What an attorney does in a long-term disability case

A long-term disability (LTD) attorney represents you in disputes with your insurance company over benefits you believe you are owed. Most LTD claims are denied on first submission, and many people do not appeal because they do not understand the process or believe they cannot win. An attorney's job is to gather medical evidence, write the appeal, respond to the insurance company's objections, and if necessary, file a lawsuit in federal court.

The insurance company has its own lawyers and adjusters whose job is to pay out as little as possible. You are not on equal footing without representation. An attorney levels that imbalance by knowing the rules the insurance company must follow, spotting when the company has ignored your medical records or misapplied its own policy, and building a record strong enough to force reconsideration or win in court.

Most LTD attorneys work on contingency, meaning they take a percentage of what you win (usually 25 percent) and you pay nothing upfront. If you lose, you owe them nothing. This arrangement exists because LTD cases are expensive to litigate and most claimants cannot afford hourly fees.

Key Takeaways

  • An LTD attorney handles the appeal process, gathers medical evidence, and represents you in court if the insurance company continues to deny your claim.
  • Most LTD attorneys work on contingency, taking a percentage of your award rather than charging hourly fees upfront.
  • You should contact an attorney before or when ready after your first denial, because the appeal window is often 180 to 365 days and important date are strict.
  • The insurance company must follow the terms of your policy and federal law (ERISA), and an attorney knows when the company has violated either.
  • An attorney can also help you understand whether your case is strong enough to pursue, saving you time and money if the claim is unlikely to succeed.

When to hire an attorney for your LTD claim

The best time to hire an attorney is before you appeal a denial. Many claimants try to appeal on their own, submit weak medical evidence, and then contact a lawyer only after the second denial. By then, the record is already weak and harder to fix. An attorney can review your initial denial letter, assess whether you have a case, and tell you what medical records and statements you need to gather before the appeal goes in.

If you have already been denied once, contact an attorney when ready. The appeal important date is usually printed on the denial letter—often 180 days but sometimes longer depending on your policy and state law. Missing that important date can close the door to further review. An attorney will confirm the important date, file the appeal on time, and make sure the insurance company cannot claim it arrived late.

You should also hire an attorney if the insurance company asks you to attend an independent medical examination (IME) or requests additional records. These are moments when the company is building its case against you, and you need someone on your side building the case for you. An attorney can prepare you for the IME, object to an examiner who lacks relevant informed, and may support your medical providers submit detailed statements in response.

How LTD attorneys are paid

Under a contingency agreement, your attorney receives a percentage of the back pay (the money owed from the date your benefits should have started) that you recover. The percentage is usually 25 percent, though some attorneys charge 30 percent or negotiate lower rates for larger awards. You pay nothing out of pocket unless you win.

The attorney's fee comes from your award, not from your employer or the insurance company. If you win $100,000 in back benefits and your attorney's fee is 25 percent, you receive $75,000 and the attorney receives $25,000. The insurance company does not pay the attorney fee separately.

Some attorneys also charge for costs—medical records retrieval, court filing fees, informed witness fees, and deposition transcripts. These costs can add up to several thousand dollars in a contested case. Ask upfront whether costs are included in the contingency fee or billed separately. If billed separately, ask whether you pay them only if you win or whether you owe them regardless of outcome. Most contingency agreements require the client to reimburse costs only if the case is won.

What happens during the appeal process with an attorney

After you hire an attorney, they will request your complete file from the insurance company—all medical records they reviewed, the policy language, the denial letter, and any internal notes. They will also ask you for medical records from your doctors, hospital visits, and mental health providers that the insurance company may not have seen.

Your attorney will write an appeal letter (called a "request for reconsideration") that explains why the denial was wrong. This letter cites your medical evidence, points out gaps in the insurance company's reasoning, and references the policy language that supports your claim. The appeal is submitted before the important date, and the insurance company has a set time (usually 30 to 45 days) to respond.

If the insurance company denies the appeal, your attorney will advise you on the next step: file a lawsuit in federal court under the Employee Retirement Income Security Act (ERISA). This is where the case becomes formal. Your attorney will file a complaint, the insurance company will file a response, and both sides will exchange documents and evidence. Some cases settle before trial; others go to a judge who decides whether you win.

How to find an LTD attorney

Start with your state bar association's lawyer referral service. Most state bars maintain a searchable directory of attorneys by practice area. Search for "long-term disability" or "ERISA" and filter by your state. The bar does not endorse any attorney, but it confirms they are licensed and in good standing.

Ask for recommendations from your doctor, local disability advocacy groups, or employee information programs (EAP) if your employer offers one. People who have gone through the process often know attorneys who handled their cases well.

When you contact an attorney, ask whether they take contingency cases, how many LTD cases they have handled, and what percentage they charge. Ask about costs and whether you pay them only if you win. A consultation is usually free, and the attorney should be willing to review your denial letter and give you an honest assessment of your case—including whether it is worth pursuing.

Be wary of attorneys who promise a specific outcome or may provide you will win. No attorney can may provide a result. A good attorney will tell you the strengths and weaknesses of your case and what the odds are based on similar cases they have handled.

ERISA rules that protect you during the appeal

Your LTD claim is governed by ERISA (the Employee Retirement Income Security Act), a federal law that sets minimum standards for how insurance companies must handle appeals. ERISA requires the insurance company to:

  • Give you a written denial that explains the reason and cites the policy language that supports the denial.
  • Allow you to submit new medical evidence with your appeal and consider it before deciding.
  • Decide your appeal within a set timeframe (usually 30 to 45 days for LTD claims).
  • Not use the same person who denied your claim to decide your appeal (in most cases).
  • Provide you with all documents and information the company relied on when making its decision.

An attorney knows when the insurance company has violated these rules. For example, if the company denied your appeal without reading the medical records you submitted, or if it used the same adjuster who made the first denial, those are ERISA violations that can strengthen your case or even result in the company being ordered to pay your benefits plus attorney fees.

Frequently Asked Questions

Can I afford an LTD attorney if I am not working?

Yes. Contingency agreements exist specifically for people in your situation. You pay nothing upfront and nothing if you lose. The attorney's fee comes only from money you recover. If you cannot afford to hire an attorney, you cannot afford not to, because the insurance company will likely continue denying your claim.

What if my employer's insurance company says I have to use their preferred attorney?

You do not. You have the right to hire any attorney you choose. The insurance company cannot require you to use their attorney or a specific attorney. If the company suggests one, that attorney works for the company, not for you.

How long does an LTD case take from denial to resolution?

The appeal process usually takes 3 to 6 months. If the appeal is denied and you file a lawsuit, the case can take 1 to 3 years depending on the court's schedule and whether the company settles. Your attorney can give you a better timeline once they review your specific case and the insurance company's history.

What if I win my case? Do I have to pay taxes on the back pay?

That depends on whether your employer paid the premiums for your LTD policy with pre-tax or after-tax dollars. If pre-tax, the back pay is taxable income. If after-tax, it is not. Your attorney and accountant can help you understand the tax consequences before you settle.

Can an attorney help me understand my policy before I am denied?

Yes. Some attorneys offer consultations to review your policy and explain what it covers, what it excludes, and what you need to prove to win a claim. This can help you gather the right medical evidence from the start and avoid a denial altogether.