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AMERICA’S TRUSTED DISABILITY INSURANCE LAWYERS

We represent the disabled in disability insurance…

APPLICATIONS

The application process for disability insurance benefits can be challenging with endless paperwork, doctor forms, and medical records being required endlessly. We can help.

APPEALS

Once denied, the appeal process may be your only chance to submit evidence to protect your benefits. You truly need a lawyer to appeal, before a lawsuit is your only option.

LAWSUITS

Applications and appeals proving disability are denied. If so, there may come a time when your only remaining option is to file a lawsuit. We sue insurance companies to recover the benefits you are owed.

SETTLEMENTS

Lump sum settlements can occur at various stages of the disability claim process. We can negotiate with the insurance company on your behalf to recover the most money possible.

Disability Insurance Lawyers

The experienced disability insurance lawyers at Abell & Capitan Law focus their legal practice on group long term disability insurance claims, individual disability insurance claims, and short term disability insurance claims. We represent the disabled individual, and never the insurance company. We fight to protect our clients’ best interests in disability applications, appeals, policy buyouts/settlements, and in litigation.

We have experience handling both physical and mental health disability claims as well as claims involving other contractual matters commonly used to deny claims, such as pre-existing condition exclusions and mental health limitations. Most clients first come to our law firm with three common scenarios:

a disability claim has been wrongfully denied on application based on a misunderstanding of the claimant’s occupation or by minimizing the severity of the disabling medical impairments, or
a disability claim is terminated based on a change in the policy’s definition of disability to “any occupation” or “any gainful occupation” alleging the individual can perform less physically demanding work such as a desk job, or
a disability claim was terminated because the insurance company alleges the medical evidence no longer supports the inability to work based on the opinion of its medical reviewer or examiner.

We develop custom appeal and claim strategies unique to each case. This is because each disabled person’s medical conditions are different, each policy is different, each person’s education and work experience is different, and each insurance company handles claims in a different manner. Our law firm can help you understand the big picture while also paying close attention to the details that may mean a world of difference to the success of your claim.

If there is one best piece of advice we can offer to any potential client, it is that you should not represent yourself during the appeals process if you are faced with a denial or termination of your disability benefits. The insurance company’s claim representative will tell you by phone that: “All you need to do is write a letter of appeal” — as if a single letter written by you will change the company’s adverse medical and vocational determinations. Reversing a denial or termination from an insurance company is no easy task. You are asking the insurance company to admit it was wrong in denying your claim and to resume payment of your benefits out of its own pocket. As you might expect, the appeal review process is not set up in a way that favors the disabled claimant. Instead, the disability insurance company is most likely to agree with its own prior decision unless you develop a comprehensive and compelling appeal that forces the insurance company to reverse course.

We also help disabled individuals from square-one during the disability claim application process, or to help manage a claim that will likely be (or is being) subjected to an aggressive review process, or to help negotiate the lump sum settlement of a claim currently in approved status. If you have a gut-feeling that the insurance company is targeting you, is giving you the run-around, is harassing you or your physicians, or is looking to offer you a low settlement offer to help its own bottom-line and close your claim, you should consult with an experienced disability insurance lawyer immediately.

If your claim has been denied or terminated you will need to rely on the experience and know-how of our legal team because you may only get once chance to appeal the disability insurance company’s decision before your only remaining option may be to file a lawsuit. If this is the case, as it is for many group disability claims, you will not have any future opportunities to submit additional evidence. There is too much on the line to “go it alone.” The most important legal work on these highly fact-sensitive and fact-intensive claims happens during the administrative process with the insurance company. If you file an appeal on your own, you may be handcuffing any future lawyer who may not be able to develop or submit additional favorable evidence, and you may simultaneously be hurting the value of your claim.

Once you have exhausted your administrative remedies with the insurance company and you are now in a court of law, the deck is often stacked against you. The reality of the situation is daunting. You are filing a lawsuit against a multi-billion dollar insurance company that hires large, reputable defense firms to validate and justify even the most obvious errors and bad acts. Also, the judicial standard of review may favor the insurance company over you, you may not be able to submit any additional evidence, you may not be permitted discovery, and the Judge may never hear your testimony and only decide the case based on a review of paper records. If looking to your potential position once in Court, it becomes much more obvious that involving an experienced disability insurance company as quickly as possible at the first sign of trouble is tremendously important.

Generally speaking, we do not handle Social Security disability claims, but we can handle those claims as an additional service for some of our long term disability and individual disability insurance clients depending on the specific circumstances.

While our core function is the practice of law and the protection of our clients, we also have intense focus on the level of customer service we provide to our clients. It is our law firm’s policy to return your emails and phone calls in a timely manner. We do not lose sight of the reality that the disability application, appeal, settlement, and litigation process must be a collaborative effort between you, your treating physicians, and your lawyers. We strive for excellent customer service and to develop positive working relationships with each and every client.

Most importantly, we take great pride in helping good people. We have many satisfied and happy clients. Please allow us to help you and your family when you need us the most.

We focus our practice of law on long term disability, individual disability, and short term disability insurance claims.

No money up front.

No attorney fee unless you are paid the disability benefits you are owed.

We explain and help you navigate the important details.

day elimination period

month pre-existing condition period

%

of your pre-disability income

months of own occupation benefits

days to file an appeal

%

wage requirement for any occupation

days to provide proof of loss

years old is maximum duration

FROM OUR BLOG

The “Any Occupation” Termination of Long Term Disability Benefit Claims

by Joe Capitan | Jul 3, 2018 | From Joe's Desk

Most group long-term disability policies provide that, after the 24 months of LTD benefits are paid, the definition of disability (or total disability) changes from “own occupation” to “any occupation” (or other similar terms such as “any gainful occupation” or “any...

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