Tennessee Injury Law Center : Lawyers for Personal Injury and Wrongful Death : Serving Memphis, Nashville, Knoxville

I have a disability insurance policy through my job.  I am disabled but the disability insurance company still says I have to submit and claim and go through all the paperwork.  The company says it is up to me whether or not I get a lawyer.  Do I need a lawyer?

I strongly recommend that you have the help of a lawyer.  It sounds like your policy is going to be covered by a special federal law and, if your policy has language in it that is often found in such policies, a federal court that reviews any  denial of your claim will be largely limited to looking only at the same evidence the insurance company looked at when it denied your claim.  Thus, it is extremely important that your file with the insurance company contain all of the relevant material that can be used to support your claim,  An experienced lawyer knows what material to submit in support of your claim and how to make the most persuasive argument that can be made on your behalf.

Also, depending on the language of your policy, it may be very difficult for a federal court to reverse the insurance company's decision to deny you benefits.  If the policy so states, the judge can only reverse a decision to deny benefits if the judge finds that the insurance company "abused its discretion"  in making its decision.

All too many people think that they can handle a claim for disability  on their own and get a lawyer involved only after an appeal has been denied.  Unfortunately, in many cases, the failure to get the help of an experienced lawyer involved early  not only means the loss of an appeal but also the loss of the entire claim.  While no lawyer can promise you that a claim will be approved if you have a lawyer's help, it is fair to say that your chances of having your claim approved increase if you have the help of a lawyer.

Many lawyers who do this type of work will work on a contingent fee basis, which means that they only get paid if they are successful in getting your claim approved.  The Law Offices of John Day, P.C. helps people with long-term disability claims.

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I have received long term disability checks for four years.  I received the policy as part of my employment with former employer.  The insurance company that issued the disability checks now claims I am no longer disabled.  What do I do now?

You should promptly contact a lawyer who is experienced in handling disability cases.  He or she will review your policy, the materials you have received from the insurance company,  and your medical records and let you know what rights you have.  You probably have a limited time to appeal the decision made (I would have to review your policy to know for sure) and the appeal process is extremely important.

You are strongly recommended not to attempt to appeal the case without the assistance of an experienced lawyer.  Your policy is almost certainly covered by a federal law known as "ERISA" that limits the ability of a court to reverse any decision made by the insurance company.  In addition,  in the event later court action is required the contents of your file with the insurance company must contain all of the evidence necessary and readily available to demonstrate that you are disabled within the meaning of the policy.  Experienced disability insurance lawyers know who to assemble and present information that will help you win the appeal or, if not, help a court be able to reverse an insurance company's position to deny your benefits.

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I have a disability insurance policy through my job.  I am disabled but the disability insurance company denied the claim.  The company says I have the right to appeal and that I don't need a lawyer.  Do I need a lawyer?

I strongly recommend that you have the help of a lawyer.  It sounds like your policy is going to be covered by a special federal law and, if your policy has language in it that is often found in such policies, a federal court that reviews a denial of your claim will be largely limited to looking only at the same evidence the insurance company looked at when it denied your claim.  Thus, it is extremely important that your file with the insurance company contain all of the relevant material that can be used to support your claim,  An experienced lawyer knows what material to submit on appeal and how to make the most persuasive argument that can be made on your behalf.

Also, depending on the language of your policy, it may be very difficult for a federal court to reverse the insurance company's decision to deny you benefits.  If the policy so states, the judge can only reverse a decision to deny benefits if the judge finds that the insurance company "abused its discretion"  in making its decision.

All too many people think that they can handle the appeal on their own and get a lawyer involved only after an appeal has been denied.  Unfortunately, in many cases, the failure to get the help of an experienced lawyer not only means the loss of an appeal but also the loss of the entire claim.

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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.

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I have a disability policy that I obtained through my employment.  I have had a lot of emotional problems recently and have been hospitalized several times for those problems.  My psychiatrist says that I need to take at least one year off of work and, in fact, I may never be able to work at my old job again.   I talked to my human resources department about receiving disability payments and  they said that the insurance policy cuts off benefits after two years if the disability is a result of mental or emotional disorders.  Can they do that?

It is not uncommon for disability policies to limit benefits in a number of different ways, including limiting the time period for payments because of mental or emotional problems that result in disability. 

You need to ask a lawyer to review the policy and medical history and see what rights you have under the policy.  Most lawyers who represent those seeking benefits under a disability policy, including our office, do not charge for an initial consultation.

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My long-term disability payments have been terminated after four years.  I received the policy through my employment many years ago.  What should I do now?

You should contact a qualified lawyer as soon as possible - you have a limited period to appeal your decision.   It is strongly suggested that you not attempt the appeal process on your own because the documentation submitted in support of your appeal not only will determine whether the appeal will be successful but also impact whether you will be able to win a case in court if the appeal is denied.

 You should also assemble certain documents for the lawyer to review.  This includes a copy of your insurance policy, all correspondence you have had with the insurance company, and any medical records you have concerning your medical condition.  Your lawyer will need this documents, and perhaps others, to help you determine your legal rights.

We do not charge for an initial consultation and are honored to help people who have had their long-term disability benefits terminated understand their legal rights.

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I receive long-term disability insurance payments from an insurance policy that I got through work. The company required me to apply for disability payments under from the Social Security Administration.  I did, was determined to be disabled by the SSA, and now my long-term disability insurance benefits are being reduced by the amount of my SSD payments.  What is going on?

It is not uncommon for private long-term disability policies to require claimants to apply for SSD payments and then off-set any SSD payment received against the benefit of the private policy.  The language of the policy often gives them the right to do this.

This certainly sounds unfair, but if the policy provisions give them the right to this offset there is little that can be done about it.

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I have been receiving long-term disability payments for eight years.  Now my insurance company has cut me off and says I need to go back to work.   What are my rights?

Your rights are dependent on the language of your disability insurance contract, the applicable law, and your medical condition.

Your contract (policy) specifies when you are entitled to receive benefits and what benefits you receive. The law applicable to your insurance contract will tell whether you can take legal action against the company and the nature of the legal action.  Your medical condition - and whether it makes you "disabled" under the definition of disability in your policy - will also determine whether you remain eligible for policy benefits.

So, the question you asked cannot be answered without more knowledge about the items described above.  Even the law applicable to your claim cannot be determined without knowing a lot more about your policy.

Here is the bottom line:  the loss of your disability benefits is a very serious matter that must be addressed quickly.  It is not uncommon for policies to have an appeal period and the appeal is something that must be approached in a very systematic way.   Do not assume that you can lose the appeal and simply file suit and get your benefits back - there are many, many problems with that approach.  

You need to speak with an experienced lawyer about this problem as soon as possible.  We offer an initial consultation at no charge.

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My long-term disability insurance benefits application was denied.  Now, they say that I have to appeal.  I don't want to appeal - I just want to sue them and get the benefits I am entitled to.  Do I really have to go through the administrative appeals process?

The answer to your question depends on the language of your insurance policy and what law applies to your policy, but if you want to challenge the denial of your claim  it is not unusual for insurance policies to require that you go through an administrative appeals process before going to court 

You should give serious consideration to seeking legal advice to help you through any administrative appeals process that is required under your policy.  If the policy is governed by a federal law known as ERISA (the Employee's Retirement and Income Security Act of 1974), compliance with the administrative appeals process is essential to the success of your case.   Success in any court action after the administrative appeal process a is extremely dependent on the contents of the file the insurance company accumulates as part of the appeal.  

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My application for benefits under a long-term disability policy have been denied.  The denial letter mentions "ERISA."  What is that?

"ERISA" refers to the Employee's Retirement and Income Security Act of 1974, a federal law that impacts the rights of employers and employees in matters concerning in a wide variety of matters, including rights under certain disability insurance plans.  If ERISA applies to your disability insurance plan, your legal rights under the policy will be determined after review of the policy terms under federal law, not state law.

IF ERISA applies to your policy your legal rights are dramatically affected.  However, just because the insurance company says that your policy is governed under ERISA does not necessarily mean that is so.  Whether ERISA applies will depend on numerous factors.  

An experienced long-term disability insurance lawyer can help you determine whether ERISA applies to your insurance policy.

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 I suffer from a disabling medical condition.  The federal government has determined that I am disabled and is paying me benefits.  However, I also have a private long-term disability policy and they have denied my client.  What gives with that?  If the government says I am disabled should the insurance company have to accept the government's determination and pay me under my insurance policy?

Unless your long-term disability insurance policy provides otherwise, the private insurance company is not required to accept the federal government's determination that you are disabled.  (It would be extremely unusual for a private insurer to have such a provision in the insurance policy.)

The insurance policy will have its own eligibility requirements for benefits under the policy, including an elimination period (a period of disability before you become eligible for benefits.)   You will have to meet those eligibility requirements to qualify for benefits even if you have requested and been approved for Social Security Disability Payments.

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I am disabled and can no longer work.  I have been receiving long-term disability benefits for over five years and now the insurance company has decided to cut me off.  Can I sue them?

You may be able to file a lawsuit against your insurance company, but the exact nature of your rights depends in part on the law applicable to your insurance policy.  It is possible that your insurance policy is governed under a federal law known as "ERISA," a law which greatly restricts what type of damages you can recover in a lawsuit and permits the insurance company to erect certain procedural hurdles before you even file suit.

Your insurance policy may be governed by state law and, if it is, the law of your state will govern what rights you have.  (You will still have to comply with the lawful terms of the policy.)  State law often permits a judge or jury to award damages that may not be awarded if the policy is governed by ERISA.

An experienced long-term disability insurance lawyer can help you determine what law governs your insurance policy and this what your legal rights are under the circumstances.

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I have long-term disability insurance through work.  I have been suffering from a  illness and I am afraid I will never be able to return to work.   How do I seek payments from my long-term disability insurance policy?

To recover long-term disability insurance benefits you will be required to fill out an application for benefits.  You will also be asked to sign a medical release that will permit the disability insurance company the right to received your medical records.  

The insurance company will review your application and your medical records to determine if you quality for benefits.  The insurance company may want to have you examined by doctor.    It is possible that the insurance company may hire a private investigator to learn more about your activities and may even videotape some of your daily activities to document what you can do and what you cannot do.

It is very important that you be 100% truthful and 100% accurate when filing out the disability insurance benefits application.  Any mistakes - even innocent ones - will come back to haunt you and may result in a delay or outright denial of the benefits you are entitled to receive.  You may wish to contact a lawyer to assist you in this effort.

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What are the eligibility requirements for long-term disability insurance?

To qualify to receive benefits under a long-term disability insurance policy, the insured must meet the requirements of the policy itself.  The policy will have a definition of the word "disabled" or "disability" and your mental or physical condition must meet that definition.  In addition, there is almost always a waiting period.  That is, you must meet have had the disabling condition for a long enough period that you qualify for long-term benefits under the plan.  Finally, the disabling condition must affect your income or some portion of your income.

Of course, it is often difficult to understand the terms of disability policies.  The policies are written in language that is unfamiliar to most people.

It is wise to seek the services of a experienced long-term disability insurance lawyer to help you understand and seek benefits under your policy.

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