What a Long-Term Disability Lawyer Does After a Denial

A long-term disability (LTD) lawyer reviews your denial letter, examines the insurance company's reasoning, and determines whether the decision was legally sound or whether grounds exist to challenge it. They do not work for the insurance company or the government—they work for you, and they are paid either through a contingency fee (a percentage of what you recover) or an hourly rate you negotiate upfront.

The lawyer's core job is to identify what the insurer got wrong. That might mean the medical evidence actually supports your claim, the insurer misread your policy language, they applied the wrong definition of disability, or they failed to follow their own procedures. A lawyer also knows the state law that governs your plan—whether it is ERISA (the federal law covering most employer plans) or state insurance law—and what that law requires the insurer to do.

Most LTD denials happen because the insurer claims your condition does not meet the policy's definition of disability, or because they say the medical evidence is insufficient. A lawyer can rebuild your case by obtaining additional medical records, requesting a functional capacity evaluation, or having a physician review the file and write a detailed opinion. They then submit this new evidence in a formal appeal or, if necessary, file a lawsuit.

Key Takeaways

  • A long-term disability lawyer reviews your denial to find legal or factual errors and decides whether an appeal or lawsuit is worth pursuing.
  • Most lawyers work on contingency, meaning they take a percentage of your recovery and you pay nothing upfront.
  • The lawyer's first step is usually a formal appeal within the insurance company's internal process, which must happen before you can sue in most cases.
  • If the appeal fails, a lawyer can file a lawsuit in federal court (for ERISA plans) or state court (for state-regulated plans), where a judge or jury decides the case.
  • You have a limited time window to appeal or sue—typically 180 days to appeal internally and one to six years to file a lawsuit, depending on your state and plan.

How the Appeal Process Works With a Lawyer

After you receive a denial, your policy almost always requires you to file an internal appeal with the insurance company before you can go to court. This is called exhausting administrative remedies, and it is mandatory under ERISA. The appeal window is usually 180 days from the denial letter, though your policy may specify a shorter period.

A lawyer will prepare a detailed appeal letter that addresses the insurer's stated reasons for denial point by point. If the insurer said your condition does not prevent you from working, the lawyer will submit medical records, doctor's statements, and functional capacity reports showing that it does. If the insurer claimed the evidence was incomplete, the lawyer obtains the missing records. The appeal is not a casual resubmission—it is a formal legal document that creates a written record of your position.

The insurer then has 45 days (for ERISA plans) to issue a written decision on your appeal. If they deny it again, you have the right to sue. If they overturn the denial, you win and your benefits resume. Many cases settle during the appeal phase because the insurer recognizes the weakness in their original decision once a lawyer has laid out the evidence clearly.

When to File a Lawsuit and What Court Handles It

If your internal appeal is denied, a lawyer can file a lawsuit. The court depends on what type of plan you have. If your LTD coverage comes through your employer and is governed by ERISA (the Employee Retirement Income Security Act), the case goes to federal court. If you have an individual disability policy you bought yourself, or if your employer's plan is governed by state insurance law, the case goes to state court.

Federal court (ERISA cases) and state court have different rules and different standards of review. In federal court, the judge reviews the insurer's decision to see if it was arbitrary and capricious—meaning unreasonable or made without a rational basis. In state court, the standard varies by state but often gives you more room to present new evidence and argue your case. A lawyer will know which court is more favorable for your situation and will file accordingly.

The lawsuit process typically takes one to three years from filing to trial or settlement. Your lawyer will conduct discovery (exchanging documents and taking depositions of the insurer's decision-makers), file motions, and try to settle before trial. Many cases settle once the insurer sees that a lawyer has built a strong record and is willing to go to trial.

What Evidence a Lawyer Gathers to Rebuild Your Case

The insurer's denial letter will tell you what evidence they say is missing or insufficient. A lawyer uses that as a roadmap. If the insurer said your doctor's notes do not show you cannot work, the lawyer requests a detailed statement from your doctor explaining your functional limitations. If the insurer said you have no objective medical findings, the lawyer orders imaging, lab work, or a functional capacity evaluation (FCE)—a test where a physical therapist or occupational therapist documents what you can and cannot do physically.

A lawyer may also retain a vocational informed to testify that, given your age, education, and medical condition, you cannot perform your own job or any other job you are reasonably suited for. This informed report is often the turning point in a case, because it directly addresses the policy's definition of disability and shows the insurer was wrong to say you could work.

The lawyer will also obtain and review the insurer's entire file—the claim notes, the medical records they received, any communications with your doctors, and the decision-maker's reasoning. This file often reveals that the insurer ignored evidence, misread a medical report, or failed to follow their own procedures. These errors become the basis of the appeal or lawsuit.

How Much a Lawyer Costs and How Payment Works

Most long-term disability lawyers work on contingency, meaning they take a percentage of the money you recover—typically 25 to 33 percent—and you pay nothing upfront. If you lose, you owe them nothing. This arrangement aligns the lawyer's incentive with yours: they only make money if you win.

Some lawyers charge hourly rates instead, usually $200 to $400 per hour, and you pay as you go. This is less common for LTD cases because the client often cannot afford to pay out of pocket while waiting for a decision. A few lawyers charge a flat fee for an appeal or a combination of contingency and hourly rates.

If you win, the lawyer's fee comes out of your recovery. If your policy requires you to repay your employer for benefits paid while you were working (called a subrogation clause), the lawyer will negotiate with the employer to reduce that amount. The goal is to maximize what you keep after all deductions.

How Long the Process Takes From Denial to Resolution

The timeline depends on whether you settle during appeal or go to trial. An internal appeal typically takes three to six months. If the insurer denies the appeal, you can file a lawsuit when ready. A lawsuit in federal court usually takes 18 to 36 months from filing to trial, though many settle much faster—within 6 to 12 months—once discovery is underway and both sides understand the strength of the evidence.

During this time, you are not receiving benefits. Some lawyers can request that the insurer pay your benefits while the appeal or lawsuit is pending, though this is not automatic. The longer the case takes, the more back pay you may be owed if you win, because the judgment will include all the monthly benefits you missed plus interest.

The fastest resolution is usually a settlement negotiated during the appeal phase or early in litigation. The slowest is a trial, where a judge or jury hears evidence and makes a decision, which can then be appealed by either side.

Questions to Ask a Lawyer Before You Hire Them

When you meet with a lawyer (most offer a free initial consultation), ask whether they think your case is winnable based on the denial letter and your medical records. A good lawyer will be honest if the case is weak. Ask how many LTD cases they have handled and how many they have won. Ask whether they work on contingency and what percentage they take. Ask what court they would file in and why. Ask how long they think the case will take and what the next steps are.

Also ask whether they will handle the appeal themselves or whether they work with a larger firm. Ask what happens if the insurer appeals a judgment in your favor—will they defend the judgment for free, or will that cost extra? Ask whether they have relationships with vocational experts, physicians, or functional capacity evaluators they can call on, because the quality of these experts often determines the outcome.

Finally, ask for references from past clients. A lawyer who has successfully overturned LTD denials will have clients willing to vouch for them.

Frequently Asked Questions

Can I sue the insurance company directly, or do I have to appeal first?

If your plan is governed by ERISA, you must complete the internal appeal process before you can file a lawsuit. This is called exhausting administrative remedies. If your plan is governed by state law, the requirement varies by state, but most states also require an appeal first. A lawyer will know your state's rule and will file the appeal on your behalf.

What if I cannot afford a lawyer?

Most long-term disability lawyers work on contingency, so you pay nothing upfront and nothing if you lose. If you cannot find a contingency lawyer, some legal aid organizations or disability advocacy groups may offer free or low-cost help. You can also contact your state bar association for a referral to lawyers who handle LTD cases.

How much money can I recover if I win?

You recover all the monthly benefits you were denied from the date of denial until the date of judgment or settlement, plus interest (which varies by state and plan). If you win, your benefits resume going forward. The total amount depends on your monthly benefit amount and how long the case takes. A lawyer can estimate this based on your policy and the likely timeline.

What if the insurance company says I did not follow the appeal important date?

If you missed the important date, a lawyer can argue that the important date was unclear, that the insurer waived it, or that equitable estoppel applies (meaning the insurer should not be allowed to hide behind a important date they did not enforce). Some states also have laws that extend important date in certain circumstances. A lawyer will review your denial letter and the insurer's communications to see if you have an argument.

Can a lawyer help me if I have already lost at trial?

Yes. A lawyer can file an appeal of the trial judgment to a higher court. Appeals are complex and have strict rules about what arguments you can raise, so having a lawyer is especially important. The appeal process typically takes one to two years and costs less than a trial because there is no discovery or testimony—only written briefs and oral argument.