By: Elliott Andalman, Attorney at Law
Many employers not only provide employees health insurance, but also Long Term Disability (LTD) insurance. LTD insurance is a valuable benefit of employment that pays a percentage of salary to an employee who becomes disabled to work. The benefit can be very substantial, often paying 60% of salary until retirement age. The LTD benefits are typically administered by an insurance company, such as Unum, Liberty Mutual, Cigna, Mass Mutual, MetLife, Aetna, among others. The federal law that regulates these benefits is known as ERISA (Employee Retirement Income Security Act).
Getting approved for LTD benefits has its challenges. Many people assume that because their doctor has determined that they are disabled, the insurance company will pay LTD benefits. Unfortunately, too often it doesn’t work that way. The insurance companies are out to make a profit, so they hire their own doctors and private investigators, among other experts, to find ways to deny these claims. In order to maximize your chances of winning, it’s important to hire a lawyer who is experienced in ERISA law to be your advocate. On an initial application, before you even apply, we can help you:
- Obtain key documents such as the insurance contract (a/k/a Plan document) so that you know terms and conditions of the contract including the definition of disability;
- Obtain application forms and review the forms with you;
- Complete insurance questionnaires about your condition, activities of daily living and ability to work;
- Obtain medical records;
- Obtain Attending Physician Statements from your treating doctor;
- Make sure you meet all of the timelines in the Plan or otherwise set by the insurance company;
- Prepare you for any interview that the insurance company wants to conduct.
Denials take on a life of their own. If you have an application that has been denied, it’s even more important to obtain a lawyer to handle the appeal as soon as possible. Under ERISA, you’re normally required to submit one administrative appeal to the insurance company. What most people don’t know is that under ERISA, if you then have to appeal to court, it generally must go to Federal Court. There, the denial decision will be reviewed by a ludge, but only on the evidence that was already submitted to the insurance company. The judge will not normally conduct a trial or allow you to introduce any new evidence into the record before the Court. Therefore, it is crucial that you build the strongest possible administrative record. We can assist you on an appeal by:
- Obtaining a complete copy of the claim file from the insurance company;
- Reviewing the claim file to look for errors and determininge how the denial decision can be rebutted in the appeal;
- Obtaining additional evidence from your treating doctors to establish that you meet the definition of disability and to rebut the reasons for denial of the claim;
- Obtaining other expert evidence to establish functional disability and vocational capabilities;
- Researching any necessary medical issues;
- Researching any necessary legal issues;
- Filing a brief explaining why the denial decision must be reversed and why the evidence requires that the insurance company award LTD benefits; and
- Meeting the 180 day deadline for filing an appeal.
At Andalman & Flynn, we understand how complex and burdensome this process can be. If your disability claim has been denied, or if you feel overwhelmed by the application process, we’re here with compassionate, professional guidance. Our seasoned attorneys will fight vigorously for your entitlement and help you get the settlement you deserve. For sound legal counsel about your LTD claim, please contact me.
About Andalman & Flynn, P.C.: Andalman & Flynn, P.C. serves clients throughout Maryland and the District of Columbia, offering compassionate, quality service and winning representation across a broad range of legal areas. With a concentration on disability benefits law and family law, the firm focuses on cases that impact the rights of everyone, and they are there for clients when responsive legal help is most critical. For more information about Andalman & Flynn, please visit https://www.andalmanflynn.com, or call 301.563.6685.