You’ve applied for long-term disability benefits, or maybe you were on long-term disability benefits and your claim or your benefits were terminated, and you have received what we call a denial letter. The denial letter is in hand and it says in the denial letter that you have 180 days to appeal. The question I always ask people is, “How many appeals do you have?” Most insurance companies only give you one appeal, so that’s one opportunity to get it right. Some insurance companies give you two appeals. They’re all different, so maybe one appeal is mandatory and one appeal is voluntary, or discretionary. It’s important to know how many you have. Because if you only have one appeal, my response is always, “You need to hire a lawyer right away.”
Don’t Be Faced With a Stacked Deck
Federal judges have looked at these cases and said that people who go through this appeals process without a qualified long-term disability attorney are facing a stacked deck of cards. You don’t want to face a stacked deck – no one wants to face a stacked deck. So if you only have one opportunity to appeal, you better believe my advice, and my recommendation is always to go ahead and hire a qualified long-term disability ERISA lawyer. And if you don’t, then you need to do so understanding the potential consequences, that is, if you are denied your long-term disability benefits again, and you don’t do everything that is necessary to make sure that that claim is reversed, then you will not be able to win when you go to federal district court. Because you can’t take the stand and testify, you can’t hire a lawyer at that point and present your case all over again, you can’t call your doctors to come to testify. What you have filed with the insurance company is all that the judge will review.
If you only have one appeal, it is super important to make sure that you go ahead and hire that attorney, make sure that it’s done right the first time. If you have two appeals, and it’s important to understand this and make sure that you get it in writing from the insurance company because you don’t want to be left holding the bag after your first appeal is denied. If you get it in writing from the insurance company that you have two appeals, perhaps you have a mandatory appeal and then a discretionary appeal. If you have those appeals, then it’s okay, it’s not advisable, but it’s okay to go ahead and try to appeal without paying an attorney. If you lose, then you have that second appeal, go hire the attorney at that point.
You should get a denial letter that lists out everything that they have decided and all the reasons why they say that you’re not entitled to long-term disability benefits. You’ll get that in a letter format and it will also say that you have 180 days to appeal. So be very careful with this folks, I want to make sure that I stress this enough — be very careful with this. If you end up only having one appeal in your long-term disability plan and you waste it with a halfway effort to maybe put in some medical records and that’s it, then your appeal is long gone, there’s nothing that you can do. By the time you look at filing a suit in federal district court, there’s simply not enough in the claim file to get a district court judge to reverse the insurance company’s decision.
“What Should I Do?”
If you’re asking for my advice, if you’re asking, “What should I do?” The first thing you do is talk to an attorney, figure out if you have one appeal or two appeals. If you’ve already appealed and you’re still within that decision frame, go ahead and talk to the attorney, see what can be done, because you have to make sure that you do everything the correct way. And if you don’t, the results can be catastrophic.
I don’t know how some people will be able to live, and pay their bills, and keep a roof over their head, and put food on their table, and keep their car insurance current, and those sorts of things that are necessary for life in America. If you need to do those things, which I know that you do, then you need to make sure that you have money coming in. You don’t want to put yourself in a position of having to work when you can’t, that is a miserable position to be in, and I don’t want you to be in that position either. So if you have questions about this, please, please, please give me a call, I’d be happy to talk to you about it.