You applied for Long Term Disability [“LTD”] benefits through a group policy associated with your employment. Unfortunately, your application for LTD benefits was denied recently.
A federal law—known as the Employee Retirement Income Security Act [“ERISA”]—applies to disputes like this. ERISA is very complicated, however, it clearly provides that you must “exhaust” the internal appeals process before you can file a lawsuit in federal court to challenge the denial. The denial letter to you should have explained how to appeal and the deadline for doing so (typically 180 days).
In our experience, the most effective internal appeals include one or both of the following:
(1) statements from one or more of your treating doctors that address specifically the medical issues cited in the denial by the LTD carrier; and
(2) statements about the nature and scope of work you did in your last job (assuming that the LTD policy says that you get paid if you cannot perform the duties of your last job).
Thus, and because there is little “lawyering” during this part of the process, we generally discourage people from hiring us (or any lawyer) at this part of the process. In fact, we believe that folks who have to spend money at this part of the process should consult with a vocational expert regarding item (2) above.
If the internal appeal is denied, your only recourse is to file a lawsuit in federal court. Unfortunately, the law is NOT favorable to individuals who do so. As a general rule, you will lose your lawsuit unless you can prove that the LTD carrier’s decision was “arbitrary and capricious” (aka “irrational”). This is a VERY difficult standard to meet.
Please contact us if you have questions.
