Long Term Disability Attorneys – Helping You Secure The Insurance Benefits You’re Entitled To

A significant number of workers experience unexpected illnesses or injuries that prevent them from returning to their jobs, either temporarily or permanently. Long Term disability insurance is designed to provide a financial safety net in these situations — replacing a portion of your income when you can no longer work.

If an illness or injury has left you unable to work and you are facing the Long Term disability claims process — or a denial — a Long Term disability attorney can help you pursue the insurance benefits you may be entitled to receive.

At Osterhout Berger Daley, our Long Term disability attorneys represent individuals filing disability insurance claims, appealing denied benefits, and litigating Long Term disability cases in federal court under ERISA. Whether you need Long Term disability claim lawyers to assist with your application, a Long Term disability denial attorney to pursue an administrative appeal, or trial counsel for federal court, our legal team focuses on protecting your rights and helping you secure the benefits available under your policy.

What is Long Term Disability Insurance?

Long Term disability insurance is a type of coverage that provides monthly benefit payments, replacing a percentage of your former income if a disabling illness, injury, or accident prevents you from working for an extended period. You may receive this coverage as part of your benefits package through your employer or purchase it independently. Long Term disability benefits typically begin after a Short Term disability benefit period ends, or after a separate elimination period of 30 to 180 days if Short Term disability coverage does not apply.

Long Term disability insurance offers various coverage and benefit options, allowing you to choose the protection that best suits your needs. Understanding these options is critical to ensuring you have the right level of protection for the duration of your disabling condition.

Long Term disability attorneys often assist individuals in understanding the terms of their policies, documenting medical conditions, and ensuring that claims meet the requirements set by the insurance company.

Coverage and Benefit Options

Long Term disability insurance comes with multiple coverage and benefit options that must be selected when purchasing your policy. The best protection is rarely the cheapest option — small differences in policy language can become decisive when a claim is denied. Key factors to consider include:

• Duration: Choose a policy that provides coverage for at least five years, ideally up to age 67 (Social Security retirement age).
• Own-occupation coverage: Pays benefits as long as your disability prevents you from returning to your previous position, regardless of whether you can work in another occupation.
• Any-occupation coverage: A more restrictive definition that ends benefits if you can work in any reasonably suitable occupation. This is the most common trigger for Long Term disability denials and terminations.
• Residual benefits: Provides partial disability benefits if your condition reduces your ability to work to less than full-time.
• Cost-of-living rider: Adjusts your benefit payments according to inflation.
• Optional riders: Unemployment waivers, future-purchase options, and other policy enhancements.

Long Term disability claim attorneys can help you understand exactly what your policy says — before a denial happens, and after — and can help frame your medical and vocational evidence around the policy language at every stage.

Requirements for Long Term Disability Insurance

To apply for and receive benefits from your Long Term disability insurance coverage, you must first meet several requirements:

• Your condition has left you totally or partially disabled (partial disability requires the residual benefits rider).
• Your treating doctor has provided a written opinion describing how your condition impacts your ability to perform the functions of your job.
• You worked full-time prior to the disabling event — usually defined as at least 30 or 35 hours per week.
• You have satisfied the policy’s elimination period — typically 30 to 180 days during which benefits are not paid after your disabling condition occurs.

Every Long Term disability policy is different, and most include strict deadlines for filing and appealing claims. Carefully check your policy to ensure your illness or condition is not specifically excluded from coverage. If you have a pre-existing condition that is worsened by your job, your policy may include an exclusion period of up to one year from the start of coverage.

We will work with you to ensure that you meet the requirements under your plan and that the evidence you submit aligns with the policy’s language.

The LTD Application Process and Critical Deadlines

Expect the application process to take between four to six weeks. To apply, you will need to submit the application, documentation of your income, and a signed release authorizing the insurance company to obtain copies of your medical records. After submitting the documents, you should be contacted to schedule a phone interview.

The next step will either be submission of your file to underwriting for final approval, or the company may require you to undergo a functional capacity evaluation (FCE) or independent medical examination (IME). It is a good idea to consult your Long Term disability lawyer before attending an IME — insurance companies frequently use these assessments as grounds to deny claims. If your case is sent to underwriting for approval, you should expect a decision within roughly two to four weeks. If you are denied, you will receive a denial letter in the mail.

Long Term disability attorneys can help ensure applications are completed properly, that medical evidence is presented effectively, and that every deadline set by the insurance company is met.

Common Reasons for Long Term Disability Claim Denials

Long Term disability claims may be denied for a variety of reasons, depending on the insurance policy and the medical documentation provided. Common reasons for denials include:

• Insufficient medical evidence or inconsistent treatment history
• Policy exclusions or pre-existing condition limitations
• Missed filing or appeal deadlines
• Disputes over whether the claimant meets the policy’s definition of disability — particularly the shift from own-occupation to any-occupation
• Adverse functional capacity evaluation or independent medical examination results
• Mental health and self-reported symptom limitation clauses in the policy
• Surveillance footage or social media activity used by the insurer to challenge the disability

Working with Long Term disability claim lawyers can help identify weaknesses in the insurer’s decision and develop the evidence needed to support an appeal.

Dealing with Denials and ERISA Appeals

Even with Long Term disability coverage, your claim may be denied once you attempt to use those benefits. When a Long Term disability claim is denied, contact Osterhout Berger Daley immediately. Our team of experienced attorneys has helped more than 30,000 individuals receive their disability benefits.

If your claim has been denied, it is critical to appeal the decision. In many cases, an insured claim is won on appeal. Most insurance companies have at least one level of appeal, and some have more. Federal law requires you to exhaust all available administrative appeals before filing a lawsuit. For Long Term disability plans governed by ERISA (the Employee Retirement Income Security Act) — which covers most employer-sponsored coverage — the administrative appeal is the most important step in your case.

When your claim is denied, the company will send you a letter outlining its reasons. Read the letter carefully to see whether you have missing documents that need to be tracked down. The letter will also explain how to file your appeal and the associated deadlines. Do not miss any deadlines — under ERISA, missing an appeal deadline can permanently bar you from pursuing the benefits in court.

Under ERISA, if your appeal is ultimately denied during the insurance company’s internal appeals process, the federal court will typically not consider any additional evidence beyond what is contained in the underlying administrative record. That makes the appeal stage your one and only opportunity to build the record you will need in court. We may locate lost records to submit to the record, have your treating physician or another medical expert write expert statements giving their opinions about the functional limitations your disabling condition causes, or secure additional objective evidence — X-rays, lab tests, MRIs, neuropsychological testing — to help bolster your claim. If your claim is denied again, we can file a lawsuit in federal court on your behalf.

Our Long Term disability lawyers handle ERISA appeals at every stage, from the initial denial letter through federal court litigation.

How our Long Term Disability Lawyers Can Help

Long Term disability lawyers assist clients throughout the disability claims and appeals process. Our attorneys may help with:

• Reviewing the language of your Long Term disability insurance policy
• Preparing initial disability applications
• Gathering and organizing medical records and vocational evidence
• Responding to insurer requests, FCEs, and IMEs
• Drafting and filing ERISA administrative appeals
• Filing and litigating Long Term disability lawsuits in federal court
• Coordinating Long Term disability claims with Social Security Disability claims

As a Long Term disability law firm focused on disability benefits cases, Osterhout Berger Daley works to help clients secure the benefits available under their policies.

Transitioning from Short Term Disability to Long Term Disability

Many individuals reach Long Term disability through their Short Term disability coverage. As Short Term disability benefits approach the end of their term — typically 13, 26, or 52 weeks — eligibility for Long Term disability benefits often becomes the next question. The transition between the two coverages frequently involves new applications, additional medical documentation, and coordination between insurance carriers.

Building a strong Short Term disability record matters here. A clean Short Term disability claim record — consistent medical treatment, thorough physician documentation, and a clear paper trail — meaningfully strengthens the Long Term disability claim that follows. Conversely, a denied or poorly documented Short Term disability claim can create serious obstacles for the Long Term disability application.

Long Term disability attorneys can help ensure the transition is handled properly, that gaps in coverage are avoided, and that the Long Term disability application is positioned for the best possible outcome.

Coordinating Long Term Disability with Social Security Disability

Most Long Term disability policies require claimants to apply for Social Security Disability Insurance (SSDI) benefits in parallel. If approved, SSDI benefits typically offset the Long Term disability benefit dollar-for-dollar — but the SSDI award itself can also strengthen the Long Term disability claim and protect benefits over the long term. Osterhout Berger Daley represents clients on both sides of this coordination, ensuring that one claim does not undermine the other.

Why Choose our LTD Law Firm?

• Specialized focus on Long Term disability and ERISA
• Decades of experience with major insurers — Unum, Principal, Mutual of Omaha, The Guardian, Cigna, Hartford, Lincoln Financial, Prudential, MetLife, Reliance Standard, New York Life, and others
• Track record of successful appeals — including reinstating denied Long Term disability benefits at the administrative level and in federal court
• More than 30,000 clients helped across our disability practice
• No-fee-unless-we-win contingency structure
• Three offices — Pittsburgh, Chicago, Jacksonville — and federal court representation nationwide
  
  

Frequently Asked Questions

What is Long Term disability insurance?

Long Term disability insurance is a form of coverage that provides financial assistance by paying a percentage of your typical income if a disabling injury or illness prevents you from working for an extended period. Some policies also provide partial disability coverage, which compensates you for a portion of your income if your condition only allows you to work part-time. Benefits commence after a specified elimination period, which ranges from 30 days to a year, based on your chosen coverage level or employer-provided benefits package.

How does Long Term disability insurance function?

When you have an eligible condition and your benefits claim is approved, Long Term disability insurance provides monthly payments equivalent to the chosen percentage of your previous income. Whether those payments are tax-free depends on whether you or your employer paid the premiums, and on what type of dollars (pre-tax or post-tax) were used. Coverage typically lasts for the policy’s term, which varies depending on your selected option.

How long is Long Term disability insurance effective?

The duration of Long Term disability policies varies, with longer terms being more costly. It is generally advisable to choose a policy that covers at least five years, or ideally up to your normal Social Security retirement age, as many disabilities last longer than shorter terms.

What does Long Term disability insurance cover?

Long Term disability insurance can cover situations where you are unable to resume work in your prior occupation if you opt for own-occupation coverage rather than any-occupation coverage. With own-occupation coverage, you may continue receiving benefits even if you can work in a different field. With the partial disability option, benefits are provided if you can only work part-time due to your condition. Optional add-ons such as cost-of-living adjustments and unemployment waivers may also be available.

How much does Long Term disability insurance pay?

The payout from Long Term disability benefits depends on your previous salary and the percentage chosen when purchasing the policy. Typically, policies cover 50 to 60 percent of your former income, though some may cover up to 70 percent. Tax implications depend on whether you or your employer paid the premiums and what type of dollars were used.

How much does Long Term disability insurance cost?

Premium costs for Long Term disability insurance depend on factors such as coverage options, length of the elimination period, group or individual rates, and your age at the time of purchase. Younger individuals pay lower premiums than older individuals. Group rate premiums are typically more affordable than individual policies, and prices vary among providers, making comparison shopping worthwhile for individual policy purchasers.

What is a functional capacity evaluation?

A functional capacity evaluation (FCE) is a series of assessments required by insurance companies to determine how your disability affects your ability to perform job-related tasks and to verify the legitimacy of your claim. FCEs are sometimes used by insurers as grounds to deny claims, which is why consulting with a Long Term disability attorney before attending one is generally a good idea.

What is ERISA and how does it affect my Long Term disability claim?

ERISA (the Employee Retirement Income Security Act) is a federal law that governs most employer-sponsored Long Term disability plans. ERISA controls the appeals process, the deadlines, and — critically — what evidence the federal court is allowed to consider if your claim ends up in litigation. In most ERISA cases, the court is limited to the evidence in the administrative record, which is why the appeal stage is so important. An ERISA Long Term disability attorney can help build the record correctly the first time.

What if my Long Term disability claim is denied?

If your Long Term disability claim is denied, seeking legal assistance from an experienced Long Term disability insurance attorney is recommended. An attorney may help gather the necessary medical evidence, build the administrative record under ERISA, negotiate a settlement, or file a lawsuit in federal court to help you obtain the benefits you deserve.

Contact Us

If you are facing a denied Long Term disability claim, navigating an ERISA appeal, or considering federal court litigation against your insurer, the experienced attorneys at Osterhout Berger Daley are here to help. Contact us today for a free case evaluation.