1. My claim was denied. Should I appeal it myself?
2. The long-term disability adjuster is nice on the phone. Isn’t he supposed to be fair to me?
3. I received Social Security disability. Isn’t that good enough to also receive long-term disability?
4. How can I afford an attorney?
5. Why has my long-term disability benefit been reduced by other benefits?
6. Can’t my lawyer just write a letter or two and win the case for me?

1. My claim was denied. Should I appeal it myself?

It is critical to hire an experienced ERISA attorney after your claim is denied. You should not appeal the claim yourself. Insurance companies and administrators have language in their plans, that give them the right to deny your claim for a wrong reason as long as there is some reasonable basis to support that wrong decision. Therefore, you need an experienced ERISA litigator to handle the appeal and make your claim record overwhelmingly strong in your favor. A court may not let an attorney make your claim stronger during litigation and so it is critical to do this during the appeal and before it is time to file a lawsuit. It may be too late to make the claim strong if you appeal yourself.

2. The long-term disability adjuster is nice on the phone. Isn’t he supposed to be fair to me?

Most disability claimants think that their claim will be handled fairly since the adjuster seems nice. However, that person knows it is her job to deny your claim! When your claim is denied it saves the company or plan money. In fact, some plans and insurance companies hire people who went through law school, and they will know how to deny your claim factually and legally. Adjusters are well trained to deny claims, and they do this every day. You are no match for them. You need an experienced ERISA litigator on your side to fight for the benefit you deserve.

3. I received Social Security disability. Isn’t that good enough to also receive long-term disability?

It should be, but for most plans and insurance companies it is not. You will be told that the Social Security Administration uses a different standard and a different definition of disability than your plan. So Social Security findings supposedly don’t matter. You may be told that the Social Security decision was based on old records and not the latest medical records. So the decision can be ignored. However, the truth is that there really is much similarity and in fact the Social Security disability definition is usually more difficult than the long-term disability plan definition. You need an experienced ERISA litigator to fight and make these points legally and factually for you during the claim process!

4. How can I afford an attorney?

We are here to help. We try to provide fee arrangements that are flexible and meet the needs of clients. The vast majority of our clients receive experienced quality representation on a contingency fee basis. This means that if we do not recover your benefit for you we do not get paid. If there is very little in back benefits, we can still help! We may be able to spread payment of fees out of the benefit over time. This allows us to treat the case like a big case, and invest the money and time needed to make the case strong so you can win. In some instances, a client may have reserves and may desire to pay us on an hourly fee basis. That is offered as well.

5. Why has my long-term disability benefit been reduced by other benefits?

Most ERISA long-term disability plans have contract language allowing the plan to reduce the long-term disability benefit by amounts received for Social Security, pensions, other long-term disability plans, and many other similar type benefits. However, insurance companies may try to reinterpret the plan to take more than is fair and right under the plan. We make sure our clients get the benefits they deserve. We fight against wrongful offsets, and make sure any offsets applied are accurate and legal.

6. Can’t my lawyer just write a letter or two and win the case for me?

No. Most of the time that would be no different than a doctor providing a Band-Aid when you have a serious illness. Plans and insurance companies have a cadre of professionals providing the support needed to deny your claim. They have doctors, nurses, lawyers and many other well-trained individuals. In order to prepare an appeal you must obtain the full claim file and many times parts will be unlawfully withheld without you knowing it. An in-depth review of that claim file utilizing legal and medical professionals is needed. You have to thoroughly know the basis for the claim denial. And then you must articulate the truth and show why the denial is wrong, and assemble medical, vocational and legal evidence to demonstrate this. This must be done with a view toward supporting the case in litigation in the event that the claim is still denied. You should run … not walk … from any attorney who thinks a simple letter is all you need. A diligent determined and quality effort is required.

 
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