a lot of long term disability claims. He said that in his office, they typically win about 30% of their administrative review claims. He said that he’s spoken to numerous other attorneys and they win about anywhere in that same ballpark of about 30% of their appeals as well. But let me tell you about our firm’s experience.
About 50% of our administrative appeals, which we file after a client comes in with their claim being denied, resulted in claims being overturned. Obviously that doesn’t guarantee any future success, but it does show that about one out of two of our cases is overturned. As for those cases that are not overturned, we take those cases to court and litigation.
Lawsuits
The first thing we need to do is clarify what we mean by the term, “winning a lawsuit.” Oftentimes when a case goes to court, the vast majority of long term disability claims settle, which means the claimant is not necessarily put on claim, but instead they accept a lump sum payment and they go their separate ways from the insurance company. If you define that as the win, the vast majority of claims that do go to court do end up settling for a lump sum payment, which we would classify as “winning the lawsuit”.
When a case does not settle in mediation, the parties typically file cross-motions for summary judgment, where the parties let the court decide which side wins and it becomes an “all or nothing”. Either the claimant wins benefits, and their benefits are reinstated, or the insurance company wins and the claimant receives nothing.
Now let’s talk about cases more generally, and more nationally. When you look at decisions that are issued by the court on cross-motions for summary judgment, you’ll see that the insurance company wins those cases that do not settle about anywhere from 80-85% of the time. I don’t think it’s because we have bad lawyers on our side of the fence (the plaintiffs’ side). In fact, I think we have a lot of good lawyers fighting on the plaintiff’s side.
However, it goes to show that the law is so heavily favored in favor of the insurance companies that they win 80-85% of the time. When you turn that around, the insurance companies understand that they might have a 15 or 20% chance of losing. To determine “settlement value”, the insurance company multiplies that 15 or 20% risk factor against the total value of the claim, which means that insurance companies typically want to settle disability insurance claims for about 15 or 20% of the total value of the case.
Our goal in representing claimants is the exact opposite of the insurance companies’ goal. We want to obtain the largest settlement possible for our clients. It is possible to settle LTD cases that have gone to court for 20-50% of the total present value of the claim. Some may settle for an even larger percentage than in that range if the case is well supported by the medical and opinion evidence, and the insurance company’s decision is without any reasonable basis.
Every case is unique, so I encourage you to give us a call to discuss your individual case. Although based in Florida, the Ortiz Law Firm represents claimants across the United States. If your LTD claim has been wrongfully denied, delayed or terminated and you’d like to speak to an experienced Long Term Disability Insurance Attorney contact us at (866) 853-7703 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.
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