When should you hire an attorney to help with your employer-sponsored long-term disability policy? To many people, it seems like it would be premature to hire an attorney before they've encountered the first signs of trouble with their claim—but that's only because they don't understand that the rules governing long-term disability policies are stacked against them from the start. If you are about to file for long-term disability or have recently filed, this is why you should consider hiring an attorney now, instead of waiting.
The rules governing long-term disability policies favor insurance companies, not the disabled.
Long-term disability policies that are part of employee benefit packages are usually controlled by the Employee Retirement Income Security Act of 1974 (ERISA), and ERISA allows the insurance company to interpret key definitions and terms within the plans. No two plans are exactly alike, and even the definition of "disability" may vary from plan to plan.
In some cases, the plan may rely on a limited definition of disability (whether or not you're capable of doing your own job) for a short period of time and then switch to a broader definition of disability (whether or not you're capable of doing any type of work). That means that even if you're initially approved, your benefits can be stopped once you cross the arbitrary time limit that uses the limited definition of disability—even though your condition is unchanged (or even worse).
If you are denied benefits or your benefits are cut off, you have limited rights.
If you're denied benefits or your benefits are cut off, all ERISA plans require you to file a mandatory administrative appeal before you can file a lawsuit. This further delays your ability to get the benefits that you need to survive and puts the decision right back in the hands of the people who denied you once already.
This is also where the worst trap for the unwary lies: not only do you have to submit a written appeal explaining why you believe the decision is wrong, you have to make sure that you supply the insurance company with all the supporting documentation that you need to prove your case. Anything you fail to submit cannot be considered later—if your claim is denied again and you're allowed to proceed to a lawsuit, the judge is obligated to make the decision on your case based on what was in the file at the time the insurance company last reviewed it.
That means that you cannot correct incorrect information in the file, cannot submit new evidence, and cannot even add evidence that was somehow missing from the records.
An attorney can help prevent you from making mistakes that could cost you later.
Waiting to involve an attorney in your long-term disability case until you take it to court is waiting too long. Because of the restrictions mentioned above, you absolutely need to make sure that your case is as strong as possible before it ever hits the lawsuit stage. While that might not prevent an unfair denial, it does offer you the best possible chance of successfully winning your case.
For more information about how to handle a long-term disability claim, especially if you sense trouble, contact a disability attorney like Bruce K Billman in your area.
