Did your insurance company deny your long-term disability benefits in Philadelphia, Pennsylvania? You still have legal options. Contact an experienced Philadelphia long-term disability lawyer at Capitan Law, PLLC at (215) 486-1673 for help fighting back and pursuing the income protection you paid for.
We focus exclusively on disability insurance claims and have decades of combined experience representing claimants whose benefits have been wrongfully handled by some of the largest insurance carriers in the country. Contact our legal team, led by Attorney Joe Capitan, today for a free consultation to learn more. We can review your policy and denial letter and give you a clear picture of where your case stands.
Why Hire Capitan Law, PLLC, for My Long-Term Disability Case in Philadelphia?
Long-term disability claims are unlike most other legal matters in Philadelphia, PA. These cases involve complex policy language and insurance companies that have significant resources at their disposal. Choosing an attorney with specific experience in this area of law is critical to the outcome of your claim. That’s where Capitan Law, PLLC can help.
Our firm was built from the ground up to handle disability insurance disputes. If you hire our Philadelphia long-term disability lawyers, you benefit from a legal team that:
- Focuses its entire practice on long-term disability, short-term disability, and individual disability insurance claims
- Has decades of combined experience taking on major insurance carriers and winning
- Understands both ERISA-governed group plans and individually purchased disability policies
- Is located in the backyard of several of the nation’s largest disability insurance companies, giving us firsthand insight into how they operate
- Handles cases on a nationwide basis out of our Philadelphia and Glen Mills, PA, offices
We treat every client’s case with the attention it deserves because we know your financial stability is on the line. Reach out to our Philadelphia long-term disability attorneys today to get started.
What Is Long-Term Disability Insurance and How Does It Work?
Long-term disability (LTD) insurance is designed to replace a portion of your income if you become too sick or injured to work. Most LTD policies pay between 50 and 70 percent of your pre-disability earnings for a set period, often until you reach retirement age. The coverage typically kicks in after a waiting period, known as the elimination period, which usually lasts 90 to 180 days.
Many people receive LTD coverage through their employer as part of a benefits package. In those situations, the employer often pays the premiums on behalf of the employee. Others purchase individual disability policies on their own. The distinction between a group plan and an individual plan matters quite a bit from a legal standpoint, which we’ll cover below.
If you become disabled and can no longer perform the duties of your job, you file a claim with your insurance carrier. The insurer then reviews the available information to determine whether you meet the definition of “disabled” under the plan. If the insurer approves the claim, you receive monthly benefit payments. If it denies the claim, the process of fighting for your benefits begins.
How Does ERISA Affect Long-Term Disability Claims in Pennsylvania?
If your LTD policy was provided through your employer, it is almost certainly governed by a federal law known as the Employee Retirement Income Security Act (ERISA). This is one of the most important details in any long-term disability case, because ERISA changes the rules in ways that tend to favor insurance companies.
You Must Appeal Before You Can Sue
Under ERISA, you cannot file a lawsuit against your insurer until you have first exhausted the plan’s internal appeals process. This is called exhausting your administrative remedies.
You generally have 180 days from the date of the denial to submit a written appeal to the insurance company. The appeal stage is critical because it is typically your last opportunity to introduce new medical evidence into the record.
Your Case Goes to Federal Court, Not State Court
If the insurance company upholds the denial after the appeal, you may then file a lawsuit. However, ERISA claims are heard in federal court, not state court. The judge usually reviews only the evidence that was included in the administrative record. In most cases, no new evidence can be submitted once the appeal is over.
The Standard of Review Often Favors the Insurer
Many policies contain what is known as discretionary language, which gives the insurer the authority to interpret the terms of the plan. When that language is present, the court applies an “arbitrary and capricious” standard.
That means the judge will only overturn the denial if the insurance company’s decision was unreasonable. This is a tough standard to meet, which is why building a compelling administrative appeal is key.
Individual Policies Follow Different Rules
Individually purchased LTD policies are not governed by ERISA. Instead, state insurance law applies. These cases may offer more favorable legal options, including the ability to pursue bad faith damages.
Our long-term disability insurance attorneys in Philadelphia can determine which set of rules applies to your claim during your free consultation.
Why Do Insurance Companies Deny Long-Term Disability Claims?
Insurance companies deny LTD claims for a wide range of reasons. Some denials are based on legitimate policy issues, but many are not. Insurers have a financial incentive to avoid paying benefits, and they use a variety of strategies to justify cutting off your income.
Some of the most common reasons for LTD denial include:
- The insurer claims your medical records do not support the level of disability you are reporting
- Surveillance footage obtained by a private investigator allegedly shows you performing activities inconsistent with your claimed limitations
- Your treating physician did not provide enough detail in their reports
- The insurance company hired its own medical reviewer who disagreed with your doctor’s conclusions
- You failed to comply with treatment recommendations or submit requested paperwork on time
- Your policy contains a limitation for certain conditions that caps benefits at a shorter period
Many of these issues can be addressed with the right legal strategy. A trusted LTD attorney with our law firm can work with your doctors to strengthen their support for your claim and respond effectively to the insurer’s arguments.
What Happens When the Definition of Disability Changes After Two Years?
One of the most common triggers for a benefit termination is the shift in the policy’s definition of disability. Most LTD policies define disability under an “own occupation” standard for the first 24 months. During that period, you qualify for benefits if you cannot perform the main duties of your specific job.
After those initial 24 months, the definition often changes to “any occupation.” Under that stricter standard, you must prove that you cannot perform the duties of any job for which you are reasonably qualified based on your education, training, and experience. Insurance companies frequently use this transition as an opportunity to terminate benefits, even for claimants who remain severely limited.
If your benefits were cut off at the two-year mark, that does not necessarily mean the insurer’s decision was correct. Many claimants continue to qualify under the any occupation standard if their medical evidence is properly documented. Our attorneys can evaluate your situation and help you challenge the termination.
What Can I Recover in a Long-Term Disability Case?
In an ERISA-governed case, the primary remedy is the payment of the benefits you were owed under the terms of the policy. Punitive damages and bad faith claims are generally not available under ERISA, even if the insurance company acted unreasonably. You may also be entitled to recover attorney’s fees if you prevail.
For individually purchased disability policies that fall outside of ERISA, your options may be broader. Pennsylvania state law may allow you to pursue additional damages beyond the benefits owed, depending on the circumstances of the denial. Our legal team can explain which damages may apply to your specific case.
How Much Does It Cost To Work With an LTD Attorney in Philadelphia, PA?
Many long-term disability attorneys in Philadelphia, including our firm, handle cases on a contingency fee basis. That means you do not pay any upfront fees to get started. Instead, attorney’s fees are only collected if we successfully recover benefits for you.
This structure ensures that cost is not a barrier to getting the legal help you need during an already difficult time. It also means we will be incentivized to help you make the most of your claim.
Contact a Philadelphia Long-Term Disability Lawyer for a Free Consultation
A denied or terminated LTD claim in Philadelphia, Pennsylvania, does not have to be the final word. Insurance companies count on claimants giving up, but you do not have to accept their decision. With the right attorney on your side, you can fight for the benefits your policy was designed to provide.
Capitan Law, PLLC, has decades of combined experience dedicated entirely to disability insurance claims. We understand the federal regulations, the policy language, and the tactics insurers use to avoid paying. If your long-term disability benefits were denied or cut off, we are ready to help.
Call our office or contact us online to schedule a free consultation with a Philadelphia long-term disability insurance attorney. We will review your claim at no cost and advise you on the strongest path forward.
