Long Term Disability Attorney
in Houston, Baytown and Galveston, Texas

Long Term Disability Insurance Denials

It has become common practice for insurance companies to systematically deny valid long term disability insurance claims as a means of containing costs and increasing profits.  Insurance companies that commonly issue disability policies are Unum Provident, Paul Revere Life, Unum Life Insurance Company of America, Provident Life and Accident Insurance, John Handcock, Liberty Mutual, Metlife, Prudential, Penn Mutual, and Mutual Benefit Life among others.

The law and procedures governing the disability claims process differs depending on whether or not you claim is “pre-empted” by Federal ERISA law.  ERISA stands for Employee Retirement Income and Security Act. The distinction generally is determined by whether or not your employer has paid any part of your disability insurance premium.  It is very common to have a group health and disability insurance plan through your employer.  Typically if this occurs, then the Insurance plan will be governed under Federal ERISA law and procedures.   If the policy is purchased privately by an individual, the policy is normally governed by state insurance law. 

Claims governed under ERISA law are quite different and distinct from normal insurance claims that are governed by state insurance law.  Most attorneys are not familiar with the nuances and legal traps in ERISA governed claims.  It is important to seek immediate legal help from an attorney familiar with ERISA early in your claim.

Claims governed under state insurance regulations are generally governed by applicable state contract and bad faith law.  A complete and thorough  knowledge of this type of law is necessary to effectively pursue these types of claims.

Unfortunately, the process of filing for benefits can be complicated, and the legal definition of “disability” can be ambiguous.  In most policies, the definition of disability shifts from an inability to perform one’s “own occupation” to the inability to perform “any occupation” after some period of time (usually after 24 months.)  It is very common for insurance companies to “cut off” claims after the expiration of the initial “any occupation” standard of disability. 

Claimants usually have only 180 days to file an “administrative appeal” of this denial. In ERISA governed claims, the administrative appeal is critically important to the claimant, in that this is generally the only opportunity for the claimant to submit critical evidence of disability.  If a lawsuit is necessary later on, generally the only evidence considered at trial is the evidence submitted during the administrative appeal.  Therefore it is important to “load the record” with medical and vocational evidence favorable to your claim.

This evidence is generally in the form of vocational expert reports, medical opinion evidence, residual functional capacity reports, objective medical testing, job description evidence under the federal government’s Dictionary of Occupational Titles and affidavits of the claimant and key witnesses.  A key mistake made at this level of appeal is not submitting this key evidence.  The penalty for the claimant is the inability of submitting this evidence in trial before the Court if it becomes necessary.  We have seen unrepresented claimants and inexperienced lawyers make this mistake repeatedly.

Insurance companies often deny legitimate claims.  Whether you have already been denied benefits, or are just now filing and need legal guidance, the Marc Whitehead & Associates will help you demonstrate to the court that you are in fact disabled under the terms of the policy, and seek a court order for regular payments.  Additionally, we will help in the event your payments have been delayed and/or you have been under-compensated.  Also, if you have been fired or laid off, and intend to file a LTD claim, we can help in the area, too. 

It’s important to note that, if you’ve been denied a LTD claim, you should not sign anything from the insurance company without first consulting with us. 

What Will a Long Term Disability Attorney Do For Me?

Every client is different and has different needs but below are just some of the things our Attorneys may do to help you with your Long Term Disability insurance claim:

1. Aid you in filing out all insurance company forms;
2. Evaluate your insurance claim and advise you on the law and your options;
3. Review your medical records and make suggestions for any additional testing required to prove your case;
4. Supplement your claim file with additional medical records;
5. Obtain your complete claim file from the Insurance Company pursuant to Federal ERISA statutes;
6. Obtain medical reports and opinion evidence regarding your disability;
7. Consult with qualified Vocational Experts to get opinion evidence rebutting an insurance company’s denial;
8. Obtain and develop evidence regarding you “Residual Functional Capacity” that is the key to your disability claim;
9. File your administrative appeal when necessary, quickly and effectively;
10. Correctly Calculate your benefits;
11. File a legal brief arguing the legal, medical and vocational issues in your case;
12. File a lawsuit in Federal Court if necessary;
13. Conduct discovery in the Federal Court case such as filing interrogatories and requests for production as needed as well as taking all necessary depositions;
14. Responding to Motions for Summary Judgment and trying your lawsuit.

Call or email the Galveston long term disability attorney at Marc Whitehead & Associates right away for a free long term disability case evaluation.