If you have long-term disability (LTD) insurance and become unable to work, you should hire an experienced LTD attorney as soon as possible to maximize your chances of success. Filing a long-term disability claim, especially when you have employer-provided group coverage, is a process fraught with danger for the unrepresented disability applicant. A single missed deadline, improperly completed form, or wrongly uttered word to a claims adjuster can place your long-term disability benefits in jeopardy.
Employer-provided group LTD insurance is governed by ERISA, the Employee Retirement Income Security Act, a federal law that provides for very specific procedures and time limits for filing LTD claims. A lawyer experienced with long-term disability claims will know how to abide by the ERISA rules and help you succeed, especially in the following areas.
One provision that frequently catches applicants by surprise is that, in a lawsuit against your insurer, you're generally prohibited from introducing new evidence. The federal judge, with very limited exceptions, decides your case based on what's in the administrative record (your claims file with the insurance company). Thus, an experienced ERISA lawyer will try to "stack the administrative record" with medical, vocational, and other favorable evidence before you exhaust your internal appeals--that is, your appeals within the insurance company. (Learn more about the LTD appeal process here.)
Your attorney will make sure that your claim file contains all your relevant medical evidence, and work with your physicians to obtain supportive opinions about your work-related limitations. Knowing the right questions to ask your doctors, rather than relying on the often biased paperwork provided by your insurance company, can be one of your attorney's most valuable contributions.
Depending on whether you have an "own occupation" or "any occupation" disability policy, your attorney may ask a vocational expert to testify about the requirements of your position or the overall labor market. It is rarely a good idea to rely on the testimony of supposedly "independent" vocational experts hired by your LTD carrier.
In addition to obtaining persuasive evidence of your disability, your attorney will also interact with the LTD carrier or plan administrator on your behalf, file your initial application and appeals in a timely manner, conduct settlement negotiations, and if necessary, bring a lawsuit in federal court.
It's never too early to hire an attorney to represent you in your disability case. As soon as you become unable to work, contact an LTD attorney to discuss how you should proceed. An attorney will generally give you a free consultation or case evaluation over the phone or in person, so there's nothing to lose.
While many workers filing for LTD benefits wait until their claim has been initially denied to talk to an attorney, hiring a lawyer to help with your initial application can protect your interests, and it's highly recommended. Here are some examples of common mistakes made by unrepresented workers who are trying to file an LTD claim on their own:
If you've already filed your initial application and have been denied, it is critical to hire an attorney to help with your administrative appeals. Both group and individual LTD policies contain strict timelines, often 180 days, to appeal a denial, so don't delay.
Most disability attorneys handle LTD cases on a contingency fee basis, typically charging between 25% and 40% the past-due benefits that the insurance company owes you. Under a contingency arrangement, you don't owe the lawyer a fee unless you win your case.
Your attorney will likely front the money for the costs of litigation, including depositions, travel expenses, medical records, and postage, but require you to reimburse the costs of these expenses, sometimes even if you lose your case. Be sure to ask about whether you'll have to pay for litigation-related expenses, how much you should expect to pay, and whether you'll be billed even if your claim is unsuccessful. Also be aware that some LTD attorneys charge a percentage of your past-due benefits and your future benefits as well. Feel free to try to negotiate this term, and if your attorney insists, consider taking your business elsewhere. For more information, see our article on how much an LTD lawyer costs.
It's essential that you find an attorney with experience handling LTD cases rather than a general practitioner who will have to learn ERISA law on the fly. LTD cases are too complex and too important to be handled by a lawyer who doesn't specialize in disability law.