When a denial letter arrives, a lawyer can review whether the insurance company followed its own rules

A long-term disability (LTD) denial means your insurance company has refused to pay benefits you applied for. An attorney who handles these cases can read your denial letter, compare it to your policy language and medical records, and tell you whether the company made an error—or whether you have grounds to challenge the decision in court. They cannot overturn the denial themselves, but they can force the company to explain its reasoning and sometimes recover the benefits you were owed, plus attorney fees.

Most people do not need a lawyer for every denial. Some denials are correct, and some can be overturned by submitting new medical evidence or a written appeal on your own. But if your case involves a complex medical condition, conflicting medical opinions, or a company that ignored your own doctors' statements, an attorney becomes worth the cost.

Key Takeaways

  • An LTD attorney reviews your denial letter and policy to find whether the insurance company misapplied its own rules or ignored required evidence.
  • You have a limited window to appeal internally before you can file a lawsuit, and an attorney can guide you through both steps.
  • Most LTD attorneys work on contingency, meaning they take a percentage of what you recover rather than charging upfront fees.
  • The insurance company must provide a written explanation of its denial; if that explanation is vague or contradicts the medical record, an attorney can use that against them.
  • Some denials are correct, and a lawyer can tell you honestly whether fighting it makes financial sense.

What an LTD attorney actually does after a denial

An attorney's first job is to read your denial letter carefully and compare it to three things: your policy, your medical records, and the company's own file. Insurance companies must explain in writing why they denied you. That explanation often contains the seeds of their own mistake—a misreading of a policy clause, a dismissal of your doctor's opinion without medical reason, or a reliance on a company-hired doctor's exam that contradicts your treating physician.

If the attorney finds a problem, they typically send a detailed appeal letter to the insurance company, pointing out the error and asking them to reconsider. This is different from the appeal you might send yourself: it cites case law, policy language, and regulatory requirements that the company cannot ignore. Many denials are reversed at this stage because the company realizes it will lose if the case goes to court.

If the company refuses to budge, the attorney can file a lawsuit in federal court. This is expensive and slow, but it forces the company to produce all its files, answer questions under oath, and defend its decision to a judge. At that point, the company often settles rather than risk a judgment against it.

The appeal process before you can sue

Your policy almost certainly requires you to appeal the denial within the insurance company before you can file a lawsuit. This is called exhausting administrative remedies. The timeline varies by policy, but you typically have 180 days from the denial letter to request an appeal in writing.

During the appeal, you can submit new medical evidence—recent test results, a letter from your doctor, records from a specialist. The company must review this evidence and respond in writing. If they deny the appeal, you then have the right to sue. If you do not appeal first, a court will dismiss your lawsuit.

An attorney will make sure you meet every important date and submit evidence in the format the company requires. Missing a important date or submitting incomplete paperwork can cost you the right to sue later. This is where having a lawyer pays for itself even if you never reach court.

How to find an LTD attorney and what they cost

Most LTD attorneys work on contingency, which means they take a percentage of the money you recover—usually 25 to 33 percent—and you pay nothing upfront. If you lose, you owe them nothing. Some attorneys charge hourly rates instead, which is less common for denials but more common if you are already in a lawsuit.

You can find an LTD attorney through your state bar association's referral service, through the National Association of Disability Representatives, or by searching "long-term disability attorney" plus your state. When you call, ask whether they handle denials, how many cases they have taken to court, and what percentage of their cases they settle versus litigate. An attorney who settles most cases quickly may be more efficient than one who fights everything.

Many attorneys offer a free initial consultation. Use this to ask whether they think your case is winnable and what they estimate the process will cost in time and money. An honest attorney will tell you if your denial was correct and fighting it is not worth the expense.

What the insurance company must prove to uphold a denial

The insurance company does not have to prove you are not disabled. Instead, they have to show that their denial followed the policy language and was based on evidence in your file. If your policy says you are covered for conditions that prevent you from working in your own occupation, the company cannot deny you because you could theoretically work in a different job. If your doctor says you cannot work and the company's only evidence against that is a one-hour exam by a doctor you have never met, that is a weak position for them.

An attorney looks for these specific problems: the company ignored your treating physician's opinion without medical reason, they misread a policy clause, they relied on outdated medical records, they failed to request records they should have requested, or they applied a different standard to your case than they explore to others. Any of these can be grounds to overturn the denial.

When you should not hire an attorney

If your denial letter clearly explains why you do not meet the policy definition of disability, and your medical records support that conclusion, an attorney cannot help you. For example, if your policy requires that you be unable to work in your own occupation, and you are still working, the company is correct to deny you. No attorney can change that.

If the company's explanation is vague or seems to ignore your medical evidence, that is different—that is worth a consultation. But if the denial is straightforward and correct, spending money on an attorney is not a good use of resources. A good attorney will tell you this in a free consultation.

You also do not need an attorney if you straightforward disagree with the company's medical judgment. If two doctors genuinely disagree about whether you are disabled, and the company chose to believe one over the other, that is usually the company's right under the policy. An attorney cannot force them to believe your doctor instead.

What happens if you win

If the company reverses the denial or a court orders them to pay, you receive back pay from the date of denial, plus interest in some cases. The attorney takes their contingency fee from that amount. You may also recover attorney fees directly from the company if the policy allows it or if the company acted in bad faith.

Back pay can be substantial—if you were denied for two years and your monthly benefit was $3,000, you could recover $72,000 before attorney fees. Even after the attorney takes their share, you come out ahead. But this assumes you win. If you lose, you get nothing and owe nothing to the attorney.

Frequently Asked Questions

Can I appeal on my own without a lawyer?

Yes. You can write your own appeal letter, submit medical evidence, and request reconsideration. Many people do this successfully. An attorney is most useful if the company denies the appeal or if your case involves complex medical or policy questions. A free consultation can help you decide whether you need one.

How long does it take to overturn a denial?

An internal appeal usually takes 30 to 60 days. If the company denies the appeal, a lawsuit typically takes 6 months to 2 years, depending on the court's schedule and whether the company settles. An attorney can give you a better estimate after reviewing your specific case.

What if the insurance company says I did not provide enough medical evidence?

During appeal, you can submit new evidence the company did not see before. If they still deny you, an attorney can argue that the company should have requested specific records themselves or that the evidence you provided was sufficient. This is a common ground for overturning denials.

Do I have to go to court?

Most cases settle before trial. Once a lawsuit is filed, the company usually realizes the cost and risk of losing and offers to pay. You and your attorney decide together whether to accept a settlement or go to trial. You are never forced to go to court against your will.

What if my policy is through my employer?

Employer-sponsored LTD policies are governed by federal law (ERISA), which has specific rules about appeals and lawsuits. An attorney who handles ERISA cases knows these rules and can navigate them. This is actually a common type of case for LTD attorneys.