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LONG TERM DISABILITY INSURANCE

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Long Term Disability Lawyers

Long Term Disability Insurance, It’s Our Exclusive Practice of Law

Our firm’s practice of law is focused only on long term disability insurance, or “LTD” claims. Attorneys Erik Abell and Joe Capitan founded Abell & Capitan Law with one goal in mind: to offer superior legal representation to our clients who face a mountain to climb once their long term disability insurance claims have been wrongfully denied or terminated. We are one of only a handful of law firms dedicated only to the practice of long term disability law. We employ unique and detailed legal strategies during the application and appeals process to help each client meet the policy’s specific standards of disability. We also file lawsuits against the offending insurance company if your best evidence establishing disability is rejected by the insurance company.

What is long term disability insurance?

Many employers offer group long term disability insurance policies to its employees. If you, the employee, suffers a disability that renders you unable to work, your long term disability policy should pay you a monthly monetary benefit for as long as you remain disabled per the terms of the specific policy. Like most insurance coverages, no one plans to utilize an insurance coverage that requires a disability so significant as to render one unable to work, but accidents happen and chronic medical conditions progress to a point where even those with the most determined work ethic can no longer continue. Long term disability insurance is a critical income replacement insurance coverage to protect individuals and families from the unexpected.

We Handle LTD Claims Nationwide Against Many Insurers On a Contingent Fee Basis

Abell & Capitan Law handles long term disability insurance claims nationwide. We work on a contingent fee basis, meaning you do not pay an attorney fee unless we recover disability benefits for you. We have successfully represented disabled individuals battling insurance companies such as Cigna (Life Insurance Company of North America), Unum, Prudential, Aetna, Reliance Standard, MetLife, Lincoln Financial, Sun Life, Standard Insurance, Liberty Mutual, Principal, and more.

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It Is Difficult and a Challenge to Be Paid Long Term Disability Insurance “Long Term”

Unfortunately, being paid long term disability insurance benefits for a “long term” duration is no easy task. The claimant is faced with many hurdles, barriers, and vertical climbs that can include a never-ending onslaught of forms to be completed by you and your doctors, requests for medical records and documentation, telephone interviews, video surveillance, field investigations, and in-person clinical examinations or functional capacity evaluations.

Most policies pay LTD benefits for the first 24 months if you are disabled from your own occupation, or “regular occupation.” Your occupation is typically defined to be your occupation as it is generally or normally performed in the local or national labor market, not your particular job at your particular employer. After the first 24 months of long term disability insurance benefits are paid, the definition of disability changes to “any occupation,” or “any reasonable occupation.” This change in the definition of disability is significant and puts you at great risk of having your benefits terminated. This is because the insurance company is no longer considering whether you can perform one specific occupation, but rather if you possess the functional capacity and have the skills to perform any other gainful occupation, which opens the door for the insurance company to go on a freewheeling medical and vocational review of your claim. Abell & Capitan Law represents many clients facing “any occupation” terminations at the 24 month mark of disability payments.

The Success of Our Experienced Long Term Disability Insurance Lawyers

Our law firm is proud of our success rate on appeal. Once a group long term disability insurance claim is denied or terminated it is almost always the case that the claimant must appeal that decision directly to the insurance company before a lawsuit can be filed. Reversing the denial or termination of group long term disability benefits is extremely challenging, but our experienced disability insurance attorneys have the legal experience and know-how to develop appeals which maximize our clients’ chances to be paid long term disability benefits without a court battle. While no law firm or attorney can guarantee success in any particular matter, more often than not our law firm is able to develop comprehensive long term disability appeals that reverse a denial or termination of benefits, avoiding a lawsuit in federal court.

The Most Common Ground Used to Deny or Terminate a Long Term Disability Claim

Insurance companies routinely uses several rationales for denying or terminating a group long term disability benefit claim. The one that is most often utilized by insurers is a lack of objective medical evidence.

The most common reason an insurance company denies or terminates a long term disability insurance claim is due to a lack of objective medical evidence. Objective medical evidence can be diagnostic testing such as MRIs, CT scans, xrays, nerve conduction testing, lab testing such as blood work, pulmonary function testing, etc… Objective medical evidence can also be a physician’s written clinical observations and physical examination findings as documented in your treatment notes. Most long term disability insurance policies do not require “objective medical evidence,” but each insurance company invariably requires such evidence as proof of disability.

The requirement of “objective medical evidence,” despite its absence in the actual language of the LTD policy, can be very problematic. Abnormal diagnostic testing may show anatomical or organic abnormalities, but it does not evidence pain. There are no studies that definitively “prove” the presence or degree of pain. In short, only you know the true impact of your impairments and the insurance company’s requirement for “objective medical evidence,” while it might sound reasonable, is merely a ruse by which the insurance company’s doctors subjectively determine the weight or importance of your medical evidence. The same exact set of evidence can be used to deny or approve a claim and the only variable tends to be the doctor assigned to review your claim. The insurance company’s medical review process is similar to Russian roulette, except that the majority of chambers tend to be loaded.

When the long term disability insurer denies or terminates your LTD claim it is most often based on the subjective opinion of the insurance company’s non-examining nurse or doctor sitting in an office hundreds of miles away from where you live. The insurance company’s internal medical reviewers and external “physician peer reviewers” hired through a “third party vendor” provide medical opinions often based on incomplete information, and almost always without the benefit of conducting an in-person examination. This paper-based medical review practice is common practice by long term disability insurance companies, Unfortunately, this widespread medical review practice can lead to wrong and unreasonable claim determinations that are not permitted according to federal law.

Insurance companies will routinely “cherry pick” the medical evidence, minimizing the abnormal evidence and focusing on evidence that does not exist. Another problem is that some medical diagnoses such as fibromyalgia, complex regional pain syndrome, and small fiber neuropathy can evade abnormal results on common forms of medical testing. This can make it medically impossible to provide objective evidence of one’s disability.

Abell & Capitan Law is very experienced in combating denials or terminations of long term disability insurance benefits where the insurer alleges a lack of objective medical evidence sufficient to prove your disability.

Other Types of Long Term Disability Insurance Matters That We Handle

  • Long term disability insurance applications
  • Long term disability claim management
  • Long term disability insurance lump sum settlement negotiations

We focus our practice of law on long term disability applications, appeals, lawsuits, and settlements.

We represent disabled individuals against insurance companies such as…

Cigna Group Insurance*
Most common denial: (1) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (2) Change in definition of disability to any occupation.

Medical reviews: Most often paper-based medical reviews by Nurse Case Managers followed by escalation to a Medical Director (non-examining, paid physicians).

Surveillance: Occasional video surveillance.

Independent medical examinations: Rarely, but becoming more commonly requested as of 2018.

*The underwriter for Cigna’s group long term disability policies is Life Insurance Company of North America.

Unum
Most common denial: (1) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (2) Surgical recovery, (3) Change in definition of disability to any occupation, (4) Applying a limitation such as pre-existing condition exclusion or mental/nervous limitation.

Medical reviews: Most often internal medical reviews conducted by nurses and board certified physicians.

Surveillance: Frequently utilizes video surveillance and field investigations. Almost always conducts internet searches and investigation of social media.

Independent medical examinations: Not often, favors paper-based medical reviews by non-examining physicians.

Prudential
Most common denial: (1) Inconsistent medical evidence, (2) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (3) Change in definition of disability to any occupation,(4) Surgical recovery, (5) Alleges “regular occupation” is less physically, mentally or cognitively demanding than it is

Medical reviews: Most often external paper-based medical reviews conducted by board certified physicians. This company is particularly combative when evaluating claims based on a cognitive impairment.

Surveillance: Occasional to frequent use of video surveillance.

Independent medical examinations: Favors in-person examinations in cognitive impairment cases, and will infrequently utilize an in-person exam for orthopedic cases.

Reliance Standard
Most common denial: (1) Inconsistent medical evidence, (2) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (3) Change in definition of disability to any occupation.

Medical reviews: Most often internal nurse consultant reviews and external paper-based medical reviews conducted by board certified physicians.

Surveillance: Infrequent use of video surveillance.

Independent medical examinations: Frequently requests an in-person examination during the appeal process.

MetLife
Most common denial: (1) Inconsistent medical evidence, (2) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (3) Change in definition of disability to any occupation.

Medical reviews: Most often internal or external reviews conducted by board certified physicians.

Surveillance: Occasionally uses video surveillance.

Independent medical examinations: Occasionally.

Hartford
Most common denial: (1) Inconsistent medical evidence, (2) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (3) Change in definition of disability to any occupation.

Medical reviews: Most often internal or external reviews conducted by board certified physicians.

Surveillance: Frequently uses video surveillance and also routinely conducts field investigations.

Independent medical examinations: Commonly requests independent medical examinations, especially when evaluating an orthopedic or neurological impairment.

Standard Insurance
Most common denial: (1) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (2) Change in definition of disability to any occupation.

Medical reviews: Most often external paper-based medical reviews conducted on appeal by board certified physicians.

Surveillance: Not typical or common.

Independent medical examinations: Rarely.

Aetna
Most common denial: (1) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (2) Change in definition of disability to any occupation.

Medical reviews: Most often external paper-based medical reviews conducted by board certified physicians.

Surveillance: Occasional use of video surveillance.

Independent medical examinations: Rarely.

Lincoln Financial
Most common denial: (1) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (2) Change in definition of disability to any occupation.

Medical reviews: Most often external paper-based medical reviews conducted by board certified physicians.

Surveillance: Infrequent use of video surveillance.

Independent medical examinations: Rarely.

Sun Life
Most common denial: (1) Alleged lack of objective evidence, clinical findings, and/or specific restrictions or limitations, (2) Change in definition of disability to any occupation.

Medical reviews: Most often internal or external reviews conducted by board certified physicians.

Surveillance: Occasional use of video surveillance.

Independent medical examinations: Infrequent.

and many more.

GET HELP.

HIRE A LAWYER.

Because there are some things in life that you should not try alone for the first time.

We represent individuals in long term disability…

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.

No money up front.

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

We have the tools, skills, know-how, and never-give-up attitude needed to help you up the steepest of climbs.

Here is what some of Abell & Capitan Law’s long term disability clients are saying…

I contacted Mr. Joseph Capitan to discuss my LTD claim after my insurance company had denied my original claim. My situation required a seasoned attorney to help me with my difficult LTD case. After many months my LTD claim was reinstated. He followed my case closely and kept me informed all thru the process. He is hard working and a dedicated attorney and uses his strong expertise and professionalism to gain the desired result. His honesty with me all during this process was greatly appreciated. It is not often you find an attorney with Joe’s expertise. I would like to personally thank Mr. Joseph Capitan for working with me during the appeal process and to get my LTD reinstated after was wrongfully denied. I would highly recommend Joe for handling any disability claim.

Anonymous

I was lucky to find Joe to handle my disability claim. He always takes the time to let you know where you are in the claim process and to make sure that you understand what needs to be done. When I received a denial for my disability claim, Joe told me that he believed in my case and worked hard getting me approved. I know that I couldn’t have done it without him. I would definitely recommend Joseph Capitan to handle your disability claims. He is very understanding and will work hard for you.

Karen

I was looking for a lawyer to handle a complicated disability case. No one was willing to take the case but Joseph Capitan. I was concerned because he practices in PA and I live in NJ. He calmed me and said it shouldn’t be a problem. And it wasn’t! I would definitely recommend Joseph Capitan to others.

Laura

Erik was referred to me as an out of state attorney to assist me with my long term disability claim. I was very impressed with how quickly he responded to my case and concerns. He was thorough and explained everything to me. Anytime I reached out to him he responded typically within 24 hours. I am so grateful and appreciative for his assistance with my claim and I can breathe easy again knowing that he got the insurance company to pay out for my disability!

Kellene

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