You Probably Won't Have To Testify In Court If Your Long Term Disability Appeal Is Denied.

Most long term disability insurance policies provided by an employer as part of your employee benefits or compensation package, are governed by a federal law, ERISA (Employee Retirement Income Security Act), so if there is any litigation on your claim for long term disability benefits, it will be in federal court.

Here's how it works:

After A Denial Of Long Term Disability Benefits, The First Step Is To Appeal

Appealing a denial of long term disability benefits is difficult, especially for someone who can no longer work and is dealing with the effects of a serious injury or medical condition (which the disability insurance company doesn't believe or doesn't believe prevents you from working).

Your appeal to the insurance company is the most critical step in the process.

It is much more than completing a form or sending in some medical records from your doctor.  You need to analyze your long term disability policy - the definitions, terms and conditions, exclusions and limitations, etc. - will help you get started on what you need to prove.

You need to analyze the denial letter and request a complete copy of your claim file from the insurance company (which may be hundreds and hundreds of pages - make sure you specifically ask for everything).

If your long term disability insurance policy is an ERISA policy, there are regulations that govern how the insurance company evaluates and decides your appeal.  As you know, the insurance policy is written by the insurance company - not only does the policy favor the insurance company, federal courts have routinely ruled in favor of disability insurance companies based on a number of factors set forth in the policy, including the standard of review the Court uses.

If Your Appeal Is Denied, You Can Sue The Insurance Company In Federal Court

Once your appeal is denied, you can file a lawsuit to get the long term disability benefits you are owed.  But there is a critical difference between an ERISA disability lawsuit and a case involving any other serious injury or medical condition - a medical malpractice case or trucking accident case, for example.

Under ERISA, the federal judge who decides your case will decide it based upon the administrative record - that is, everything your long term disability insurance company had when it denied your appeal.  There won't be any discovery, depostions or additional evidence.  You won't have a jury trial.

That record will include everything you submitted as part of your appeal - so you have to make it count.  That's why we focus on the appeal, on generating all of the medical, vocational and other evidence necessary to prove that you are disabled as defined by your specific policy. While this would not include testifying in court, we interview you (and others with knowledge of your medical condition and job) extensively to prepare a powerful statement as part of our evidence.

Unfortunately, we've turned away people with legitimate, serious medical conditions who are ready to file their case in court because they did not properly and thoroughly file an appeal - and there won't be enough evidence, or the right kind of evidence - for the judge to rule in their favor.

If Your Long Term Disability Insurance Policy Is Not Governed By ERISA, You May Testify in Court

Again, most policies fall under ERISA but some are private, state law contracts. If you have an disability insurance policy that isn't covered by ERISA, you may be able to sue the insurance company in state court, like almost any other case and have discovery, including your deposition.  And if the case goes to trial you may testify in court.

Speak To An Experienced Long Term Disability Today 

If your long term disability benefits have been denied or terminated, fax us your denial letter from the insurance company.  We'll review it for free, in confidence, and with absolutely no obligation.  Just send it to [email protected] We'll give you or thoughts on what you should do next.

And we offer different levels of service depending on your needs - maybe you are just applying for long term disability and only need to consult with us for an hour or two, or you've been denied and need to research, draft, prepare and file an appeal.

We're happy to help.  Call us today at (202) 393 - 3320 to get started.

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer