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Why You Need a Long-Term Disability Attorney

Video Transcription:

Mason Waring: Hello! My name is Mason Waring. I am an attorney and partner at Chisholm Chisholm and Kilpatrick. I am joined here with my colleague, Attorney Leah Small. We devote much of our practice to handling long-term disability claims, appeals, and court litigation for disabled workers. These are individuals who receive long-term disability insurance coverage through their employer or purchase a policy directly from the insurance companies themselves.

Mason: Today, we are going to discuss why you need a long-term disability lawyer to assist you with your claim. We are going to break it up into six segments and talk about six key ways an experienced long-term disability lawyer can help you. That is going to include analyzing the policy issues, navigating the complex law, working to hold the insurance company accountable to the LTD policy terms and deadlines, avoiding common mistakes, working with doctors and experts to gather the necessary evidence, and taking the burden off you so you can focus on your health.

Mason: So Leah, let us get started and talk about the first key item that a long-term disability lawyer can help you with, and that is, analyzing the policy issues.

Leah Small: Sure. All long-term disability policies are different, even those that come from the same insurance company. It is really important that you read your Long Term Disability Policy carefully because your policy’s specific terms are what are going to govern your LTD claim and determine things like what definition of disability you need to meet, how much you are able to receive each month, and how long you can receive benefits for, among other things.

Leah: However, these policies can be complicated and it may not always be clear whether you are eligible to receive benefits. An attorney, like those at CCK, can read your policy, analyze its terms, and review the facts of your case to help you determine whether you have a potential LTD claim. An attorney can also help you flag any potential issues that there may be with your policy based on your claim, based on the terms of your policy, and facts of your case we know, such as at the outset of your claim, and having those issues in mind can allow you to try and build your claim around them and try to minimize their impact.

Mason: Thanks, Leah. Let us move to the second item. The second way that an experienced long-term disability lawyer can help you is with navigating the complex law. There is a mesh of federal laws so if it is an ERISA-governed long-term disability claim, there is the federal ERISA law, there are the individual laws of the different federal jurisdictions, and then there are the DOL Regs, and if it is not ERISA, there is a state law. Leah, talk to us about that.

Leah: As you mentioned, there is a federal law known as the Employee Retirement Income Security Act or ERISA and that is going to apply if you obtained your long-term disability coverage through your employer. ERISA is a very unique area of the law and an attorney can help you navigate that. There are special rules that apply to these ERISA government claims, so it can be important to have an attorney involved who knows how to navigate those rules.

Leah: For example, if both your initial LTD claim and the administrative [inaudible] are denied, which means that you are at the point where you had to file a suit in court, the evidence the court reviews will usually be limited to the evidence that was submitted to the insurance company during the claim and appeal. This means that you often cannot submit new evidence in court. If you are not aware of this and, as a result, do not submit all the evidence you need during that administrative appeal stage, there may not be enough evidence in the record to bring a successful suit in court.

Leah: Additionally, if the insurance company denies your LTD claim and you do not appeal that denial within the applicable deadline, you can lose the rights to your benefits completely. Because, typically, completing the administrative appeal with the insurance company is a prerequisite to filing a suit in court. If you do not file an appeal, you would not be able to pursue your LTD benefits in court, and the insurance company’s denial will be final. This is also true if you appeal, but appeal after the deadline’s due has already passed.

Mason: Let us move on to our third item which is, a long-term disability lawyer should help you hold the insurance company accountable to the terms of the Long Term Disability Policy and to the deadlines.

Leah: There may be certain rules that the insurance company must follow under the terms of your policy or under state or federal law. An example of one of these rules is how long the insurance company can take to make a decision on your claim or your appeal. But even though these rules exist, insurance companies do not always follow them. But an attorney, like those at CCK, know what rules apply and can help make sure that the insurance company is following them. This helps prevent unreasonable delays on claims or appeals.

Mason: We cannot make the insurance company do anything. You can use the rules, use the law, use the terms of the policy, to explain why the insurance company should or should not do something but, as lawyers, we cannot force the insurance company to do anything. To do that, we have to go to court. During that claim and appeal process, the job of the lawyer is to remind the insurance company “Hey, this is what you promised to the insured in the policy, you need to do this”.

Mason: If they decide not to do it, it is really important to have the lawyer making that record for you if you have to go to court. The court would be the entity that actually forces the insurance company to do something. If the lawyer goes to court, you want to have all that documented during the claim and appeal process.

Mason: So really understanding what the insurance companies obligations are during that process, and making sure that those are being documented, that is a really important function that a lawyer does for you because that will hopefully give you more leverage in court and persuade the courts that “Hey! We explained to them. We remind them of their obligations and they still chose not to”. That can be really beneficial to have that record made for litigation.

Mason: Item four. A long-term disability lawyer will help you to avoid common mistakes. What types of mistakes are we talking about?

Leah: There are actually several common mistakes that claimants make when handling their long-term disability claims on their own. These include failing to understand what their definition of disability is, excluding some of their disabling medical conditions from their claim, using inaccurate language when they are completing claim form, speaking with their doctors or the insurance company, not communicating with their doctors well, relying on the insurance company to gather evidence of their disability, and missing deadlines, or not responding to requests for information from the insurance company. Unfortunately, these mistakes can result in claim denials or benefit terminations. An experienced attorney who is familiar with these claims and this area of the law can help you avoid most of these mistakes.

Mason: Moving on to item five. We, as attorneys, often work with doctors and experts to gather the necessary evidence needed to prove our clients’ claims. Leah, tell us about that.

Leah: Many individuals who handle their LTD plans on their own will complete their claim forms but then leave it up to the insurance company to obtain their medical records or other evidence of their disability. But, even if the insurance company is able to get your record without issue, sometimes medical records, on their own, may not fully or accurately document your disability.

Leah: In those cases, a report from a treating physician or another expert is often necessary and a lawyer can help you identify when evidence beyond the medical records is necessary and then help you obtain it. A lawyer can also help make sure that your doctor understands what the applicable definition of disability is, and make sure they will complete claim forms in a supportive manner for your claim.

Mason: That is a great point. We spend a good amount of time trying to bridge the gap between what the insurance company is asking for and the treatment that our clients’ doctors are providing. The doctors are usually really focused on getting UL, managing your symptoms, things like that, not on serving up the exact information that the insurance company is asking for.

Mason: Many times, there is a communication barrier, and having a lawyer involved that understands the policy terms that are used to dealing with the insurance companies and has an understanding as to what they are looking for and what your obligations are as an insured, can really help facilitate that stream of communication.

Mason: So, item six and an important one: a long-term disability lawyer will take the burden off of you. Leah, tell our viewers about that.

Leah: This is actually one of the things that our clients tell us is one of the most valuable to them. These long-term disability claims and appeals can be time-consuming and burdensome. It can be difficult for individuals to handle these on their own especially when they may be dealing with a significant health condition. A lawyer, like those at CCK, can take that burden off of you which allows you to focus on taking care of yourself and taking care of your health. We handle all aspects of the LTD claim and appeal process for our clients: completing claim forms, gathering medical records, obtaining position reports, hiring experts when needed, and responding to all information requests from the insurance company.

Mason: Some claims are pretty straightforward but a lot of claims have challenges. It does not mean that you are not entitled to your benefits. It just could mean that maybe the medical records do not have all the details they should have. Maybe there is some complexity in how your job was done or maybe things changed in your employment situation. It could be any number of things, including, an insurance company taking an unreasonable position and just not wanting to pay your benefits because they are expensive.

Mason: When you are not feeling well, that may not be the best time to learn something new and feel your way through your own claim because if you make mistakes, they could be catastrophic, and sometimes you cannot always fix them later on. Having an experienced long-term disability insurance lawyer, a team that has worked through this process many times over, that has seen probably the issue you are dealing with, can really help you bring comfort to you and, hopefully, give you the best chance that you can of recovering the benefits that you are entitled to.

Mason: Leah, what are the key takeaways for our viewers today?

Leah: Key takeaway: while many individuals do choose to handle their long-term disability claims on their own, it is often a good idea to have a lawyer involved. A lawyer can help you navigate this unique area of the law and make sure that the insurance company is handling your plan properly. Additionally, these policies can be complex and a lawyer can help assess the viability of your claim, and identify any potential issues with that claim.

Leah: Further, as we just mentioned, a lawyer will take the burden of the claim or appeal process off of you which allows you to focus on your health. We know the mistakes to avoid, and how to gather the necessary evidence to build the strongest long-term disability claim possible. Having a lawyer involved does not guarantee that your long-term disability claim or appeal will be approved, but it can make the process easier for you, and help you identify and try to avoid those issues that result in claim denials.

Mason: Thank you, Leah. Thank you all for tuning in. If you all would like to contact us to see if we can assist you with your long-term disability claim, it costs nothing to reach out to see if we can help. You can reach us by phone at 401-331-6300. You can also find us on the web at cck-law.com. Thank you all very much and have a great day!