Transcript of video:
Hi everybody, I’m Scott Kolligian, Ohio’s disability attorney, here to discuss the timing of your long-term disability appeal. Oftentimes we get phone calls stating that somebody was either turned down from a long-term disability application or terminated from their long-term disability benefits. They appealed the case right away because they were upset. But, today I want to explain to you why in many cases, this is exactly what the insurance company wants you to do and exactly what you should not do.
First, let’s back up a bit. When I’m talking about long-term disability benefits today, I am specifically discussing ERISA-governed long-term disability benefits. What that means, in most cases, is that this is an long-term disability policy that you received through your employer, oftentimes as a part of your benefits package. ERISA stands for the Employee Retirement and Income Security Act, inferring that it is protecting the employee, but the reality is the law is so advantageous to insurance companies that it is really more of a problem for you, the disabled employee.
ERISA law allows you 180-days to submit your appeal to the insurance company. That sounds like a long time, so why would you want or need to wait so long to submit your appeal? One important aspect of appealing an ERISA long-term disability claim is considering what will happen if the insurance company does not pay your benefit claim. Ultimately, a long-term disability claim that is denied and closed out by the insurance company can be fought in a federal courtroom by filing a lawsuit. To most people’s surprise, the federal judge assigned to your lawsuit will not hold a trial, there will be no witnesses, and you cannot testify before that judge. In fact, in many cases:
- you don’t even get to meet the judge
- there will be no jury deciding the case, and
- your doctor will not be able to submit anything in support of your claim.
So what does happen at federal court? In most cases, the judge gets the complete file from the insurance company, reads arguments submitted by your lawyer and the insurance company’s lawyer, looks ONLY at information that was in the insurance company’s file and nothing else, and then the judge issues a decision.
So the outcome all depends on which judge you get, right? A judge that would look at your medical records and what the insurance company had and say I don’t think that the insurance company got this right so I’m going to roll for you. Right? Wrong. Written into the overwhelming majority of these long-term disability policies is something called a discretionary clause where the insurance company grants to itself the ability to exclusively make decisions regarding the medical and other aspects of your case.
What exactly does all of this mean? It means that the federal court judge when deciding your case doesn’t get to decide whether or not he believes you are disabled, but simply whether or not the insurance company so lost its way that the decision to deny or cut off your benefits was arbitrary and capricious. What in the world does this mean? Some courts have interpreted it as meaning that if an average person could look at the insurance companies decision and say that there is some evidence, then you lose. Simple as that. Awful, isn’t it?
So how does this bring us back to our initial discussion today of whether or not you should appeal your case quickly? By now you can tell that if you have to seek the help of the federal courts to get your case overturned, you know that the judge does not get to issue a decision based on what he or she thinks should have happened. That judge only gets to look at the insurance company’s file when they denied your case for the last time. So, if you want to prove something in court, give it to the insurance company with your appeal. If you want your doctor’s statement to be considered at any point, make sure the insurance company has it with your appeal. Do you want a court to see just how disfigured your hands are from your arthritis? You better get those photographs to the insurance company with your appeal. Need a statement from a co-worker? Family member? Even your own statement? Guess what… You better get it in with your appeal.
Bottom line, there is nothing more than the insurance company wants (other than not submitting an appeal at all) than for you to submit an appeal without a lot of medical evidence, without a report from a jobs expert, or without any other support. They will hurry up and issue a denial letter or a final denial letter because that insurance company knows that a judge will never overturn your case without more evidence, and the judge won’t look at that other evidence if you didn’t give it to the insurance company first.
If you want to put your case in the best position to win, please at least pick up the phone and speak with an attorney who is skilled in challenging insurance companies on long-term disability appeals. Your strategy in presenting your case to the insurance company can be the difference of tens of thousands, if not hundreds of thousands of dollars in lifetime benefits on your long-term disability insurance claim.
And as always, if you have questions about this topic or any other disability benefit-related issues, please reach out to us at our website Akrondisabilitylawyer.com, or give us a call. We’re here to help.
If you have a question about anything I mentioned, give our office a call or visit our website to so you can stop worrying about work and start focusing on your health.
