Many people find themselves in a position where they can no longer perform all or some of the duties of their job because of a disabling condition. If your employer provides Long Term Disability insurance, or you have a private Long Term Disability plan, you expect the insurance coverage to provide vital financial support when illnesses or injuries keep you out of work.

But insurance carriers are private corporations, and the policy decisions they make are often based on profit margins – not your best interests. It’s important to have someone on your side who knows what it takes to get you the compensation you need.

At Fields Law Firm, our attorneys understand the entire process from submitting applications, to writing compelling appeals, negotiating substantial settlements, and filing ERISA lawsuits. Our attorneys help disability clients throughout the United States and are ready to help you get the full value of your Long Term Disability plan.

It costs nothing to get answers to your questions – get a free consultation today!

First, find out if you have Long Term Disability coverage. Did you buy a policy on your own? Or does your employer sponsor a Long Term Disability policy as part of an employee benefits package? If you aren’t sure, ask your Human Resources department at work.

Next, make sure that you have your doctor’s support. It’s important that you are treated with your doctor, and that they agree that you are unable to work due to your injury or disability. Your most valuable asset in a successful Long Term Disability claim for benefits is the opinion of your treating physician.

Request an application for benefits from the Long Term Disability insurance company. The application will ask for biographical information, as well as information about your disability, condition, or illness. It is important to take the time to read through the application and then fill it out completely and accurately. You may even request an attorney’s help at this stage.

After you submit your application, the insurance company will review your application and the other material you submitted with your application. The insurance reviews this material in order to make a decision on whether or not to pay you benefits. The insurance company may have a medical expert review your records and make determinations about your conditions. The insurance company will likely request information about your job duties from your employer. The insurance company may have a vocational expert review the job description and other information about your job.

Waiting for the insurance company to make a decision can be agonizing. Although the insurer typically has 45 days to make a decision, they will likely request either one or two 30-day extensions to make their decision. Unfortunately, it can take up to 105 days to get an answer from the insurance company.

The Denial. Not surprisingly, many people are denied Long Term Disability benefits at the application stage. The insurance company will mail you a written denial letter. The denial letter should include the reason for the decision and reference the parts of the policy in which the decision is based. Additionally, the denial letter should contain information about your right to receive, free of charge, copies of documents and records relevant to your claim. This is often referred to as the “claim file.”

Submitting an Appeal. The Long Term Disability benefits denial letter should inform you what the next steps are. The denial letter will usually inform you that you have 180 days to appeal the insurance company’s decision. In other words, you have a second chance to convince the insurance company that you should receive Long Term Disability benefits.

Get an attorney. It’s important to hire an attorney as soon as possible once you receive a denial letter. Typically, you only have one chance to build your record to get your Long Term Disability claim approved.

Client Success Story

A clinical assistant with a major healthcare provider in the Twin Cities loved her work assisting physicians and their patients but began suffering from fibromyalgia, untreated spina bifida, chronic migraines, and had widespread issues with her spine and bones. She initially applied for Long Term Disability benefits from the insurer, but they denied her claim stating that her medical information didn’t support a finding of functional impairment.

She knew she wanted to appeal the decision but didn’t know how to go about doing it. She learned that Fields Law had a proven record of success at winning benefits. After our initial consultation with our client, our attorneys immediately began writing her appeal. We argued that the medical evidence conclusively established her disability, noting the insurer failed to give our client’s chronic pain due consideration.

However, the Long Term Disability insurance company ignored our arguments and denied the appeal, avoiding having to pay out on our client’s claim.

We immediately filed a lawsuit in the United States District Court. We made preparations for litigation, and the insurance company eventually began negotiating a settlement. The insurer agreed to pay out a lump sum on our client’s Long Term Disability benefits claim, and she was able to move forward with her life and focus on taking care of herself.