Employees in Chicago and elsewhere in Illinois speaking with a long term disability insurance attorney often become emotional about the insurer denying the claim. Most often, the first question they ask a lawyer is how long it will take to resolve the matter with the insurer. Like that of any good lawyer, my response is usually “it depends.” It depends on whether the denial can be overturned through the administrative appeal process, or whether the administrative appeal process has already been exhausted, and the next step is litigation under ERISA § 502(a). The earlier a good long term disability lawyer gets involved in the claim, the more value the lawyer can add, and the sooner the claim can be ultimately resolved. A great ERISA disability insurance lawyer can provide the best odds of getting a claim denial overturned and avoiding litigation. A recent case displays why you should get help to avoid litigation.
In Marcin v. Reliance Standard Life Ins. Co., No. 13-1308, 2015 U.S. Dist. LEXIS 140061 (D.D.C. Oct. 14, 2015), Marcin went through litigation three times over the same issue with the Reliance Standard Life Insurance Company. From the text of the opinion, it appears Marcin did not have long term disability attorney during her administrative claim and appeal. After a final administrative denial, she received Social Security Disability benefits, and a lawyer attempted to obtain reconsideration on her behalf. Marcin sued under ERISA § 502(a), and the court held there was insufficient evidence in the record to justify Reliance Standard’s decision. The court remanded the matter back to Reliance Standard. During that remand, Reliance Standard refused to accept any additional evidence from Marcin, and added only a vocational expert opinion and upheld its denial. Marcin again sued, and the court held in the second case that it was unreasonable for Reliance Standard to ignore the additional evidence and the Social Security award. The court remanded a second time, and Reliance Standard then addressed the Social Security award, citing different standards for the two benefits, and again upheld its decision.
The court again considered the dispute and, thankfully, declined to give Reliance Standard a third remand. Nevertheless, Reliance Standard had three reviews of the same claim before paying any benefits. Marcin ceased work in 2008, and finally, after three rounds of litigation, she has some closure as to the status of her claim. For reasons like this, I always counsel individuals that nobody wins in litigation. A good lawyer will help you win a lawsuit. A great one will strive to keep you out of a lawsuit.
If your claim for long term disability benefits has been denied, and you want to discuss how to have the best chance of getting the claim paid without lengthy litigation, consult an experienced ERISA long term disability attorney.