A long term disability (LTD) can leave you either off the job or earning considerably less for a significant amount of time, which can quickly derail your life’s plans and goals. If you are covered by private long term disability insurance, there are federal and state laws in place to help ensure that your LTD is addressed and compensated fairly. LTD claims tend to be challenging, and working with an experienced long term disability lawyer in Cupertino is in your best interest. 

Insurance Coverage

The Employee Retirement Income Security Act (ERISA) governs disability coverage plans that the private sector establishes voluntarily, and there are also state laws in place that address the private LTD coverage that many professionals carry. Although both forms of coverage are private, there are nevertheless legal requirements on the books that guide these challenging claims. The fact is that the insurance company covering your claim is invested in keeping settlements low (and profits high), which means you can expect roadblocks ahead. 

Your Administrative Appeal

If your initial ERISA claim is denied, there is a required appeals process before you can move forward with filing a lawsuit against the involved insurance company. The process includes:

• The insurance company must provide you with its reason for denying your claim. 
• You must respond to the denial by filing an administrative appeal with the original insurance company.

Your administrative appeal sets the stage in terms of your options moving forward, which makes it of primary importance. 

Restrictions

There are a wide range of restrictions that apply, and failure to carefully adhere to them can thwart your appeal. Consider the following:

• You have only 180 days from the time of the insurance company’s denial of your LTD claim to file your administrative appeal.
• Your appeal is your only opportunity to address the key evidence supporting your claim (if you do file a lawsuit, this is the only evidence that will be allowed). 

The requirements for filing an administrative appeal are exacting, and the range of evidence and information that should be carefully addressed include

• The classification of your position in accordance with the Dictionary of Occupational Titles
• The accounts of your primary witnesses (in the form of legal affidavits)
• Your medical team’s professional opinions regarding your LTD
• Your medical test results
• Professional reporting on your residual functional capacity  

If you do need to bring a lawsuit against the insurance company handling your LTD claim, the information included in your administrative appeal represents your only shot in terms of backing up your position with evidence, which makes focusing on the details a top priority. 

Turn to an Experienced Long Term Disability Lawyer in Cupertino for the Help You Need

If your LTD claim has been denied or has led to an unfair settlement offer, it can leave you facing a very difficult future. The formidable long term disability lawyers at Roberts Disability Law, P.C., in Cupertino have an impressive track record of successfully guiding claims like yours toward optimal outcomes, and we’re on your side. To learn more, please don’t hesitate to reach out and contact us today.