Can You File a Long-Term Disability Claim on Your Own?
Yes, it is possible to file a long-term disability claim on your own, but it is not always advisable. While filing an LTD claim can seem straightforward, even small mistakes can lead to delays or denials.
When an individual is dealing with a debilitating medical condition, filing a claim can be even harder. Further, insurance companies are businesses, and their goal is to minimize payments whenever possible. Thus, the claim and appeal process can be more complicated than most people realize.
In this article, CCK Law will answer the following questions:
- Why is filing an initial LTD claim without an attorney a disadvantage?
- Why is appealing an LTD denial without legal help so difficult?
- What is the ultimate risk of navigating the LTD process without an attorney?
- And more
Is It Risky to File an Initial LTD Claim Without a Lawyer?
Yes, it can be risky to handle an initial LTD claim without a lawyer. This is because LTD policies contain numerous terms such as “own occupation” or “pre-existing condition exclusion” that can affect eligibility. If an individual misunderstands their policy’s provisions, it can lead to mistakes.
Mistakes, even minor ones, can lead to delays and/or denials of claims. When a person handles a claim on their own, they may make common mistakes, including:
- Missing filing deadlines — which may permanently bar benefits
- Using inaccurate terminology — (e.g., “I can never drive” vs. “It’s hard for me to drive most days”
- Not submitting evidence that demonstrates why they meet the policy’s disability definition
- Assuming a diagnosis automatically proves disability — it isn’t the condition itself but how that condition prevents a person from working that qualifies for disability benefits
- Not fully documenting how functional limitations affect the performance of job duties
These common mistakes are often avoidable, especially when you have an attorney to review the policy and prepare the evidence before filing the claim.
Why Is It Difficult to Appeal a Long-Term Disability Claim Denial Alone?
Appealing a long-term disability claim denial alone is difficult because a claimant must be able to rebut and overcome the insurance company’s denial position. In ERISA-governed cases, this is especially challenging because there are unique and, often, strict rules.
These rules typically include the inability to submit new evidence after an appeal decision is made. A claimant who handles their claim on their own may not submit sufficient comprehensive evidence to overcome the denial. If the appeal fails, then it can go to litigation, but the judge will be limited to reviewing only the evidence contained in the administrative record. Additionally, LTD claimants with ERISA-governed claims must go through the entire administrative appeal process before proceeding to litigation; there are strict deadlines for appealing and missing that deadline could mean claimants losing their rights to their benefits.
Types of Evidence Often Needed in an LTD Appeal:
- Updated medical records
- Detailed physician reports on functional limitations
- Third-party physical and/or cognitive evaluations
- Vocational expert opinions
- And more
Because the administrative appeal may be your last opportunity to strengthen the record, professional legal guidance can make a significant difference.
Can You Lose LTD Benefits by Handling Your Claim Without an Attorney?
Yes—the biggest risk of handling a claim on your own is losing access to LTD benefits, even if you meet the medical requirements, because of procedural errors under ERISA.
ERISA—a federal law—governs most group LTD policies. However, this law heavily favors insurance companies. Thus, having an attorney well-versed in ERISA can help build a strong case that can withstand the procedural hurdles this law presents.
Frequently Asked Questions
How does insurance company surveillance affect long-term disability claims?
Insurance companies often conduct surveillance—both online and in person—to look for inconsistencies between your reported limitations and your daily activities. Even brief footage taken out of context can be used to question your credibility.
An attorney can help by explaining how surveillance is typically used, advising you on what to expect, preparing you to avoid common pitfalls, and challenging surveillance evidence that is misleading or improperly obtained.
What evidence do insurance companies expect when reviewing an LTD claim?
Insurers typically look for detailed medical records, physician statements, diagnostic testing, and clear documentation linking your symptoms to functional limitations. They expect evidence that aligns with how your condition prevents you from performing your job duties. Without organized and consistent evidence, claims are more likely to be challenged or denied.
What are the risks of communicating with the insurance company on your own?
Insurance companies may appear helpful, but are ultimately protecting their financial interests. Without guidance, claimants may unintentionally provide information that weakens their case or accept requests that go beyond what their insurance policy requires. Statements—whether verbal or written—can be misinterpreted and used against the claimant later. An attorney can serve as your direct point of contact, ensuring all communication protects your legal and medical position.
Can I take my LTD case to litigation without an attorney?
It is possible, but litigation involves strict procedural rules, legal strategies, and extensive knowledge of disability insurance law. Insurance companies are represented by experienced counsel, and unrepresented claimants are typically at a significant disadvantage. Legal representation is especially important if the case proceeds to federal court under ERISA.
Conclusion
Filing or appealing an LTD claim alone can put your benefits at risk, especially under ERISA rules that limit evidence after the appeal stage.
If you’re thinking about filing an LTD claim or appealing a denial of an existing claim, then CCK Law may be able to help. Since 1999, we’ve been assisting individuals with LTD claims and helping them get the benefits they deserve. Call us today at (800) 544-9144 for a free case evaluation with a member of our team. We will analyze your case and determine if we can help.
