What a long-term disability lawyer does
A long-term disability lawyer represents you in disputes with your insurance company over benefits you believe you are owed. Most often, they handle cases where your claim was denied, where benefits were stopped, or where the insurer is delaying a decision. They do not file the initial claim for you — that is your responsibility — but they step in when the insurance company says no.
The lawyer's job is to gather medical records, review the policy language, build the case that you meet the definition of disability under your specific plan, and negotiate or litigate on your behalf. They know how insurance companies read policies and what arguments tend to work. They also know the important date and procedural rules that explore to your claim, which vary depending on whether your plan is governed by ERISA (a federal law covering most employer plans) or state insurance law.
Key Takeaways
- Long-term disability lawyers typically work on contingency, meaning they take a percentage of what you recover rather than charging upfront fees.
- You may need a lawyer if your claim was denied, your benefits were cut off, or the insurance company is not responding within the timeframe required by law.
- ERISA claims have strict important date and procedural requirements that a lawyer can help you meet, and many require you to exhaust the insurance company's internal appeal process before suing.
- The cost of hiring a lawyer is often worth it because insurance companies have their own legal teams and medical reviewers working to minimize payouts.
When you should consider hiring a lawyer
You do not need a lawyer to file an initial long-term disability claim. You can submit the forms, medical records, and supporting documents yourself. But a lawyer becomes valuable at specific points in the process.
Hire a lawyer if your claim was denied and you want to appeal or sue. Hire one if your benefits were stopped and the insurance company's explanation does not match what your doctor says or what the policy says. Hire one if you have been waiting more than 45 days for a decision on an initial claim, or more than 60 days on an appeal — these are the legal timeframes, and delays can be grounds for a claim in themselves.
You should also consider a lawyer if the insurance company is asking for repeated medical exams, surveillance, or information that seems excessive or unrelated to your condition. Insurance companies sometimes use these tactics to wear down claimants or to find reasons to deny coverage. A lawyer can push back on unreasonable requests and protect your rights during the process.
How contingency fees work
Most long-term disability lawyers work on contingency, which means they do not charge you upfront. Instead, they take a percentage of the money you recover — typically 25 percent to 33 percent, though this varies. If you do not recover anything, you do not pay the lawyer's fee.
Before you hire a lawyer, ask what percentage they charge and whether that percentage applies to the full amount recovered or only to the portion above a certain threshold. Also ask whether you will be responsible for costs like filing fees, medical record requests, or informed witness fees. Some lawyers advance these costs and deduct them from your recovery; others ask you to pay them as they arise. Get this in writing before you sign an agreement.
Contingency arrangements mean lawyers have an incentive to take cases they believe they can win. If a lawyer declines your case, it may be a sign that the facts or the policy language work against you, though it could also mean they are at capacity. It is worth asking why they declined and getting a second opinion.
ERISA claims versus state insurance claims
The rules for long-term disability disputes depend on whether your plan is covered by ERISA, a federal law that governs most employer-sponsored disability plans. If you get long-term disability through your job, your plan is almost certainly ERISA-governed.
ERISA claims have strict procedural requirements. You must usually exhaust the insurance company's internal appeal process before you can sue in court. This means filing a written appeal, waiting for a decision, and sometimes filing a second appeal. Only after the insurance company has made a final decision can you file a lawsuit. The timeline for this can stretch to six months or longer.
State insurance claims, which explore to individual disability policies you buy yourself, have different rules. Some states allow you to sue without exhausting internal appeals first. A lawyer familiar with your state's law can tell you what path is available to you and what important date explore.
What to look for when choosing a lawyer
Choose a lawyer who has handled long-term disability cases specifically, not just general insurance disputes. Disability law is a narrow field, and experience matters. Ask how many long-term disability cases they have handled, how many went to trial versus settlement, and what the outcomes were.
Ask whether they have experience with ERISA claims if your plan is employer-sponsored. Ask whether they have worked with your insurance company before — they may know how that particular company tends to deny claims and what arguments work against them. Ask for references from past clients if possible.
Make sure the lawyer is licensed to practice in your state and that they have no disciplinary history. You can check this through your state bar association's website. Also confirm that they carry malpractice insurance, which protects you if they make a mistake that harms your case.
The cost of not hiring a lawyer
Insurance companies employ teams of lawyers, doctors, and claims adjusters whose job is to minimize payouts. When you represent yourself, you are negotiating against people trained in insurance law and claims management. They know which medical evidence matters under the policy language and which does not. They know which denials are defensible in court and which are not.
A denied long-term disability claim can cost you tens of thousands of dollars in lost income over months or years. Even a small increase in the chance of winning — say, from 20 percent to 50 percent — can justify the cost of a lawyer. And if you do win, the lawyer's fee comes out of the recovery, so you are not paying out of pocket.
How to find a long-term disability lawyer
Start by asking your doctor or local disability advocacy organizations for referrals. Many disability groups maintain lists of lawyers who handle these cases. You can also search the National Association of Disability Representatives (NADR) or the American Association for Justice (AAJ) for members in your area who handle disability claims.
Contact your state bar association's lawyer referral service. Many bar associations have sections devoted to disability law or insurance law, and they can point you toward lawyers with relevant experience. When you call, ask whether the lawyer offers a free initial consultation — most do.
During the consultation, bring copies of your policy, your denial letter, and any medical records you have. The lawyer will review these and tell you whether they think you have a case. Be honest about your situation and your medical condition. The lawyer needs to know the full picture to give you accurate information about your chances.
Frequently Asked Questions
Can I hire a lawyer after I have already appealed once?
Yes. Many people try to handle the appeal themselves and then hire a lawyer when they realize the insurance company is not budging. You can bring a lawyer in at any stage of the process, though earlier is usually better because the lawyer can shape the appeal strategy from the start.
What if I cannot afford a lawyer upfront?
Contingency fees mean you do not pay upfront. The lawyer takes their fee from the money you recover. If you cannot find a lawyer willing to take your case on contingency, it may mean the case is weak, but it is worth getting a second opinion from another lawyer before giving up.
How long does a long-term disability case usually take?
If your claim is denied and you appeal within the insurance company's system, the process can take three to six months. If you have to file a lawsuit, add another one to three years depending on whether the case settles or goes to trial. Your lawyer can give you a more specific timeline based on your state and the insurance company involved.
Will hiring a lawyer make the insurance company more likely to deny my claim?
No. Insurance companies cannot retaliate against you for hiring a lawyer or filing an appeal. In fact, the presence of a lawyer often signals that you are serious about the claim, and some companies settle faster once a lawyer is involved.
What happens if I win my case?
If you win, the insurance company must pay the benefits you were owed, usually with interest. Your lawyer's contingency fee comes out of that payment. You may also recover costs like filing fees and informed witness fees. Your lawyer will explain exactly what you receive after fees and costs are deducted.