Challenging a Long Term Disability Denial Means Filing a Complaint & Possibly Settling Out of Court
Disability Appeals Are Resolved In & Out of Court
Once a short or long-term disability appeal has been denied, the only way to challenge the decision is to file a complaint in court. Assuming your disability insurance plan is governed by the Employee Retirement Income Security Act of 1974 (ERISA), your complaint will be filed in federal court. A judge will then decide if the insurance company’s actions were unreasonable.
ERISA Claims Are Different Than Other Insurance Disputes
Unlike other cases, you almost certainly will
not have the opportunity to go to trial and prove your inability to work. Instead, a judge will review the information in the insurance file in order to determine if the insurance company had a good basis to deny your claim.
In rare cases, the judge may be allowed to decide if, based on the evidence in the file, they believe you are disabled. Most often, though, the judge will not overturn the denial unless the insurance company’s conduct was downright unreasonable. Due to this high standard, it is crucial that you have representation from experienced disability attorneys who are familiar with ERISA’s procedural requirements and the courts.
Non-ERISA Claims Can Go to Trial
If your claim for disability insurance benefits is governed by state law instead of ERISA, your case can be filed in your local circuit court. The primary claim you can bring is a breach of contract claim against the insurer who denied your disability benefits. There is the opportunity for discovery – that is, making written requests for information and taking testimony of witnesses. These claims can proceed to trial where a jury decides whether the insurance company breached its insurance contract. While state law claims provide the opportunity for you to develop the record, tell your story and prove your entitlement to benefits, the litigation process can also be costly.
You May Have the Opportunity to Settle Your Claim
It can take years before you get a final decision from the court. Not only is litigation time consuming but there is an element of risk. You never can be 100 percent certain what a judge will decide.
In the best case scenario, a court will order the insurance company to start paying disability benefits. Still, the insurance company can stop paying your disability benefits in the future. For these reasons, settlement is appealing to some individuals. We have experience negotiating settlements with insurance companies so our clients get paid and never have to deal with the insurers again.
We Have Extensive Experience Litigating LTDI Denials
Hawks Quindel’s disability attorneys are experienced litigators, negotiators and counselors. We represent individuals at all stages of the disability claim process.
Contact us if you would like to discuss your situation or legal rights with a Wisconsin disability attorney.
Please call a Madison disability attorney directly at (608) 257-0040 or a Milwaukee disability attorney at (414) 271-8650, or email us via our Contact Page.