Frequently Asked Questions about Long-Term Disability Claims
How can an attorney help me appeal the denial of benefits under an employer-sponsored disability plan?
Most employer-sponsored long-term disability plans are governed by ERISA, which is a federal law. Under ERISA, an individual who has been denied benefits has 180 days after receipt of the written denial letter to submit information in support of the claim. After the 180 days, a court reviewing a denial of an appeal of an ERISA claim usually will not accept or consider new evidence. So, all relevant evidence and arguments in support of the disability claim should be submitted to the insurer or disability plan administrator for the initial administrative appeal.
As your attorney on an administrative appeal, we will obtain the complete claim file and evaluate all medical, factual and considered by the insurance company. But we will go farther by seeking medical and vocational opinions in support of your claim, as well as providing additional factual information to support the claim. We prepare a detailed appeal brochure critiquing the insurer’s analysis of the claim and documenting the evidence that supports a favorable disability determination, based on the insurance policy or group disability plan document.
What kinds of medical conditions result in favorable disability findings?
Each client’s job requirements and medical conditions are unique, so we evaluate disability claims based on your particular medical condition and work requirements. Most disability insurance policies and plans provide benefits for being disabled from your own occupation for a certain period of time, typically 2 or 3 years. After that, benefits are granted only if you are unable to work in any occupation for which you are reasonably qualified, based on your education, training and experience. We have successfully represented individuals by fully exploring the extent of their injuries and future ability to work, based on orthopedic injuries, neurological conditions, fibromyalgia, chronic fatigue, mental health conditions such as depression and post-traumatic stress disorder, back injuries, injuries or medical conditions affecting the use of arms, hands or legs, chemical dependency, and numerous other physical and mental health conditions.
How do I pay for legal services when I am not employed and my benefits have been denied?
We represent individuals both under hourly-fee arrangements and under contingent-fee arrangements. Under a contingent-fee arrangement, our attorney fee is a percentage of the benefit that we achieve for our client; our client does not pay a fee if we do not recover benefits for them. Clients who have limited financial assets usually prefer a contingent fee.
Additional questions you may have specific to your situation can be answered by one of our experienced attorneys. Please note that the information provided on this website is not legal advice, but is provided for information purposes only. For advice specific to your case, please contact our firm for a consultation.