Long-Term Disability Benefits Denied? Get Help Today
You purchased long-term disability benefits through your employer or on your own.
Now you are at a time in your life where you need to use the benefits you paid for. 
Unfortunately, applying for long-term disability benefits from a disability insurance company can be full of pitfalls.
The paperwork is beyond reason; the same question gets asked over and over by a friendly “case manager.” It’s easy for individuals to become confused and need help.
Maybe you were initially awarded long-term disability benefits under your employer’s policy, but now the disability insurance company is doing an “any occupation” review.
Or maybe your claim has been unfairly denied or unnecessarily delayed.
You get a letter stating "We have concluded that an adverse benefit decision on your claim is warranted." What does that even mean?
The sad truth is that the long-term disability insurance industry has taken advantage of individuals with disabilities for far too long.
However, with the help of Louisiana disability attorney Loyd J. Bourgeois, you can fight back against these reprehensible tactics to deprive individuals with disabilities of their rights.
Find out how to get treated fairly after an injury or disability in Louisiana.
Has Your Long-Term Disability Application Been Denied or Have Your Benefits Been Terminated?
Did you receive a denial or termination of benefits letter and are unsure of the next steps? We will review your denial letter with no cost and no obligation and give you a detailed strategy for moving forward.
If you make a mistake with your appeal, it could cost you hundreds of thousands to millions of dollars in future benefits (depending on your age and how much you were making.)
Get Your Denial Letter Reviewed
How We Can Help with Your Long-Term Disability Benefits
Long-term disability insurers will go to great lengths to get out of having to provide policyholders with the benefits they deserve.
However, help is available. We can help you with:
- LTD Filing Assistance
- LTD Appeals
- LTD Repayment
- LTD Litigation
Additionally, Louisiana long-term disability applicants can find many of the answers to their questions about the long-term disability claims process on our LTD FAQs page.
What to Do Before You File for Disability
If you're preparing to file for long-term disability, we've created a checklist of "8 Specific Actions to Take Before Filing Your Long-Term Disability Claim." All we need is your name and email address, and we'll send you the checklist right away. Don't make a million-dollar mistake before you've even applied! Just click here to receive your copy of "8 Specific Actions to Take Before Filing Your Long-Term Disability Claim."
What is ERISA?
ERISA stands for the Employee Retirement Income Security Act of 1974. ERISA is a federal law that sets minimum standards for retirement and health benefit plans in private industry. ERISA does not require any employer to establish a plan. It only requires that those who establish plans must meet certain minimum standards.
ERISA covers retirement, health, and other welfare benefit plans (e.g., life, disability and apprenticeship plans). Among other things, ERISA provides that those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct. The law also contains detailed provisions for reporting to the government and disclosure to participants. There also are provisions aimed at assuring that plan funds are protected and that participants who qualify receive their benefits.
Because ERISA is a federal law, and your employee benefits plan is governed by it, any dispute you have with your long-term disability insurer will be heard in federal court and not by your local state court.
ERISA Long-Term Disability Claims
The Employee Retirement Income Security Act (ERISA) is an important safeguard for the rights of employees and is the federal law under which most employee benefits are provided by employers. ERISA requires that plan beneficiaries be fully informed of their rights and the status of health and retirement plans and other benefit plans, like long-term disability or short-term disability.
ERISA provides important protections for employees by allowing them to pursue legal action when their rights to disability benefits are denied. If your long-term disability or short-term disability claim has been denied, you may have grounds to pursue an ERISA claim in Louisiana.
The Erisa Disability Claim Process
If you are sick or injured and cannot work, you may file a claim for short-term or long-term disability benefits. The process seems easy enough, but it is filled with pitfalls and landmines that can destroy your claim.
You will generally get the initial application from your human resources office.
After you make your application, the disability benefit insurer will contact you. Usually, it will be a “very nice” and “friendly” case manager or claims manager. This person will put you at ease (by design) and be your “guidance” through the process.
Do not be fooled. This is not your friend. This is an employee of an insurance company who does not want to pay you benefits. They want to get information that can defeat or minimize your claim.
You will have to provide all of your doctors and medical facilities. The company will obtain your records and will often speak to your doctor. The insurance company then makes a decision on your initial claim. The ERISA disability insurer has a certain amount of time to make their decision under ERISA.
If your initial decision is favorable – that is you get benefits – great. But, the claim is not over. The ERISA LTD claim manager will review your claim periodically (usually every 6 or 12 months). The policy requires you to cooperate and provide the requested information. If you take longer than they want, your claim may be denied.
Your claim will also be reviewed after a period of time (usually 24 months) under what the industry calls the “ANY OCCUPATION” review. Your claim may be denied here as well. You have to appeal to the long-term disability insurer in order to file a court case.
At every step along the way, the long-term disability insurer must make decisions within certain time frames. If they miss the deadlines, there may be damages available to you. But, you must also perform certain actions within certain time frames. If you miss your deadline, in some cases the penalty is the loss of your claim.
How Long Do I Have to Appeal a Long-Term Disability Denial?
The answer depends on where in the process the denial was rendered.
If you were denied by the insurance company, either initially or after receiving benefits, you generally have 180 days from the date of the denial to request an administrative review.
If your administrative review resulted in a denial, you may have up to three years to bring a federal court claim depending on the statute of limitations for similar claims in your state.
For example, in Louisiana, I want to bring a long-term disability denial case to federal court within one year from the administrative denial.
Who Decides If I am Disabled?
Unfortunately, the long-term disability insurance company makes the decision on whether or not you are disabled. They have this power because the United States Supreme Court has ruled that the insurance company can reserve to itself the discretion to make such decisions. After the ruling, all long-term disability insurance companies reserved the power to themselves.
Thus, even though you may have a favorable doctor’s opinion, or several, and other supporting documentation, do not be surprised to receive a denial. Why? In the face of such documentation, the long-term disability insurer will often have their internal company doctors, or their own consulting doctors, render an opinion on whether or not you can work with your ailment or whether or not you are truly suffering from your ailment. At the insurer’s discretion, they can decide to rely on this one opinion from a doctor who never treated or examined you and deny your claim.
Can I Get Punitive Damages for a Denied Long-Term Disability Claim?
Recently, while working on a claim for a disabled heavy equipment mechanic, he asked if it was possible to recover punitive damages because of his improper disability denial. My answer to him and now you follows:
I know that having your disability claim denied is very frustrating. The long-term disability insurance industry has a history of bending and twisting laws just to avoid paying benefits to people who need and deserve it. Unfortunately, the law governing Louisiana ERISA long-term disability claims simply does not have any way to hold these insurers accountable. The ERISA law does not provide for punitive damages or bad faith damages.
While my client was disappointed in the news, he knew there was nothing we could do.
However, if your plan is not an ERISA plan, you may be able to win other damages for the insurance company’s bad faith actions. This includes those with private disability insurance policies, those employed by federal, state and local governments, and those employed by churches or other religious organizations. Because these plans are not covered by ERISA, often they rely on state insurance laws that provide certain penalties for bad faith actions.
To discuss a plan of action for your denial, call disability attorney Loyd Bourgeois at 985-240-9773 for a free consultation.
TALK TO AN ERISA CLAIMS ATTORNEY IN LOUISIANA
Long-term disability insurance companies will tell you that they are serving a vital niche for disabled Americans and giving workers a safety net when they fall ill. These insurance giants, (like Unum, The Hartford, and many others) spend millions each on marketing their virtues each and every year.
But their dirty little secret is that they have systematically denied and delayed long-term disability benefits to covered and premium paying policyholders for years.
While they may be trying to change their image, their past cannot be hidden. Their exploitation of the American worker is well known.
If you have been denied ERISA long-term disability or short-term disability benefits, I can help.
Contact my team by calling 985-240-9773 today to learn more about the legal options that are available to you and what we can do to help you fight your denial.
Speak With a Long-Term Disability Attorney in Louisiana
If you have any questions or concerns about your long-term disability claim, call the offices of Loyd J. Bourgeois today at (985) 240-9773 for a free consultation with a knowledgeable legal professional and learn more about what can be done for you.
