When Should You Hire a Disability Lawyer?

If you have filed a claim for disability benefits through your employer-provided disability insurance policy and received a denial letter, you should contact a long-term disability attorney for a denial letter review. Unlike the social security administration, long-term disability insurance companies are not impartial and fall under ERISA law.

The first sign your disability insurance company is about to deny your claim is when they start asking specific questions about your employment, medical condition, or daily activities. Employer-provided insurance policies have strict criteria for qualifying for benefits, and there is little oversight when insurance companies decide to deny or approve benefits.

When the insurance company denies your benefits, you will receive a letter from the insurance company explaining why they rejected your application. An experienced ERISA disability insurance attorney can evaluate your claim using the denial letter and outline your options.

What Does an ERISA Disability Insurance Attorney Do?

One major way ERISA disability is different from social security disability is that the insurance company has the discretion to deny claims based on subjective evidence. Employer-provided insurance companies have huge financial incentives to deny claims, and sometimes they will deny legitimate claims so claimants will exhaust their appeals.

When evaluating your claim, an ERISA attorney will:

  1. Review your denial letter
    Your denial letter typically contains all the technical reasons the insurance company denied your claim.
  2. Request your medical records
    Insurance companies contract independent medical examiners to review your medical records, sometimes without doing a medical evaluation. These doctors are paid to deny claims, and the insurance company favors independent medical examiners who debunk claims.
  3. Analyze your insurance policy
    Private insurance companies can largely write their own rules. Your policy may contain stipulations that require claims to have “objective medical evidence,” which can kill your claim if you suffer from fibromyalgia, migraines, or other neurological conditions.

After the evaluation, the attorney will outline your options and help you decide if you need representation. You don’t always need to hire an attorney for your long-term disability denial, but we always recommend consulting with an attorney before filing your first appeal. Most disability insurance policies limit appeal, and once you have exhausted your appeals, your claim is done.

Should You Hire an ERISA Long-Term Disability Attorney for Your Appeal?

There are several reasons you should hire a lawyer at the appeals stage, but what convinces most claimants is that the appeal is NOT in the same category as the initial benefits claim. The significant is an extension and foundation of the lawsuit. Your attorney should build their entire case into the substantial. ERISA restricts the lawsuit to the evidence and arguments presented in the appeal.

An ERISA attorney will also write an appeal that educates the judge on exactly what the insurance company has done wrong in handling your claim. When filing an appeal, your lawyer will compile all evidence of your disability and make it as clear as possible to the insurance company that you deserve benefits. This can be difficult if you don’t know the history of ERISA law, even for attorneys in other practice areas.

If you’ve received a denial letter from your long-term disability insurance company, you should contact an attorney and do a consultation. Appeals are tricky, and you must present all the evidence supporting your disability insurance claim when you submit the appeal.

For more information about disability appeals in Virginia, please download a free copy of Ben Glass’s book, Don’t Try This at Home: A Guide to Your Disability Insurance Appeal, from our website. You can also contact BenGlassLaw by calling (703) 584-7277 or by filling out a form at JustAskBenGlass.com.