What an attorney does after your long-term disability claim is denied

A long-term disability (LTD) denial means your insurance company rejected your claim for benefits. An attorney who handles LTD denials does not overturn the decision by themselves — instead, they review the denial letter, gather medical records and work history, identify gaps in what you submitted, and prepare a written appeal or file a lawsuit if the appeal fails. The goal is to show the insurance company (or a court) that they made a mistake in denying you.

Most LTD denials happen because the insurance company says your condition does not meet the policy definition of disability, or because the medical evidence in your file was incomplete when they made the decision. An attorney's job is to build a stronger record — one that clearly connects your medical condition to your inability to work.

Whether an attorney is worth hiring depends on the amount of monthly benefit you stand to receive, how clear-cut your medical evidence is, and whether you have already tried to appeal on your own. Some denials are straightforward enough to challenge without legal help; others require an attorney's knowledge of insurance law and appeal procedure.

Key Takeaways

  • An LTD attorney reviews your denial letter, identifies why the insurance company rejected your claim, and prepares a written appeal or lawsuit based on that reason.
  • Most attorneys work on contingency, meaning they take a percentage of the back pay you receive if you win — typically 25 percent — and you pay nothing upfront.
  • The appeal process usually takes three to six months; if the appeal fails, a lawsuit in federal court can take one to three years.
  • You have a limited window to appeal an LTD denial — often 30 to 60 days from the denial letter — so contacting an attorney early protects your important date.
  • An attorney cannot force the insurance company to pay, but they can file a lawsuit that gives you the right to present evidence in court if the appeal fails.

How an LTD attorney prepares and files your appeal

The appeal process begins with the attorney requesting your complete claim file from the insurance company. This file contains everything they reviewed when they denied you: your medical records, your job description, your work history, and any statements you submitted. The attorney reads the denial letter carefully to understand the exact reason they said no — this reason determines what evidence needs to be added or corrected.

Common denial reasons include: your condition does not prevent you from doing your job duties, your medical records do not support the severity you claim, you did not provide enough documentation, or you did not follow the policy's definition of disability. Once the attorney knows which reason applies to you, they work backward to gather what is missing. If the denial says your records lack detail, they request updated medical records from your doctors. If the denial says you could still work, they obtain a statement from your treating physician explaining why you cannot.

The attorney then writes an appeal letter — a formal document that responds point-by-point to the insurance company's denial and includes the new medical evidence. This letter is submitted within the appeal important date (usually 30 to 60 days from the denial letter). The insurance company then has 30 to 45 days to reconsider and issue a new decision.

When an attorney files a lawsuit instead of appealing

If the insurance company denies your appeal, or if your policy allows you to skip the appeal and go straight to court, an attorney can file a lawsuit in federal court. This is called an ERISA lawsuit when your LTD coverage comes through an employer plan, or a bad-faith lawsuit when you bought the policy yourself.

A lawsuit gives you the right to present evidence and arguments before a judge. The insurance company must explain their decision under oath, and your doctors can testify about your condition. The judge then decides whether the insurance company acted reasonably when they denied you. If the judge agrees with you, the insurance company must pay your benefits plus attorney fees and sometimes interest.

Lawsuits take longer than appeals — typically one to three years from filing to final decision — and they cost more in attorney time. However, they also give you more power: in an appeal, the insurance company reviews their own decision; in a lawsuit, a neutral judge does. Some attorneys will not file a lawsuit unless the monthly benefit amount is high enough to justify the time and cost, or unless the denial was clearly unreasonable.

How much an LTD attorney costs and how they are paid

Most LTD attorneys work on contingency, which means they take a percentage of the back pay you receive if you win and charge you nothing upfront. The standard contingency fee is 25 percent of the back pay awarded, though some attorneys charge 20 or 30 percent depending on the complexity and how far the case goes. Back pay is the money owed from the date your benefits should have started until the date they are approved.

If you win $12,000 in back pay and your attorney's fee is 25 percent, the attorney receives $3,000 and you receive $9,000. Going forward, your monthly benefit is paid directly to you with no attorney fee deducted. Some policies also require the insurance company to pay your attorney fees if you win; your attorney will know whether yours does.

If you lose the appeal and do not file a lawsuit, you owe the attorney nothing. If you file a lawsuit and lose, you still owe nothing under a contingency agreement. However, you may owe the insurance company's attorney fees if the judge finds your lawsuit was frivolous — this is rare but possible. Ask your attorney upfront whether they carry insurance against this outcome.

What documents and information you need to gather

Before meeting with an attorney, gather your denial letter, your insurance policy, and any medical records you have. The attorney will request the rest from the insurance company, but having these on hand speeds up the initial review.

Your denial letter is the most important document — it states exactly why the insurance company said no and what important date you have to appeal. Keep this letter safe and bring it to your first conversation with an attorney. Your policy document shows what the insurance company's definition of disability is; the attorney will use this to argue that your condition meets it.

Medical records should include any records from the date you stopped working through the date of the denial. If you have seen multiple doctors, ask each office to send their records to the attorney. Work history and job descriptions are also important — the attorney uses these to show that your condition prevents you from performing your specific job duties, not just any job in the world.

Finding an LTD attorney and what to ask in the first meeting

LTD attorneys are usually found through disability law firms, bar association referral services, or online directories that filter by practice area and location. Many offer a free initial consultation where you can describe your case and ask questions before deciding whether to hire them.

In your first meeting, ask the attorney: How many LTD cases have you handled? What is your success rate on appeals? Do you handle ERISA cases, bad-faith cases, or both? What is your contingency fee, and does it change if the case goes to lawsuit? How long do you expect the appeal to take? What are the chances the insurance company will reverse the denial?

A good attorney will be honest about your chances — they will not promise you will win, but they will explain why they think the denial was wrong and what evidence could change the outcome. They will also tell you if they think your case is not strong enough to pursue, which is a sign they are being realistic rather than just trying to collect a fee.

The timeline from denial to resolution

The timeline depends on whether you appeal or file a lawsuit. An appeal typically takes three to six months from the date you file until you receive a new decision. Some insurance companies decide faster; others take the full time allowed by the policy or by law.

If you appeal and lose, you then have a choice: accept the denial or file a lawsuit. If you file a lawsuit, the case usually takes one to three years to resolve. The first few months involve discovery, where both sides exchange documents and information. Then there may be a settlement discussion. If no settlement is reached, the case goes to trial or a judge's decision based on written briefs.

The appeal important date is the most time-sensitive part. Most policies give you 30 to 60 days from the denial letter to file an appeal. If you miss this important date, you may lose the right to appeal and have to go straight to a lawsuit (if the policy allows it). This is why contacting an attorney soon after a denial is important — they can make sure the important date is met.

Frequently Asked Questions

Can an attorney get my LTD benefits reinstated while we appeal?

Not automatically. Some policies allow an attorney to request that benefits continue while the appeal is pending, but the insurance company usually says no unless there is a strong reason to believe the denial was clearly wrong. Your attorney can ask, but do not count on receiving benefits during the appeal process.

What if I already appealed on my own and lost?

You can still hire an attorney to file a lawsuit, as long as you are within the time limit set by your policy or by law (usually one to three years from the denial). The attorney will review what happened in your appeal and look for errors or new evidence that can be presented in court.

Do I have to hire an attorney, or can I appeal on my own?

You can appeal on your own. However, insurance companies have lawyers reviewing denials, and they often deny appeals from people without legal representation. An attorney increases your chances because they know what evidence the insurance company looks for and how to present it persuasively.

What happens if the insurance company settles before trial?

Many LTD cases settle during the lawsuit process. The insurance company may offer to pay your back pay plus a lump sum to avoid trial. Your attorney will advise you on whether to accept. If you accept, you receive the settlement amount minus your attorney's contingency fee, and your case is closed.

Can an attorney help if my policy was cancelled or I am no longer covered?

Yes. If you were covered when you became disabled, you may still have a claim even if the policy is no longer active. An attorney can review your policy language and the circumstances of the cancellation to determine whether you have a legal claim. This is a complex area and requires an attorney's review of your specific situation.