What a Long-Term Disability Attorney Does in California

A long-term disability (LTD) attorney in California handles disputes between you and an insurance company over benefits you believe you are owed. Most LTD claims are denied or underpaid the first time; an attorney's job is to challenge that decision, gather medical evidence, and push back against the insurer's reasons for saying no.

California law treats LTD claims as contracts between you and your employer's insurance plan. The insurer must follow the plan's own rules and California state law. When an insurer denies your claim or stops paying, an attorney can file an appeal within the insurance process itself, or file a lawsuit in California state court or federal court, depending on how your plan is structured.

LTD attorneys also handle cases where an insurer wrongly offsets your benefits—reducing what they pay you because you received Social Security Disability Insurance (SSDI), workers' compensation, or other payments. California has specific rules about when offsets are legal and when they are not.

Key Takeaways

  • California LTD attorneys work on contingency in most cases, meaning you pay nothing upfront and they take a percentage of what you recover.
  • The insurance company's first denial is not final; an attorney can file an appeal through the plan's internal review process before going to court.
  • California courts can order an insurer to pay your full claim, plus interest, attorney fees, and sometimes penalties for bad faith conduct.
  • You have strict time limits to appeal within the insurance process and to file a lawsuit, so contacting an attorney early protects your rights.
  • Many LTD plans are governed by federal law (ERISA), which limits what you can recover and changes where you can sue, so your attorney must know which rules explore to your plan.

How LTD Claims Are Denied and Why You Need an Attorney

Insurance companies deny LTD claims for reasons that are often disputable. Common denials include: your condition does not meet the plan's definition of disability, you did not provide enough medical evidence, your doctors' opinions conflict with the insurer's hired doctor, or the insurer claims you can work in some capacity even though you cannot find a job.

The insurer has a financial incentive to deny your claim. They do not have to explain their reasoning in detail, and many people accept the denial without challenge. An attorney knows how to read the plan's language, spot where the insurer misapplied it, and gather the medical records and informed opinions needed to prove the insurer was wrong.

California also recognizes a legal duty called bad faith. If an insurer denies your claim dishonestly, ignores clear medical evidence, or uses a process that is fundamentally unfair, you can sue not just for the benefits owed but for damages—sometimes much more than the monthly payments you lost. An attorney can identify whether your case involves bad faith and pursue that claim.

ERISA Plans Versus Non-ERISA Plans in California

Most employer-sponsored LTD plans are governed by ERISA (the Employee Retirement Income Security Act), a federal law. Some plans—particularly those offered by very small employers or self-employed individuals—are not. This distinction matters because it changes what you can recover and where you can sue.

Under ERISA, you can recover only the benefits the plan says you are owed, plus attorney fees in some cases. You cannot sue for emotional distress, lost wages beyond what the plan covers, or punitive damages. You must exhaust the plan's internal appeal process before filing a lawsuit, and you must file in federal court.

Non-ERISA plans fall under California state law. You can sue in California state court and potentially recover damages for bad faith, emotional distress, and penalties. The trade-off is that the plan itself may offer fewer protections or clearer rules. An attorney will review your plan documents to determine which law governs and what that means for your case.

The Internal Appeal Process and important date

Before you can sue, you must ask the insurance company to reconsider its denial. This is called the internal appeal. The plan documents specify how long you have to request an appeal—typically 30 to 90 days from the denial letter. Missing this important date can bar you from going to court later.

During the appeal, you submit new medical evidence, written arguments, and sometimes a statement from your doctor explaining why you meet the disability definition. The insurer reviews the appeal and issues a decision. If they deny it again, you then have the right to sue.

An attorney handles the appeal by organizing your medical records, writing a detailed brief explaining why the insurer was wrong, and coordinating with your doctors. They also preserve evidence of bad faith—such as the insurer ignoring a key medical opinion or misquoting your records—that can be used in court if the appeal fails.

Finding an LTD Attorney in California

Start by searching for attorneys who list LTD or disability insurance as a practice area and who work in California. Bar associations, including the State Bar of California, maintain directories. You can also search "long-term disability attorney California" or "ERISA attorney California" online.

Many LTD attorneys work through referrals from disability advocates, patient organizations, or other lawyers. If you have a disability-related nonprofit or support group in your area, they often maintain lists of attorneys who handle these cases.

When you contact an attorney, ask whether they work on contingency (you pay nothing upfront), what percentage they take if you win, and whether they have handled cases involving your type of disability and your plan type (ERISA or non-ERISA). Ask how long they expect the process to take and what they will need from you—medical records, plan documents, and correspondence with the insurer.

What to Bring to Your First Meeting

Gather your plan documents—the Summary Plan Description (SPD), the full plan text if you have it, and any amendments. Bring your denial letter and any other correspondence from the insurer. Collect your medical records, including doctor's notes, test results, and any reports from specialists who have treated you.

Bring documentation of your work history and what you were doing when you became disabled. If you have tried to work or look for work since becoming disabled, bring records of those attempts. Bring any communications with the insurer, including emails, phone notes, and letters.

If you have already filed an internal appeal, bring copies of that appeal and the insurer's response. If you have not yet appealed, the attorney will advise you on timing and strategy.

Costs and Contingency Fees

Most LTD attorneys in California work on contingency, meaning they take a percentage of the money recovered—typically 25 to 33 percent. You pay nothing upfront. If the case is dismissed or you lose, you owe the attorney nothing.

Some attorneys charge hourly rates instead, particularly if the case is complex or if you are asking for information on a specific issue rather than representation through a full appeal and lawsuit. Ask about this when you call.

The attorney's fee comes out of what you recover. If you win $50,000 in back benefits and the attorney takes 33 percent, you receive $33,500. The insurer does not pay the attorney's fee separately; it is deducted from your recovery.

What Happens After You Hire an Attorney

Your attorney will review your plan documents and denial letter, then advise you on whether to appeal or go straight to court (if the appeal important date has passed). They will request your complete medical file from your doctors and any records the insurer has. They will also request the insurer's file on your claim, which may reveal how the decision was made.

If you appeal, the attorney prepares a written brief and coordinates with your doctors. The insurer responds, and then issues a final decision. If they deny the appeal, your attorney files a lawsuit in the appropriate court—federal court for ERISA plans, state court for non-ERISA plans.

The lawsuit process includes discovery (exchanging documents and taking depositions), motion practice, and potentially a trial. Many cases settle before trial. Throughout, your attorney communicates with you about strategy, timing, and what to expect.

Frequently Asked Questions

Can I sue my employer directly for denying my LTD claim?

If your plan is ERISA-governed, you sue the plan itself and the insurance company, not your employer directly. If the plan is non-ERISA, you may be able to sue your employer, but an attorney will review your plan and the facts to determine who the proper defendant is. In either case, the focus is on the insurer's decision, not on your employer's role.

How long does an LTD case take from start to finish?

The internal appeal typically takes two to four months. If you then file a lawsuit, the case can take one to three years depending on court schedules, discovery disputes, and whether it settles or goes to trial. Your attorney can give you a more specific estimate after reviewing your plan and the insurer's conduct.

What if I already received SSDI and the insurer is offsetting my LTD benefits?

California law and ERISA both regulate offsets. Some offsets are legal; others are not. An attorney can review your plan's offset language and the insurer's calculation to determine whether they are complying with the law. If the offset is improper, you may recover the difference.

Do I have to go to court, or can we settle?

Most LTD cases settle before trial. Your attorney will negotiate with the insurer's counsel. A settlement typically includes back benefits owed, sometimes future benefits, and attorney fees. You decide whether to accept any settlement offer; your attorney advises but does not decide for you.

What if the insurer says I can work part-time, but I cannot find a job?

The plan's definition of disability matters. Some plans require that you be unable to work in any occupation; others use a narrower definition. If the insurer claims you can do part-time work but you have genuinely tried and cannot find an employer willing to hire you given your condition, that is evidence the insurer is wrong. Your attorney will gather job search records and medical evidence to counter the insurer's position.