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What can I do if I was receiving long term disability and the Insurance cancel my income after ME even though my doctor says .

Amarillo, TX |

I'm disabled and I'm waiting on a decision from social security?

Attorney Answers 4

Posted

It seems you are asking about getting social security disability but the question seems confusing. If you are needing to get SS disability you should hire a local SS disability lawyer in your area to fight for you.

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Posted

You should contact an SSDI lawyer.

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Posted

Yes, if you don't already have a Social Security attorney, you should get one of those, but more importantly, you need an employee benefits / ERISA attorney if your long term disability claim was denied. If you look around, you may be able to find someone who can handle both your Social Security disability claim and your long term disability claim at the same time, which is best, in my opinion.

Social Security has what's known as a "treating physician rule." It says that if your own doc says something about you, generally the Agency is going to follow that over what some one-time examining doctor says about you. However, LTD companies don't have to follow that rule, and in many cases they can get away with denying benefits based on a one-time exam by a third-party doc, even if your doc says you're disabled. If you got your LTD coverage through work, your claim is likely governed by a complicated federal law called ERISA, which not many attorneys like to deal with. Ideally, you should hire an ERISA attorney to help you before you finish all the appeals with the LTD company - there's much less an ERISA attorney can do for you if you only hire one after you get a final denial from the LTD company. If you've been denied, and you have an appeal available, talk to someone ASAP. You can try to find someone in your area by searching on this website for an "employee benefits" attorney.

Jeremy Bordelon is a licensed attorney in the State of Tennessee only, and is authorized to practice in all Tennessee State and Federal courts, and before the Social Security Administration in any jurisdiction. The answers provided on Avvo.com are for information purposes only, and should not be relied on as legal advice. This answer does not create an attorney-client relationship between us. In some jurisdictions, this answer may be construed as attorney advertising.

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Posted

If you are seeking to have disability benefits from your insurance company reinstated, the first thing you or your attorney will need to do is determine if your policy is governed by the Employee Retirement Income Security Act of 1974, or ERISA.

If the policy is not governed by ERISA, then you basically have a breach of contract situation. Hire a lawyer and have them sue the insurance company would be my approach.

However, if your policy is governed by ERISA, you face a much more difficult and uphill battle. If your policy was provided by your employer, and your employer was not a governmental entity or a church, then the policy probably is governed by ERISA. First, after the initial denial, you must exhaust the administrative remedies by appealing the denial. This must be done within 180 days of the denial. The insurance company then has up to 90 days to review its original decision and make a new decision on your claim. After the appeal process is complete you will have the right to bring suit in federal court before a judge, and almost certainly there will not be a jury and no discovery. Because of these circumstances, the appeal process is particularly important.

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