If you've been injured or become ill and can't work, and your long-term disability (LTD) insurance company denies you benefits, it's in your best interests to get an attorney. Unlike a disability claim with the federal government (Social Security disability), long-term disability insurance companies are not impartial. Long-term disability insurers have a vested interest in the outcome of LTD claims, because the more disability claims they approve and pay out, the less financially healthy their bottom line is. And the fewer long-term disability cases they approve, the greater their profit margins will be.
Here's why it makes sense to hire a long-term disability lawyer if your insurance company denies your initial claim.
Some LTD insurance companies will deny or delay your claim unfairly. This is called acting in bad faith; here are some examples:
Some LTD companies will conduct surveillance on people applying for benefits. For example, an investigator from the company may secretly follow a claimant and take a video of their activities, such as taking out the trash, grocery shopping, even bending down to pick up a newspaper. Later, this visual evidence might be used to justify a denial on a long-term disability benefit claim, or even to make the argument that the LTD applicant falsely misrepresented his or her condition.
Video footage of claimants can often be unfair to an injured applicant because it often doesn't show the whole picture. While an injured or sick worker can be recorded taking a heavy bag of garbage to the curb or bending down to get a newspaper, the recording probably won't show the worker later resting and recuperating from the demands of such physical activity. LTD companies are notorious for showing only the "highlights" from the recordings they obtain, meaning they show only evidence that may damage a person's disability claim, not support it.
Because LTD companies sometimes do not always play fairly, finding legal representation for your LTD claim is more important than for other types of disability claims. It's particularly important to get a disability lawyer before a hearing on whether you should be granted benefits. An LTD company will not tell you that, by the time an administrative hearing is to be held on your disability claim, your record will be "closed," meaning that you can't add additional records to your file. The company doesn't tell you this at the beginning, because if it did, you would try to ensure that all possible medical evidence that supports your claim is in the file before the hearing, including by asking your doctors to submit supporting information on your behalf.
Sometimes it makes sense to consult with an experienced attorney before you even file for benefits or get denied for long-term disability. There are a few reasons why. At the outset of an LTD claim, the insurance company, as part of their claim processing procedures, may ask you to submit information that it will later use against you. The company may also try to have you sign releases for specific types of information (such as credit information) that will later facilitate its investigation of you. Most applicants for long-term disability benefits willingly comply with every request for information that is made by an insurer. Having an attorney from the outset can give you protection in the form of experienced oversight, advice, and recommendations on what is in your best interest.
LTD insurers count on the fact that you probably won't know their rules and procedures and, as a consequence, will have a more limited chance of fighting to win your disability benefits, despite the fact that you or your employer have dutifully paid the premiums for your disability benefits. To level the playing field, it makes sense to hire a disability lawyer with experience with LTD claims.