Claimants are often misguided in believing that they will get their long-term or short-term disability benefits, as long as they submit their own physician’s opinions and a few medical records supporting their diagnosis. Although, in some obvious disability cases this is true, when there is any dispute regarding a diagnosis or impairment and its disabling effects on the claimant, the insurance company will usually resolve that doubt in it’s favor. The insurance company will do this by taking advantage of the claimant’s naivety and by using the exclusive power ERISA has given it to exercise it’s discretion to develop a reasonable excuse for it’s denial.
Once this is done, even when claimants finally decide to obtain legal representation, it is usually to late. At this point, it becomes extremely difficult to contest the insurance company’s denial. While competent legal advocacy increases the chances of a successful outcome, a reasonably sophisticated and careful insurance company can summarily deny almost all appeals and immunize their decision from reversal in federal district court. This is true because under ERISA, regardless of the merits of a disability claim, to prevail a claimant must show that the insurance company’s decision was unreasonable, only supported by more than a scintilla of evidence, or both.
It is extremely important to obtain competent representation at the beginning of your long-term or short-term disability claim.