To explain why an attorney is necessary for a long-term disability case, you need to know why doing it yourself is dangerous.
If you appeal yourself, there is a strong likelihood that you will mess something up, or simply not do enough. If that happens, there is no fixing it. In federal district court, the case is not your typical day-in-court type of case. There are no witnesses. No evidence is presented. The judge, by himself, decides the case based on briefs from both sides and a box of records submitted by the insurance company.
An attorney will write better briefs than someone who isn’t versed in legal jargon. But more important is that box of records. The case is decided on the something like the following question: Was the insurance company’s decision reasonable in light of information it had before it at the time of the decision?
The information before the insurance company at the time of the decision (that box of records submitted to the judge) is very important. You cannot add to that box of records at or before trial. The only adding to that box of records comes during the appeal. This is why the appeal is the make-or-break moment of any claim. If you fail to get your documents into that box, and you simply cannot win at trial.
This is the danger of doing it alone: you might fail to do enough. An attorney specializing in long-term disability is necessary because they know what that judge will find persuasive, what documents that judge will want to see. As an example, when I do an appeal I collect the following items:
- Updated medical records from all providers (insurers often obtain only records that will help them)
- A summary of all the medical records in a succinct format
- Letters from friends, family, and colleagues about the following:
- Activities of daily living and home life
- Struggles at work
- Observations regarding the disability
- Testimonial opinions on employability
- Letters from treating physicians attesting to their observations and their medical opinions
- Independent medical exams to help describe the exact consequence a given disability has on employability
- Pharmaceutical records
- Independent medical literature to help a judge understand a medical condition
- Policy provisions that govern how a determination was supposed to have been made
There are a plethora of other things we obtain and use, as well. The point is, we know what information a judge needs based on the policy language in your contract, and we know how to get it to them in the manner they want. Including that information in an appeal is necessary, even though in an appeal it is only the insurance company which is making the decision. If the insurer sees that a claim is prepared to take it to the next level (to go to court), then that forces them to reconsider their termination (they pay legal fees too, you know).
There are other reasons to hire an attorney. We know what arguments work and which don’t, for both judges and insurance companies, because I've been doing this for a while. We step between the insurance company and the claimant, preventing any communication between the two absent my intervention. This saves the client harassment and also protects them from saying something they shouldn’t. Of course, there is also the financial consideration. Hiring me gives you a better chance of recovering the money you are owed. Obviously, my representation has a cost. Not hiring me also has one: a significantly increased chance of defeat.
Why Hire a Lawyer Immediately?
Now, it is of the utmost importance to decide to move forward with legal representation as quickly as possible. There is a lot of information that will need obtaining, and a lot of things to synthesize and refine. This takes time, and time is very limited. I tell all my clients the same thing: the more time I have to work on your appeal, the better the end product. To maximize your chances of winning your appeal, give me as much time as you can. You only have 180 days to appeal. With all the work that goes into an appeal, it is simply impossible to write a decent appeal in less than 90 days.