You've got a serious illness or injury and can't work - no one questions that. So you apply for long term disability benefits. And you're getting benefits for awhile, but then you get a long, professional letter from the insurance company and it says they are now denying your claim.
So the real short answer to this question is - get a lawyer who handles ERISA disability cases.
Here's why - if you have an ERISA disability claim (most policies are governed by ERISA, a federal law) you have tight and unforgiving deadlines, on top of a standard that makes these cases difficult on you. As a start, here's some of the procedures and deadlines you're probably dealing with:
- Your appeal is due 180 days after you receive the denial letter
- The insurance company has 45 days to respond (and they can get an extension of 45 days)
- You appeal goes to the insurance company (the same one that just denied or terminated your benefits).
- If the insurance company doesn't change it's mind, reverse itself and award benefits, your next step is to file a lawsuit in federal court.
- The federal judge assigned to your case will decide it based upon the administrative record (which is the appeal you filed).
- The standard of review the judge uses is probably discretionary so the judge will likely just be deciding whether the insurance company decision was reasonable.
If your group disability policy was provided by the company you work for, it is probably subject to ERISA.
If so - you need someone to focus on your appeal. This is not just filling out a form or sending in your doctor's note. It is working with medical and vocational experts, gathering and formulating evidence, interviewing witnesses, analyzing and drafting your best arguments.
Give us a call at (202) 393 - 3320 so we can review your denial letter and you can learn more.