Often, my clients ask “Can I just sue this company for not paying me what they owe me? Can I make them pay all the backpay? Can I make them pay my attorney’s fees? Can I make them pay interest on what they should have paid me before?” And it’s a short and a long answer. The short answer is initially, no. You can’t just sue your insurance company, whether it be The Hartford, Lincoln Financial, Cigna, whoever it may be, if they deny or terminate your long-term disability benefits. You can’t just sue them. You have to go through the administrative process.
What you have to do first
The case law says that you have to exhaust your administrative remedies before you are allowed to sue. In the letter that denied your long-term disability benefits, there is an entire section of that letter that is dedicated to explaining to you what your administrative process looks like because it could be different for every case. In almost every case, the rule is that they’ve got to give you 180 days to appeal. They have to provide you in a reasonable and principled decision-making process, in an appeal situation where you have an opportunity to see everything that they based their decision on and then turn around and provide evidence and arguments and documents and medical opinions and things that ultimately support your claim for long-term disability benefits. Then they have to take that information and have to consider everything. After they consider it, they reach a decision, and if they award your benefits at that point, there’s no real reason to sue them.
So, what if they deny you again?
If they deny you benefits again, and finally say you do not have the right to get long-term disability benefits, then at that point, that letter will say what your legal rights are, which is to file a lawsuit in federal district court. Once you file a lawsuit in federal district court, you’re asking a judge to reverse the insurance company’s bad decision. They will tell you when your deadline is for filing. They have to tell you. It’s called a statute of limitations. They have to tell you when that date is in the letter. A lot of times they’ll say it’s three years from the day that you’re denied. However, most times, insurance companies will actually tell you the date, the actual date by which you need to have your lawsuit filed. Don’t wait three years. Get it done now. Better yet, hire an attorney for your administrative appeal, and then your chances of winning and getting back on claim are that much higher.
Hope this video has been helpful. If you have any questions, comment below or send me an email and I’d be happy to answer them.