Long Term Disability Appeals

Developing and executing long term disability appeal strategies is what all of our attorneys do on a daily basis. Abell and Capitan Law dedicates approximately 95% of our time, effort, and energy to long term disability benefit claims exclusively. Most of that time is spent on developing long term disability appeals in response to the wrong and unreasonable denials of our client’s LTD claims. Most of our clients come to us with (1) a denied LTD application, (2) a termination of “own occupation” or “regular occupation” LTD benefits, or (3) a termination of “any occupation” benefits alleging the person is capable of less demanding work. While we are located in Pennsylvania and Kentucky, our clients are located across the continental United States. We have experience with physical and mental health impairment claims. We have won appeals for our clients against insurance companies such as Cigna, Unum, Hartford, Lincoln, Reliance Standard, Prudential, MetLife, Guardian, Standard, Mutual of Omaha, Boston Mutual, AXA, etc.

We work on a contingent fee basis – requiring no money up front and with no attorney fee paid unless we recover LTD benefits for you. We offer free legal consultations. Below we provide you with important information about the LTD appeal process and the reasons why you should strongly consider hiring Abell and Capitan Law before you go toe-to-toe with a billion-dollar insurance company.

Making the most of what may be your only opportunity to prove disability

When a group long term disability claim is denied or terminated, the disabled worker is often required to file at least one appeal. At this point, a line has been drawn in the sand. The claim administrator, which is most often an insurance company, is alleging that you are not disabled according to the terms of the LTD policy and that no further benefits are payable to you. The future months, years, or possibly decades of your disability income insurance benefits hang in the balance. Here is our best recommendation:

Hire an experienced long term disability lawyer to represent you as soon as possible before you file an appeal so that you have the benefit of legal representation during the appeal process. This may be your only opportunity to submit evidence in support of your disability per the specific terms of your policy. Waiting until the 11th hour of the appeal process or waiting until the appeal process is complete to hire a lawyer may be very much to your disadvantage.

You Have received a LTD denial or termination letter in the mail – now what?

Most individuals immediately call the insurance company representative that issued the letter and expresses their disappointment and shock. In response, the insurance company representative explains that an “independent” physician or nurse case manager disagrees with your treating doctor and has concluded that the medical evidence does not support your disability. You ask, “What can I do about this because I cannot afford my bills and can’t return to work?” The claim representative replies, “Just write a letter. All you need to do is write a letter stating that you want to appeal. We will then conduct another review and make a new decision.” In our opinion, the “just write a letter” advice is the worst advice you could possibly follow. Here is what you should understand:

  1. You may only get one opportunity to file an appeal and this may be your only chance to submit evidence supporting your claim. For this reason, you would be best served to hire an experienced LTD attorney to represent you before you file an appeal so that you have the benefit of legal representation during the appeal process. If you handle your own appeal, and do not submit a comprehensive appeal that develops all of the medical, vocational, and testimonial evidence needed to respond to the insurance company’s adverse findings, you may not get another opportunity to introduce additional evidence to the insurance company or in a Court of law further down the road.
  2. Developing and executing a comprehensive appeal strategy requires experience, planning, and teamwork. The insurance company you are about to go up against denies countless claims every month and also routinely defends those claims in Court. The insurance company trains its claim representatives how to “properly” deny or terminate claims according to its procedures, it hires an army of internal and external physicians and vocational staff, and retains prominent defense firms to defend its lawsuits. An experienced long term disability insurance lawyer can help you level the playing field and maximize your chance of success as well as the value of your claim by helping you evaluate the terms of your policy as well as the basis of the insurance company’s decision. In doing so, you are more likely to establish your disability.

How long does the LTD appeal process take?

Generally speaking, most disabled workers are provided with a 180-day period in which to develop and submit their appeal. Depending on the complexity of the appeal, it usually takes anywhere from 3 months up to a full 6 months to develop a comprehensive appeal. The insurance company then typically gets up to 90 days to make a new decision on appeal. In total, the appeal process can take approximately 6 to 9 months.

Can the long term disability insurance company request that I attend an in-person examination during the appeal process?

Most often, yes. However, if you are represented by an experienced group long term disability lawyer during the appeal process, your attorney may be able to alter the course or circumstances of that evaluation, will help prepare you for the exam, and will assist you in evaluating how to best document what did or did not happen during the exam with the insurance company’s doctor.

I filed an LTD appeal on my own. I am now being asked to review and respond to more physician or job expert reports. What do I do?

New regulations pertaining to most group long term disability claims require that claim administrators provide the disabled claimant with an opportunity to respond to adverse findings before an appeal decision is finalized. This is usually referred to as a “review and respond” period. You are usually only given 14 to 21 days to respond, which is an extremely short period of time when the dispute may involve a complex medical condition, months or years of medical records, and a lengthy medical report that requires a good deal of your busy treating physician’s time and effort. Beginning to hire a LTD attorney at these later stages of an appeal process may prove difficult because of the urgent deadlines in play for a lawyer that would be starting from scratch. If you unrepresented and are presented with additional reports for your review and response during the appeal process, you should absolutely seek legal counsel, but in a perfect world you would have hired a LTD lawyer from the start of the appeal process so that you are in a better position to review and respond in a meaningful and effective fashion.

The Myth: “I will win my appeal because…”

In our opinion, there is rarely a single magic bullet that will win your appeal. The best approach to developing an appeal should be a comprehensive strategy that considers the medical, vocational, and testimonial evidence that can best support your claim. [frm-name] refuses to use a “one size fits all” mentality. We develop custom appeal strategies that considers the particular policy, the particular medical impairments, the particular person, and the particular insurance company.

Contact an Attorney Who Specializes in Long Term Disability Appeals

If your LTD claim has been denied, having an attorney on your side during the appeals process could improve your chances of it being successful. Contact Abell and Capitan Law today at (267) 419-7888 to schedule a consultation.

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