Can't I Wait To Get an Attorney After the Long-Term Disability Insurance Appeal Process Ends?
My doctor and I both think I am disabled. I have long-term disability insurance that I purchased through my employer. The insurance company denied my claim - my doctor says they do that all the time and that I should get the money I am entitled to receive if I just file an appeal with the company. Why should I go to the expense of hiring a lawyer now? The appeal process looks pretty simple.
The appeals process looks simple enough, but if your insurance policy is covered under the Employment Retirement and Income Security Act of 1974 ("ERISA") (and given the limited information you in your inquiry it probably is) you do not have the rights you may think you have.
For example, when you participate in the appeals process you give the company additional information that it says it needs to evaluate the claim. However, if the company turns down the appeal again, you may not be appeal to submit more evidence to a court. Thus, the court will be limited to looking only at what the company who denied the claim looked at and, depending on the language of your policy, the court may be able to reverse what the company did only if the court finds that the company "abused its discretion." This is a difficult legal standard of meet, especially if the record created on appeal does not include all of the necessary and available information.
Therefore, if you wait to hire a lawyer until after your appeal is denied you may not include those materials in your file with the company on appeal that will persuade the company to reverse its earlier decision or to enable a court to do so upon later review.
I would encourage you to discuss your claim with a lawyer before you appeal. Our office does not charge an initial consultation, and we will consider employment on a contingent fee basis in appropriate cases.
