If you have been denied Long Term Disability benefits, you may be wondering whether to hire an LTD attorney to handle the appeal of that denial. While it is possible to handle the various appeals on your own, it is not advisable to do so.
Here are some Q&As about the process and whether or not you should hire an LTD attorney.
Does ERISA apply to my Long Term Disability Claim?
The federal law known as ERISA applies to most private companies, as well as not-for-profit organizations. It excludes governmental entities and jobs and some church organizations. It is important to distinguish whether ERISA covers your LTD claim or not, as the administrative process you will be required to comply with during the course of your claim will look different depending on this distinction.
What do I do when my insurance company denies my LTD claim? Can An LTD Attorney Help?
Typically, you have 180 days from the date of the denial in order to file an appeal of that denial, if your appeals have not been exhausted. If your appeals have been exhausted, your claim file is closed and no more evidence may be provided, even if you want to file a lawsuit. The court cannot look at additional evidence, it can only consider evidence that you submitted with your claim during the administrative appeal which is why it is so important that the correct medical evidence is put before the insurance company in a timely manner.
What does Own Occupation definition of Disability mean?
In a dispute over Long Term Disability benefits, the term “own occupation disability” can start to take on more meaning than those two words seem to imply at first glance. The general gist of this examination is that a claimant is found to be disabled if they become unable to perform the material and substantial duties of their own occupation. Typically, the own occupation period of analysis covers the first two years during which benefits are owed. Later, the standard changes to any occupation.
Explain Mediation?
Mediation is a settlement conference and a very important step in the process leading up to trial once a lawsuit has been filed. In cases in United States District Courts, it is mandatory unless the court approves some other process for dispute resolution. Mediation is a voluntary, alternative dispute resolution, during which a client will usually need to make a decision whether to accept a lump-sum offer.
What happens after my LTD claim is approved?
So many people have been calling us as LTD attorneys seeking help on their Short Term Disability and Long Term Disability claims at a point in time when benefits have been approved. Usually, for some other reason, another issue has arisen for which advice is sought.
Should I hire an LTD Attorney?
It is very important to build your claim as strongly as possible and as early in the process as possible. An experienced LTD attorney at Herbert M. Hill, P.A. can help you navigate this complicated process to do just that. The federal law governing most of these kinds of cases, known as the Employee Retirement Income Security Act (ERISA), is extremely complicated and ever-evolving. Our attorneys stay abreast of these changes and apply them to your individual claim in order that you can maximize the benefits you are owed.
How Do I Write an LTD Appeal?
An appeal following a Long Term Disability denial is an opportunity to let the insurance company know how they may have misconstrued the medical evidence and your treating physician’s opinions. It is important to collect the medical records pertinent to your disability and ensure that they are in the claim file before the claim representative makes a determination in your claim. Further, a claimant would be remiss if he or she does not obtain an affirmative statement of some form or other from their treating physicians outlining their functional capacity and restrictions and limitations. Often, medical records do not give the kind of information that claims representatives need in order to understand your limited functional capacity.
How much is my LTD case worth?
We calculate the present value of their claim and provide a breakdown of the income streams they would have expected had their claim not been improperly denied. The present value calculation is intended to capture the total value of Short and/or Long Term Disability benefits in dispute. These totals fall into two categories, past and future benefits. Both categories are calculated by multiplying the number of months benefits are due by their net monthly benefit. The net monthly benefit can be found by subtracting offsets (other sources of income that are set out in the policy) from the total gross monthly income. The past and future benefits are brought to present value using the appropriate factor to account for inflation and/or interest.
What is a Social Security Disability Offset?
Under most Long Term Disability claims, claimants are required to apply for Social Security Disability benefits. The securing of Social Security disability benefits can be a long process. Most claims are denied at the application phase and after an appeal, as well. However, once these benefits are secured, generally they are deducted from the amount of Long Term Disability benefits a claimant will receive. Because Social Security benefits can take some time to secure, the amount of Long Term Disability benefits paid before that point in time were “overpaid” and are due back from the amount of the Social Security Award.
How long will my application for LTD take?
After applying for or appealing a denial for Long Term Disability benefits, the wait to hear from the insurance company with a decision can seem like an eternity. The insurance company is allowed 45 days to make its decision under the applicable regulations in an E.R.I.S.A. claim. However, they are granted an additional 45 days, should they request it, as a matter of right. This means that typically the window of time is much closer to 90 days than 45 days in the majority of cases we see in our office. In addition, the insurance company may present the claimant or their attorney will a medical reviewer’s report prior to a decision and allow for the opportunity for response by a claimant’s treating physician prior to a decision, which can delay the process further.
What is Waiver of Life Insurance Benefits?
Waiver of Life Insurance Premiums or Extension of Death benefits is sometimes provided in connection with group Life Insurance benefits. They are usually associated with a pending claim for Short Term Disability or Long Term Disability benefits. Basically, when a person is medically disabled from work, there is a provision in the Plan Documents or life insurance policy whereby the premiums for the continuation of the life insurance are waived during the pendency of a total disability. The standard or definition used for determining “total disability” is usually very similar to that of determining disability for Short Term or Long Term Disability benefits. However, the wording may not be exactly the same so a careful review of the policy and the language found therein is necessary.
There are many pitfalls a layperson can overlook to the detriment of their case in the long run. Once the final appeal is denied, there is no more opportunity to add evidence to the record which would eventually go before a judge. There are no do-overs.
It is very important to build your claim as strongly as possible and as early in the process as possible. An experienced attorney at Herbert M. Hill, P.A. can help you navigate this complicated process to do just that.
The federal law governing most of these kinds of cases, known as the Employee Retirement Income Security Act (ERISA), is extremely complicated and ever-evolving. Our attorneys stay abreast of these changes and apply them to your claim.
Insurance companies also tend to harass unrepresented claimants in an effort to exhaust their efforts to build their claim. They employ unfair evidence collection, deny claims for invalid reasons, and/or cause unreasonable delays in the claim process. These kinds of tactics are not tolerated in our practice.
If you have any questions about your Short Term Disability or Long Term Disability claim, please give Herbert M. Hill, P.A. a call and an LTD attorney would be glad to answer any questions you may have. In most circumstances, that conference would be free of charge but in no circumstance would you be under any obligation to hire me nor would you feel any pressure from me to do so.
Herbert M. Hill, P.A. is a law firm located in Orlando, Florida with a practice extending throughout the state of Florida. While the vast majority of cases handled are for disability insurance benefits, areas of practice include employee benefit claims of all sorts. The firm handles any claims arising under the Employee Retirement Income Security Act (“ERISA”) for disability benefits, medical benefits, retirement benefits of any sort, including pension, 401k, termination agreements, or the like as well as claims arising under private disability policies.
