Long-term disability (LTD) insurance is meant to provide a safety net. You work hard to earn a living, and with long-term disability insurance you trust that if you’re seriously injured or become seriously ill and can’t return to work, your LTD benefits will help support you. You or your employer–or a combination–have been paying your premiums, and your long-term disability insurance carrier should live up to its end of the bargain. But, it doesn’t always play out that way.
When your LTD claim is denied, an experienced long-term disability attorney can be your best resource. It’s easy to make missteps that could hurt your claim, so the sooner you speak with an attorney who has a thorough knowledge of long-term disability appeals and litigation, the better.
Fighting Your LTD Denial
Of course, some LTD denials are legitimate. It may be that a condition isn’t covered by your policy, or that the condition that ultimately left you disabled pre-dated your purchase of the policy and is excluded. But, you should never assume that your LTD denial letter is the end of the road. Insurance companies make money by taking in significantly more in premiums than they pay out in benefits. So, they’re always on the lookout for an excuse to deny a claim or minimize the payout.
When your LTD claim is denied, you’ll want to talk to a disability insurance attorney that focuses on long-term disability denials right away. The key to fighting the denial may be found in the denial letter you received, in your file, or in your policy documents. Without extensive experience in this area, it can be very difficult to pinpoint what went wrong and how to challenge it. The insurance company is counting on you getting it wrong. At Coffman Law, we have the knowledge and experience to identify missing information, violations of contract terms, or whatever aspect of the claim, and denial opens the door to fighting for your LTD benefits.
A Special Note about ERISA Claims
Most claims for disability benefits through an employer-sponsored plan are governed by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA is designed to protect workers’ benefits, but there is one important procedural issue. In most cases, evidence closes on an ERISA claim when the insurance company renders a final decision on appeal. In plain English, that means that if you exhaust your administrative appeals on your own, you will likely not be allowed to introduce additional evidence later–even key information like medical records that were left out of the application and not introduced on appeal.
This limitation can make it more difficult to win long-term disability benefits after that final decision is rendered. So, if your LTD plan is provided by your employer–even if you pay some of the premiums–it is especially important to retain an experienced long-term disability attorney as early in the process as possible.
Next Steps after an LTD Denial
If your long-term disability claim is governed by ERISA, and in some cases when it is not, you will be required to go through all possible administrative appeals before you can file a lawsuit to collect your LTD benefits. This is called exhaustion of administrative remedies. Don’t assume that because the appeals process looks relatively simple, you should move forward with that step on your own. An experienced long-term disability lawyer will know how to maximize your chances of approval on appeal, and how to create a record in case you have to go to court.
When you retain Coffman Law to represent you in an LTD denial case, we will obtain your file from the insurer and medical evidence to support your appeal. This process typically takes a few months, so it is important that you contact us as soon as possible after receiving your denial letter. We will need time to build your case before your deadline to appeal.
Even if you aren’t required to go through the full appeals process before filing a lawsuit, it may make more sense to do so. One reason you may want to use the appeals process before resorting to a lawsuit is that you will typically get a response much more quickly. In most cases governed by ERISA, you are entitled to a decision within 90 days after your appeal (45 days with an easily met 45 day extension insurers are usually in the habit of taking). A lawsuit, on the other hand, may take anywhere from months to a year or more to resolve depending on how it is resolved.
Your long-term disability attorney will be able to advise you whether to complete the appeals process – which is usually a good idea – or try to go directly to court.
Learn How Coffman Law Can Help after an LTD Denial
Attorney William S. Coffman, Jr. has dedicated his legal practice to disability appeals and litigation, primarily long-term disability insurance claims governed by ERISA. He understands the ins and outs of the disability appeals and litigation processes, the substantive law, and tactics disability insurance companies employ to try to avoid making payment of disability benefits. When Coffman Law represents you, our entire team is dedicated to the success of your claim.
Mr. Coffman also understands that it is important that you have sufficient information to choose the right long-term disability attorney for you, and to make important decisions about your next steps. That’s why Coffman Law always offers a free strategy session to people who have been denied long-term disability benefits in Tampa and throughout the state of Florida.
Whether you have just received your LTD denial letter, have appealed and been denied again, or have lost a lawsuit and want to appeal to the 11th Circuit Court of Appeals, you owe it to yourself to find out if Coffman Law is the answer for you. To schedule your free strategy session, call 888-583-7243 (888-LTD-PAID) right now, or fill out the contact form on this site.