A lawyer can help you challenge a denial, but you do not need one to appeal

When an insurance company denies your long-term disability claim, you have the right to challenge that decision. A lawyer who handles disability denials can review the reasons the insurer gave, gather medical evidence to counter those reasons, and file an appeal on your behalf. But you can also appeal without a lawyer—many people do, and some win.

The choice depends on how much time you have, how complex your case is, and whether you can afford a lawyer's fees. This guide explains what a disability lawyer actually does, what it costs, and how to decide whether you need one.

Key Takeaways

  • Long-term disability lawyers typically work on contingency, meaning they take a percentage of your back pay if you win, rather than charging you upfront.
  • The appeal process and timeline depend on your specific insurance policy and plan—some require internal appeals first, others go straight to court.
  • You can appeal a denial yourself by gathering medical records, writing a detailed response to the insurer's reasons, and submitting it before the important date in your policy.
  • A lawyer becomes more valuable if the denial was based on a medical dispute, if your policy is complex, or if the insurer is a large company with a legal team.
  • The first step after a denial is reading the denial letter carefully to understand exactly why the claim was rejected and what important date you have to respond.

Why insurers deny long-term disability claims

Insurance companies deny claims for a handful of recurring reasons. They may say your condition does not meet the definition of disability in your policy, that you did not provide enough medical evidence, that you returned to work, or that you failed to follow their procedures—like submitting forms on time or attending a required medical exam.

Some denials are straightforward mistakes. Others reflect a genuine disagreement about whether your medical condition prevents you from working. A lawyer's job is to identify which type of denial you received and build a case to overturn it. If the insurer made a procedural error or ignored medical evidence, that is usually easier to fix. If the denial rests on a medical judgment call—whether your back pain truly prevents you from sitting at a desk, for example—you will need strong medical documentation to win.

What a long-term disability lawyer does

A disability lawyer reviews your denial letter, your policy, and your medical records to find the weakest points in the insurer's reasoning. They then gather additional medical evidence—often by asking your doctor to write a detailed statement explaining why you cannot work—and submit a formal appeal with that evidence attached.

If the insurer denies the appeal, the lawyer can file a lawsuit in court or pursue other legal remedies depending on your policy type. Some policies are governed by federal law (ERISA plans), which limits what you can recover but also sets strict rules the insurer must follow. Others are governed by state law, which may allow you to recover more but also gives the insurer more flexibility. A lawyer who knows the difference can choose the strongest legal path for your case.

Lawyers also handle communication with the insurer on your behalf, which can reduce stress and prevent you from accidentally saying something that weakens your case. They know what documents the insurer will ask for and what important date matter.

How much a disability lawyer costs

Most long-term disability lawyers work on contingency, meaning they do not charge you upfront. Instead, they take a percentage of the back pay you receive if you win—typically 25 to 33 percent, though this varies. If you lose, you owe them nothing.

Some lawyers charge a flat fee for an appeal or an hourly rate, but contingency is far more common in disability cases. Before you hire a lawyer, ask in writing what percentage they will take, whether that percentage applies to the entire back-pay award or only to the portion they recover, and whether they will charge you for costs like medical records or court filing fees.

If you cannot afford a lawyer, some disability advocacy organizations offer free or low-cost help with appeals. Your state bar association can also refer you to legal aid programs in your area.

When you should hire a lawyer

You should consider hiring a lawyer if the denial was based on a medical disagreement, if your policy is complex or you do not understand it, if the insurer is a large company with a legal team, or if you have already appealed once and been denied again. You should also hire a lawyer if the amount of back pay at stake is substantial—the larger the award, the more a lawyer's help is worth.

You do not necessarily need a lawyer if the denial was clearly a mistake—for example, if the insurer lost your medical records or missed a important date. In that case, a straightforward written appeal with copies of the missing documents may be enough. You also do not need a lawyer if you feel confident reading your policy, gathering medical evidence, and writing a formal response to the insurer's reasons.

How to appeal without a lawyer

Start by reading your denial letter word for word. The insurer must explain why they denied your claim and what you can do about it. Write down the specific reasons they gave—do not paraphrase, use their exact language. Then read your policy to see whether the insurer's reasons match what the policy actually says.

Next, gather medical evidence that contradicts the insurer's reasons. If they said your condition does not prevent you from working, ask your doctor to write a statement explaining why it does. If they said you did not provide enough information, collect any records you have and ask your doctor for any additional notes. If they said you missed a important date, check your policy to see whether that important date was actually required.

Write a formal appeal letter that addresses each reason the insurer gave. For each one, explain why you believe it is wrong and attach the evidence that supports your position. Send the letter to the address listed in your denial letter, keep a copy for yourself, and send it by certified mail so you have proof of delivery. Include the date you received the denial and the date you are submitting the appeal.

What happens after you appeal

The insurer must respond to your appeal within a timeframe set by your policy and by law—usually 30 to 45 days. They will either overturn the denial, deny the appeal, or ask for more information. If they deny the appeal, you may have the right to file a lawsuit, pursue arbitration, or go to an external review process, depending on your policy type and state law.

This is the point where many people hire a lawyer, because the next step often involves the legal system. If your policy is an ERISA plan, you will likely end up in federal court. If it is a state-regulated plan, you may have other options. A lawyer can tell you which path is available and whether it makes sense to pursue.

Finding and choosing a disability lawyer

Start by asking your doctor or local disability advocacy group for referrals. You can also search the National Association of Disability Representatives (NADR) or your state bar association's lawyer referral service. When you contact a lawyer, ask whether they have handled long-term disability denials before, what percentage they charge on contingency, and whether they offer a free initial consultation.

During the consultation, explain your denial and ask the lawyer whether they think you have a strong case. A good lawyer will be honest about your chances and will not promise a specific outcome. They should also explain the process clearly and answer your questions without rushing you. If a lawyer guarantees a win or pressures you to hire them when ready, that is a red flag.

Frequently Asked Questions

Can I appeal a denial on my own, or do I need a lawyer?

You can appeal on your own. Many people do. You will need to read your denial letter carefully, understand why the insurer rejected your claim, gather medical evidence that contradicts their reasons, and submit a formal written appeal before the important date in your policy. A lawyer is helpful if the case is complex or the denial was based on a medical disagreement, but it is not required.

How long do I have to appeal after I receive a denial?

Your policy will state the appeal important date—usually 30 to 180 days from the date you receive the denial letter. Check your denial letter for the exact important date and mark it on a calendar. If you miss the important date, you may lose the right to appeal, so do not wait.

What if I hire a lawyer and we win—how much will I actually receive?

If you win, the insurer will pay you the back pay you are owed. Your lawyer will take their contingency fee from that amount—typically 25 to 33 percent—and you will receive the rest. Ask your lawyer in writing how their fee is calculated before you hire them, so you know exactly what to expect.

Do I need a lawyer if the insurer made a straightforward mistake, like losing my medical records?

Not necessarily. If the error is clear and straightforward, you can often fix it yourself by resubmitting the missing documents with a brief written explanation. A lawyer becomes more valuable if the insurer disputes whether the error happened or refuses to reconsider the denial even after you provide the missing information.

What is the difference between an ERISA plan and a state-regulated plan?

ERISA plans are employer-sponsored disability plans governed by federal law. State-regulated plans are usually individual policies you buy yourself. ERISA plans have stricter rules about what the insurer must do, but they also limit what you can recover if you win. State plans may allow you to recover more, but the insurer has more flexibility. A lawyer can tell you which type you have and what that means for your case.