In this video and article disability insurance attorneys Gregory Dell and Stephen Jessup discuss: When should a disability insurance claimant hire an attorney? Learn the 4 times a disability insurance attorney can help claimants receive disability insurance benefits and the importance of hiring an ERISA trained attorney to represent disability income policy holders seeking benefits. Gain insight into:

  • How an attorney helps with: Applying, Monthly Claim Handling, The Appeal Process & The Litigation Process
  • The Benefits of Monthly Claim Handling
  • Why It Is Important To Have a Disability Insurance Attorney Represent a Claimant For An Appeal
  • The Importance of Having an ERISA Trained Lawyer

GREG DELL: Hi, I am Greg Dell with attorneys Dell & Schaefer, here with Steven Jessup. And our question of the day today is, when should you hire a disability attorney? And Steve, this is a great question because there’s so many situations. But maybe you can help us to break this down. And we’ll just touch on the different areas about when a disability attorney would help someone to perfect their chance to get benefits approved.

There Are 4 Times You Can Hire a Disability Insurance Attorney: Applying, Monthly Claim Handling, The Appeal Process & the Litigation Process

STEPHEN JESSUP: There are four times. And a lot of people think there’s only one time when you have to file a lawsuit because they have this idea that they can’t get a lawyer involved until after their appeals. But there’s four times – when you’re applying for the benefits. Second, if you’re on claim, and you want assistance with the monthly claims handling to avoid a future denial potentially, the appeal process, and then finally the litigation process. So in any of those four times, and really anytime in between, you can get a lawyer involved to help you.

GREG DELL: OK. And let’s quickly break these down because we have lots of other videos going into great detail about each of these four situations. So the first one is when someone’s applying. And what’s the snapshot of why that’s a good opportunity to get a disability attorney involved?

STEPHEN JESSUP: Your application sets the groundwork for everything. That is going to tell the story of your disability claim to the insurance company. And if that isn’t done well, if something’s done improperly, they will use that against you. And it’ll carry through the entire process of your claim through potential litigation. So it’s a way to make sure you’re putting your best foot forward and giving you the best chances of winning your benefits.

The Benefits of Monthly Claim Handling

GREG DELL: OK. Second level is what we call ongoing claim handling. That’s a service we offer where we help to manage people’s claims. And some people say, well, if I’m getting paid already, why do I need you? So why is that the second level of which someone could consider hiring a disability attorney?

STEPHEN JESSUP: Yeah. And that’s a good question. But there’s also a lot of people that say I’m sick of dealing with their forms. They’re harassing me. They’re always threatening to cut off my benefits.

They’re trying to tell me that in a couple months, they’re going to kick me off claim because I’m not going to be disabled under this new standard. So that continuance of claim – you’re on claim. Yes, you’re being paid. But like we said in other videos, there’s no such thing as a guaranteed disability benefit.

You can be denied in any given moment if your insurance company decides you don’t meet their definitions of the policies for disability. So that ongoing claims, it’s a way to make sure medical records are being documented properly, claim forms are being executed appropriately to avoid those common road bumps along the way that end up in denials.

GREG DELL: Right. A lot of people think, oh, they get approved, and it’s just going to stay on claim as long as they need it. And that’s not the case because the disability carrier, once a month, has to re-approved that claim. And if there is a reason to deny that claim, they’ll look for it and use it.

Why It Is Important to Have a Disability Insurance Attorney Represent a Claimant for an Appeal

The third claim, which is the area probably where we see the most people hiring us is when the claim has been denied. And in many of these policies, it requires them to file an appeal. Now, the disability companies, when they send these denial letters, don’t say you should hire a lawyer. But why is it so important at that stage– and again in a snapshot– to have a lawyer for an appeal.

STEPHEN JESSUP: Yeah, because we could talk about that for an hour. At that point, under ERISA, which is the federal statute that’s going to govern your employer-provided disability policy, in the event of a denial, you have one level of mandatory appeal. Some have voluntary. Some have second– but let’s just say you have one level.

That is your last opportunity to present all your information to the insurance company to prove that their initial decision was wrong. It’s going to go to a new department. New doctors are going to take a look at it. So the issue really becomes is if your appeal is denied, at that point, no new information will come into the record for a judge to consider. So you have to get everything.

And a lot of times, people will just read the letter. It says I have 180 days to appeal. My claims person said just write a letter why you don’t agree with our decision. They do that. I mean, I’ve seen handwritten appeal letters to people.

And all of a sudden, there’s rubber stamped– we had another doctor look at it. We don’t think you’re disabled under this policy. And it really sets you up for being in a poor position in any real chance of succeeding in trial to get your benefits.

GREG DELL: Right. I mean, this is your one bite at the apple to do it right. And if you don’t do it right, there’s nothing we can do after they make a final decision to undo it or to add to that record. So there’s so many strategies and so many appropriate ways to do an appeal that we’re happy to discuss with you. But we really want you to be aware that you shouldn’t try to do that on your own because we’re going to be married to what you do in that appeal.

The Importance of Having an ERISA Trained Lawyer

And that’s what we’ll put forward in a lawsuit, which is going to lead us to the fourth level where basically someone really has to hire a lawyer. Even though our court system allows you to do something alone, there’s a reason that people go to law school and train for years to be proficient in what they do. So having a lawyer for the final stage of litigation, especially in the world of ERISA, is extremely important. And Steve, having an ERISA-trained trained lawyer as opposed to just any lawyer trying to file an ERISA lawsuit, why is that so important?

STEPHEN JESSUP: ERISA’s unlike any other area of the law. Other colleagues, we have other lawyers in other areas. And we try to explain how the law works. They’re blown away by it.

Just as a quick snapshot, there are no jury trials. Only a federal judge is going to make a decision on your case. You don’t get to testify. Your doctors don’t testify. No one from the insurance company will.

Like we said in the appeals, after a final denial, no new information can come in. So a judge is only going to look at your claim file from the beginning to that last and final denial. If it doesn’t exist in paper in that file, it doesn’t exist for the purposes of the judge.

And then, the standard review that the judge is, of course, going to look at is known as arbitrary and capricious, which requires a two-step process for the insured. One, you have to prove you’re disabled. If you don’t even have enough medical information, you could lose your case there.

But if the judge says, yes, I find this person is disabled, it goes to the second step. And that is, did the insurance company act arbitrary and capricious? Or did they have a reasonable basis to deny the claim?

It’s a very low threshold for an insurance company to say, hey, we provided a reasonable review. And we don’t think this person’s disabled. So puts a judge in a position where they think you’re disabled, but under the law, they think it was a reasonable decision made by the insurance company. And they have to uphold the decision.

GREG DELL: So this is a snapshot of four situations when a person should consider hiring a disability attorney. And regardless of what situation you’re in as a claimant, you should take us up on our offer to provide you with a free initial consultation of your claim at any of the stages that we mentioned. Regardless of where you live in the country, whether it’s Stephen or myself, we’re available to discuss your claim with you and provide you immediate feedback. Whenever you call our office, your call’s always going to be answered by an attorney, which is a unique service that we offer. So we’re very serious about providing you with very quick and efficient information that you want to know.

We provide these videos on a regular basis. And we have a nice following on YouTube. And we encourage you to subscribe to our YouTube channel and watch our videos in the future, which we hope will help you with your disability claim. And we look forward to the opportunity to speak with you when you need us.

If you are considering hiring a disability insurance attorney to help get your disability income benefits paid, our disability insurance lawyers are available nationwide to provide you with an immediate FREE consultation to discuss your disability insurance claim.