What a Long-Term Disability Lawyer Does
A long-term disability (LTD) lawyer represents you in disputes with your insurance company over benefits you believe you are owed. Most LTD policies are employer-sponsored group plans, and the insurance company—not your employer—makes the final decision on whether you meet the definition of disability under that specific policy. When the insurer denies your claim or stops paying, a lawyer's job is to gather medical evidence, challenge the insurer's reasoning, and either negotiate a settlement or file a lawsuit in federal court.
The work is narrower than SSDI representation. An LTD lawyer does not file applications with the government or argue before judges about Social Security rules. Instead, they work within the contract between you and the insurance company, using the policy language, your medical records, and sometimes informed testimony to prove the insurer made a mistake or acted unfairly.
Key Takeaways
- Long-term disability lawyers work on contingency in most cases, meaning they take a percentage of what you recover and you pay nothing upfront.
- You typically need a lawyer only after the insurance company denies your claim or stops your benefits, not when you first file.
- The insurer's own medical reviewers often contradict your doctors; a lawyer's job is to show why your doctors' opinions are more credible.
- Federal law (ERISA) governs most employer group LTD plans and limits what you can recover to the benefits owed under the policy, not damages for emotional distress or lost wages beyond the policy amount.
- The timeline from denial to settlement or trial can be 18 months to three years, so hiring early matters if you plan to pursue the claim.
When You Need an LTD Lawyer vs. Handling It Yourself
You do not need a lawyer to file an initial LTD claim. The insurer will ask for medical records, work history, and a description of your condition. You can gather these yourself and submit them. Many claims are approved at this stage without legal help.
You should consider hiring a lawyer if the insurer denies your claim, stops your benefits, or offers a settlement you believe is too low. At that point, the dispute is no longer administrative—it is adversarial. The insurer has already decided against you, and reversing that decision requires evidence and argument that most people cannot mount alone. If your condition is complex, your doctors' opinions conflict with the insurer's medical reviewers, or the policy language is ambiguous, a lawyer becomes valuable.
You may also want a lawyer if the insurer requests a Functional Capacity Evaluation (FCE) or Independent Medical Examination (IME). These are examinations the insurer pays for, and the results often contradict your treating doctors. A lawyer can help you prepare for the exam, object to the examiner's credentials, and challenge the findings afterward.
How LTD Lawyers Charge and What It Costs
Most long-term disability lawyers work on contingency, meaning they take a percentage of the money you recover and you pay nothing upfront. The percentage is typically 25 to 33 percent of the settlement or judgment, though some lawyers charge less for straightforward cases. You are responsible for costs—medical record copying, court filing fees, informed witness fees—which usually range from $500 to $3,000 depending on complexity. The lawyer may advance these costs and deduct them from your recovery, or ask you to pay them as they arise.
Some lawyers charge hourly rates instead, usually $200 to $400 per hour. This is less common in LTD work because the client often cannot afford to pay as the case develops. If a lawyer offers hourly billing, ask whether they will switch to contingency if the case goes to trial, or negotiate a hybrid arrangement.
Before signing a fee agreement, confirm what percentage the lawyer takes, whether costs are deducted before or after the fee, and what happens if you lose. A written fee agreement is required by law in most states.
What Happens After You Hire a Lawyer
Once you hire a lawyer, they will send a letter to the insurance company notifying them of representation. The insurer must then communicate with your lawyer, not you directly. Your lawyer will request your complete claim file—all documents the insurer has, including medical records they obtained, their internal notes, and the reasoning behind the denial.
Next, your lawyer will review the policy language, your medical records, and the insurer's decision letter to identify weaknesses in the denial. They may hire a medical informed—a doctor in your specialty—to review your records and write an opinion letter stating that you meet the policy's definition of disability. This informed opinion is often the turning point: if your treating doctors say you cannot work and an independent informed agrees, the insurer's own medical reviewer becomes harder to defend.
Your lawyer will then send a demand letter to the insurer, laying out why the denial was wrong and proposing a settlement amount. Many cases settle at this stage. If the insurer refuses, your lawyer will file a lawsuit in federal court (because most group LTD plans are governed by ERISA, a federal law). Discovery follows—both sides exchange documents and take depositions—and then either settlement negotiations resume or the case goes to trial.
ERISA and What You Can Recover
ERISA (Employee Retirement Income Security Act) is the federal law that governs most employer-sponsored LTD plans. It sets the rules for how the insurer must handle your claim and what you can recover if you win. Understanding ERISA is important because it limits your options in ways that surprise many people.
Under ERISA, you can recover only the benefits owed under the policy—usually monthly payments from the date the insurer wrongly denied or stopped your claim until the date you would have aged out of the plan (often age 65). You cannot recover damages for emotional distress, punitive damages to punish the insurer, or lost wages beyond what the policy promised. If the policy pays $3,000 per month and the insurer wrongly denied your claim for two years, you can recover $72,000 plus interest and attorney fees—not more, even if you suffered greatly.
ERISA also requires the insurer to follow a specific appeals process before you can sue. You must exhaust the insurer's internal appeal—usually a written request for reconsideration—before filing in court. Your lawyer will handle this appeal, but it is a mandatory step. Some insurers deny appeals quickly; others take months.
Finding and Vetting an LTD Lawyer
Start by asking your primary care doctor or specialist whether they have worked with disability lawyers and can recommend one. Many doctors have relationships with lawyers who understand their field. You can also contact your state bar association's lawyer referral service, which screens lawyers by practice area and experience.
When you contact a lawyer, ask about their experience with LTD claims specifically—not just SSDI or workers' compensation, which operate under different rules. Ask how many LTD cases they have handled, what percentage they settled versus litigated, and what the average timeline was. A lawyer who has tried cases in federal court is valuable if your case is complex, but many LTD disputes settle before trial.
Ask for references from past clients if possible, and check online reviews. Be wary of lawyers who may provide a result or promise to "beat the insurance company"—no honest lawyer can may provide an outcome. A good LTD lawyer will be honest about your chances based on the policy language and your medical evidence.
Interview at least two lawyers before deciding. Most offer free initial consultations. Use that time to assess whether the lawyer understands your condition, has handled similar cases, and communicates clearly. You will be working together for months or years, so fit matters.
The Timeline and What to Expect
The process from denial to resolution typically takes 18 months to three years, though some cases move faster. Here is a rough timeline: the insurer denies your claim (or stops your benefits) in weeks or months. You hire a lawyer and they request your claim file (two to four weeks). Your lawyer reviews the file and may hire a medical informed (four to eight weeks). Your lawyer sends a demand letter and the insurer responds or ignores it (four to twelve weeks). If the insurer does not settle, your lawyer files a lawsuit in federal court (two to six weeks). Discovery and depositions follow (six to twelve months). Settlement negotiations resume or the case is scheduled for trial (two to six months before trial).
During this time, you are not receiving LTD benefits (unless you are on an interim payment while the dispute is pending). Some lawyers can negotiate with the insurer to resume payments while the case is ongoing, but this is not may provide. Plan your finances accordingly.
Frequently Asked Questions
Can I have both an SSDI lawyer and an LTD lawyer at the same time?
Yes. SSDI and LTD are separate programs with different rules and timelines. An SSDI lawyer handles your Social Security claim; an LTD lawyer handles your insurance company dispute. They do not interfere with each other, though you should tell both lawyers about the other case so they can coordinate if needed. For example, if you win SSDI, the LTD insurer may reduce your benefits under an offset clause in the policy.
What if the insurance company says I have to go to their doctor before they will reconsider my claim?
The insurer can require an Independent Medical Examination (IME) as part of the appeals process. Your lawyer can attend the exam, object to the examiner's qualifications beforehand, and challenge the findings afterward. Do not refuse the exam—that gives the insurer grounds to deny your appeal. Instead, prepare with your lawyer, bring a list of your symptoms and limitations, and be honest about what you can and cannot do.
What happens if I settle with the insurance company—do I have to repay SSDI or Medicaid?
If you receive SSDI, a settlement from LTD may trigger a work incentive called a Plan to Achieve Self-Support (PASS), which lets you set aside part of the settlement without losing benefits. If you receive Medicaid, you may have to spend down the settlement to a certain level before Medicaid will resume. Your SSDI representative payee or Medicaid caseworker should be notified before you settle. Your LTD lawyer may not know these rules, so coordinate with your SSDI representative.
Can I sue my employer instead of just the insurance company?
In most cases, no. ERISA preempts state law claims against employers for benefits disputes. Your claim is against the insurance company, not your employer, even if your employer chose the plan or administers it. There are narrow exceptions if your employer acted in bad faith or breached a fiduciary duty, but these are rare and require a separate legal theory. Your lawyer can advise whether your situation qualifies.
What if the insurance company offers a lump sum settlement instead of ongoing monthly payments?
Many insurers offer lump sums to close claims. Your lawyer will calculate what the ongoing payments would be worth and compare it to the lump sum offer. A lump sum is often lower because the insurer avoids future risk, but it may be the best you can get. Your lawyer should explain the trade-offs: a lump sum gives you control and certainty, but if you live longer than expected, you may wish you had taken the monthly payments. This is a decision you make with your lawyer's input, not one they make for you.