When you have been representing long term disability claimants for as long as we have, you develop relationships with the adjusters and attorneys on the other side. Sure, you each fight for your client, but the ERISA long-term disability insurance world is a small world. There are only a handful of lawyers in Virginia who are qualified and willing to touch these difficult cases.
Recently I had an interesting conversation with an attorney at a big law firm that defends these cases. No, I won't name names, she's a big time partner at a national law firm.
I asked her about the denial process: whose claims get denied? What are the stats?
Here's what she told me:
- Claimants who simply send in releases for medical records and allow the insurance company to request the records, but then never submit anything else, are likely going to lose. The insurance adjusters are experienced enough to know what NOT to request.
- Most of the adjusters handling your basic claims are very low level, and they have broad authority to say "no."
- The adjusters and their supervisors know that even if they are wrong, it might be years before you get paid. They make money on that.
- For every ten long-term disability denials, six claimants will simply go away, never to be heard from again (or they will file simple appeals that beg for the decision to be reversed, which is just like going away.)
- 4 of the claimants will find lawyers, but only 1 in 3 will find an experienced ERISA disability attorney.
- The one who finds the right attorney has a high likelihood of getting paid.
So there you go. The numbers favor the insurance company. They are experts at playing the odds, aren't they? Here's an article I wrote on applying for long-term disability insurance benefits.