The chances of winning your long-term disability appeal or litigation depend on several factors, but there are two that prove most crucial. The first is the amount of solid evidence submitted, and the second is the quality of your legal representation. While it is possible to file an appeal on your own, the process is complicated. Any errors could reduce the chances of winning your appeal.
Hiring the experienced long-term disability attorneys at Marc Whitehead & Associates can improve your chances of winning your appeal and litigation.
Understanding the Long-Term Disability Claims Process
The initial disability claims process
Start the claims process by reviewing your long-term dsability policy and its terms and conditions thoroughly and making sure you understand it. Find out exactly how the policy defines disability. Some policies require full disability before a person is eligible for benefits, while others permit partial disability. If the policy is unclear regarding your situation, it is time to consult a disability attorney.
You will have to complete an employee statement, which includes your work information as well as other benefits, such as workers’ compensation. Fill out all the necessary forms, answering questions specifically and honestly.
Gather all the necessary medical and financial documentation to support your claim. The latter includes state and federal tax forms and other information you will find in the Proof of Claim section of the policy.
Speak to your doctors and explain your situation. Along with medical records, lab and test results, and similar information, your doctor must provide more than just evidence detailing your disability. They must also explain in detail why you are no longer able to work.
After reviewing your claim for accuracy, submit it to the insurance company by the required deadline.
If your Insurance Company denies your claim for benefits, you have the right to appeal their decision.
Factors Influencing the Success of Appealing a Long-Term Disability Claim Denial
Medical evidence and documentation
Ensure that your medical records are as comprehensive and up-to-date as possible. You do not want to omit any relevant information. In addition to obtaining supportive statements from healthcare providers, you need documentation demonstrating the severity of the disability.
If necessary, secure expert opinions regarding your disability and prognosis. Your experts will test you in several areas. These include:
- Functional capacity–Your ability to function physically. The results will show the limitations of your ability to perform your job on the physical level.
- Neuropsychological evaluation–An assessment of your mental or cognitive abilities, again focusing on the limitations of your ability to perform your job.
- Vocational assessment–This assessment details the physical and mental functions of your job and why your disability means you can no longer function in this capacity. The assessment will consider whether you can perform your current duties or if you can perform the duties for any job.
Keep in mind that insurance companies are known to hire private investigators to perform surveillance on those filing for Long-Term Disability. This may take the form of video surveillance, keeping tabs on social media accounts, and even photographing the claimant outside their home. If these PIs find evidence that the person is not as disabled as alleged, such as participating in sports or other strenuous activities, the insurer will use this as evidence against the claim.
Legal representation
The role of an experienced disability attorney cannot be underestimated. Your lawyer will ensure that all submissions are made in a timely manner and craft a compelling appeal letter, addressing the insurance companies’ reasons for the denial and highlighting all of your key evidence and arguments.
When seeking a lawyer to represent you, look for an attorney experienced in disability denials.
The Litigation Option: When Appeals Fail
If your appeal fails, all is not lost. You still have the option to file a lawsuit. If your plan is covered by the Employment Security Act of 1974 (ERISA), you can file a lawsuit against your insurance provider in federal court.
First, you must exhaust all appeals. If you have an individual disability policy that is exempt from ERISA, you must follow the procedures outlined in the policy.
In most cases, the insurance policy will state the statute of limitations for filing a lawsuit. If the policy does not provide a statute of limitations, the court will likely look for a statute of limitations in your state. In many cases, but not all, that period is three years.
Usually, these cases are heard before a judge and not a jury. There are three basic outcomes. The parties may negotiate a settlement, or the judge will either grant or deny your relief request.
Litigation takes a long time. While your case may come before a judge in a matter of months, it is also possible that the process may take a few years before a resolution is reached.
Building a strong legal case
You must have a lawyer if you go forward with litigation. An Attorney builds your case through the process of discovery and evidence gathering. They will help you navigate the challenges of litigation.
Contact a Long-Term Disability Appeal Lawyer
If your disability claim was denied, you need the services of the seasoned attorneys for disability benefits at Marc Whitehead & Associates. Schedule a free, no-obligation consultation today.
