Disability
​  Remedies
Our Services
 Ways in which we can assist you with your disability benefits in Florida, Georgia, and Nationwide
At Julie A. Rice, Attorney at Law, & Affiliates our Disability Attorneys have over 50 years of collective legal experience helping our clients obtain their rightful disability benefits. Our Disability Attorneys have full service law firms with several locations in florida, georgia, and nationwide so that you are able to get the services that you need under one roof and from the same group of professionals without having to look elsewhere for professional assistance. As such, our affiliated Disability Lawyers are able to offer you key services to obtaining and maintaining your disability benefits that are so important to your life. Our Disability Attorneys represent clients who are seeking assistance with disability benefits from both private insurance companies and claims, as well as group (ERISA) disability companies and claims.  we accept cases and have locations and offices in georgia, florida, and nationwide to serve you.

There are many ways in which we can assist you with your Disability Insurance Claim. In this particular section we will discuss specific ways that we can assist you with your Disability Insurance Claim


1.) Assistance During the Disability Application Process for both Long and Short Term Disability Insurance Benefits;


The type of Applications in which we can assist you with, in particular:
a.) An Individual or Group Disability Policy
b.) A Doctor of Dentist Disability Policy
c.) A Business Overhead Policy
d.) A Disability Buy-Out Policy
e.) A Third-Party Administrators Policy

2.) Representation during an Appeal of a Denial of a Disability Claim (ERISA);
3.) Representation during an ERISA Disability Lawsuit;
4.) Representation during a Non-ERISA Disability Benefit Denial a/k/a a Private Insurance Company Disability Denial;
5.) Continued Representation and Monthly Disability Claims Administration and Handling; and
6.) Representation during Lump-Sum Disability Policy Buyout Negotiations.
7.) Class Action Law Suit
8.) Total vs. Residual Disability Analysis
9.) Co-Counsel Nationwide

The (8) ways in which we can assist shall be explained in detail hereunder.



 We can Review and Represent you in the Disability Insurance Application Claim for Short or Long Term Disability Benefits

The information that is contained in the initial application for disability benefits is the most important aspect at this juncture of said filing of the claim. Yet most people do not know how important this process is and the motives of the insurance companies. When filing for disability there must be a coordinated effort between many professional such as treating physicians, the employer, an accountant, past and present co-workers as a start. Regardless if you are a business owner, physician, engineer, lawyer, teacher, financial planner, salesperson, or any range of professional vocations, do not make the assumption that you will instinctively know how to apply, and be successful, in obtaining Disability Benefits. The Disability Application Process for Disability Benefits is complex and heavily scrutinized and investigated by the Disability Insurance Company.

Our law firm has counseled and guided hundreds of applicants throughout the disability application process and we know how to file for disability. We always recommend that a claimant speak to a Disability Benefits Lawyer before they even notify the insurance company of a potential claim for disability. The Disability Insurance Claim that you file will be evaluated by the Disability Insurance Company with the goal of denying your claim, and, at the least diminishing your claim, so that you are returned to work as soon as possible. To this end, the insurance companies will use every method at their disposal to deny and diminish the value of your claim such as interview you at your home and then conduct video surveillance in an effort to show that you really are not disabled after all. Furthermore, Disability Companies will utilize the services of a physician that is not independent and have that physician review your the disability claim you have filed and then render an opinion claiming that you are not, in fact, disabled.

These are just a few of the tactics used by Disability Insurance Companies when evaluating your Initial Disability Application. Over the past several years, the Disability Insurance Attorneys that are affiliated with us have successfully handled hundreds of thousands of Disability Insurance Claims against almost, if not every, major Disability Insurance Company. As such, the Disability Lawyers that handle your claim are intimately familiar with the tactics used by Disability Insurance Companies when evaluating Disability Insurance Claims and as such we prepare you for the types of tactics that you may be subjected and how to handle those accordingly. Our Disability Attorneys have been dealing with these Disability Insurance Carriers daily and have had many opportunities to engage in hundreds of hours of depositions with the Disability Claims Companies and its’ examiners so our Disability Attorneys are able to get into the heads of the Disability Carriers and know how they think. As such, this renders our Disability Claim Lawyers as the top in the Business in giving you advice on how to handle your Disability Applications. Please contact us at by phone at 770-865-8654 or 813-363-6664, by email at juliericelaw@outlook.com, or on our Contact Page for a free legal consultation that may include a review of your disability application and claim.

It is important to keep in mind that the more that you anticipate the actions of the insurance company in evaluating your claim the better your position will be in obtaining your ultimate goal and that is securing the best disability benefits possible. The insurance company has drafted the disability benefits application and many times vague questions can be misleading to you as the claimant, your doctors who must complete the application and forms so it is in your best interest to arm yourself with as much experience and knowledge as possible so that you have the the best chance and obtaining the best disability benefit to which you are entitled and that is why it is imperative that you have solid, experienced, and successful Disability Attorneys on your side every step of the way.

A.) There are Approximately Five (5) Types of Disability Benefit Applications that Can We Assist You With.

1.) Individual or Group Disability Policies Disability Applications

The attention to detail is the same when applying for disability whether you are applying through an employer provided group disability policy or whether your are applying through a long-term individual disability policy that you bought yourself from an insurance agent. All applications must include specific information that is supported by documentation that is proper to support said information. Therefore, this process shall involved a collaborative effort between several people, including, but not limited to: 1.) Your treating doctors and physicians; 2.) Co-workers who worked with you at the time of the Disability; and 3.) Likely an Accountant. The Disability Application should look something similar, if not identical to the following:

Your job and occupational duties must be broken down specifically into categories and the amount of time must be established that you spend working on each of these duties. How this is established can mean the difference between receiving only partial disability benefits or total disability benefits so this step is imperative in your application process. The Insurance Company will, in an effort to verify said occupational duties analyze items including, but not limited to, your tax returns, loss and profit statements, pay-stubs, books showing appointments, (for physicians only: your annual and monthly CPT code production reports), and any and all other documentation available to show work you have performed within the three (3) years prior to filing the claim as well as work performed since the claim has been filed.

Your Treating Physician must submit to the Insurance Company Attending Physician Statements stating whether or not you can perform duties of our occupation or, sometimes, duties of another occupation. Furthermore, the Insurance Company will discuss with the Treating Physician, by phone or in a meeting, your claim for Disability Benefits. Our Disability Attorneys routinely consult with your Treating Physician so that said Physician can properly make the connection and evaluate your limitations and restrictions and how they related to your daily job and occupational duties. To be complete in the application process so that the Disability Insurance Claim Examiner does not rely on a lack of information as a reason to deny a claim, your disability should be addresses in specific, not generic, terms as the disability relates to your particular occupation.

During the evaluation of your claim for benefits, the Insurance Company will most likely send out a Field Representative from the Company to several things such as interview you, review financial documentation in your possession, and, given the highly sensitive nature of these evaluations they should NEVER be conducted without the presence of your Attorney. At any given time, how you may chose to phrase a response to a question or inquiry may follow you throughout the entire claim’s process, and you may be required to appears for an IME which is an Independent Medical Examination and a FCE which is a Functional Capacity Evaluation so in order make sure that these tests are conducted legitimately and to protect your rights we always recommend that you have an attorney present at best and at the least have these Medical Exams Videotaped and Recorded with a copy of the report provided to you when complete.

Finally, and without your knowledge or consent, the Insurance Company will most likely hire a private investigator follow you for several days or more and conduct a video surveillance of you, and then send the video to the Independent Medical Examiner and/or your own Doctors to determine if the observations in the video are consistent with your claims that you can’t perform the duties of your occupation. Since this is such sensitive material, before any claim decision is made it is our procedure to request that the Insurance Company provided us with a copy of said video and, furthermore, to give your treating physicians the opportunity to review said video.

Many claimants are unaware that the Insurance Companies are not always entitled to each and every piece of information that they request from you so you should know your rights and be aware of the legal implications of each and every piece of documentation requested by the Insurance Company as well as each and every communication with the Insurance Company. The insurance companies are not entitled to every piece of information they request, and an applicant must be aware of the legal implications of every communication and document requested by the insurance carrier. Although the Insurance Companies may appear to have a lot of discretion under the terms of a Disability Insurance Policy they are still required to focus on the restrictions and limitations that prevent you from being able to perform your duties at work, your occupational duties, and this determination must be made when the disability started and determining this actual date of disability can be difficult. It must, however, be determined in conjunction with the medical records that support such a finding. In this regard, many view the playing field as being unequal where the Insurance Carrier is really a wolf in sheep’s clothing. This is why it is important to level the playing field and one way you can do that is to contact us by phone at either 770-865-8654 or 813-363-6664, by email at juliericelaw@outlook.com or on on Contact Form on our website for a free legal evaluation of your Disability Benefits Claim; we represent clients Nationwide.


2.) Our Lawyers Help Doctors, Dentists, and Chiropractors Apply For Disability Insurance Benefits

The highest level of scrutiny in terms of filing a claim for Disability Insurance Benefits, seems to be reserved for dentists, chiropractors, and doctors. This is often due to the higher dollar amount that the claimant may be entitled to as a Disability Benefit and also the broad potential range of a physician’s occupational duties. The most challenging part of determining a medical professional’s claim is accurately determining the date of the disability and the occupational duties of the professional a that time. In many disability claims, a doctor may either suffer a degenerative condition or suffer a medical condition they have been working through for many months or years. Therefore, when a professional such as a doctor reaches that point where she or he can not work any longer, the Disability Insurance Company will likely make the argument that the medical professional is only partially disabled instead of totally disabled.

To complicate this scenario, some doctors own their own medical practices and, arguably, can still earn income even if they can’t actually work in their vocation. A Disability Carrier will then make the argument that the claimant is only residually or partially disabled and treat the situation such that the doctor can work as an administrator in the office at the time that they became disabled. Therefore, doctors may sell their practices or stop working and seek Disability Benefits without first obtaining medical support through a treating doctor. This creates problems since medical documentation, work activity documentation, financial documentation, and timing are crucial when filing for a Claim for Disability Benefits.

Fortunately, our Experienced and Successful Team of Disability Insurance Attorneys have assisted hundred of physicians, dentists, nurses, surgeons, doctors, chiropractors, and more in the medical field successfully apply for and obtain Long Term Disability Benefits. In fact, our Earliest Disability Division Attorneys started by representing those fine women and men in the medical professions and we have since handled all, in not just about all, of every imaginable disability scenario, and have further experience with the every Disability Insurance Policy Sold by Every Disability Insurance Company in the Medical Association so it is safe to say that we have seen it all. Our experience has taught us that our clients who are medical professionals much have a Disability Plan to Implement in case the medical professional needs to file a claim for Disability Insurance Benefits to protect the amount of earning capacity that is usually substantial and that ends up being a significant reduction in this income in the event of a Disability so a solid plan must be a priority.

We understand that in the event of a Disability that many of our our client’s financial futures, not just in the medical profession, are dependent upon the Approval and Continued Payment of Long Term Disability Benefits. We are, therefore, deeply committed to applying our knowledge, experienced, and expertise into making sure that these individuals, as well as all of our clients, have the best chance at collecting the Disability Benefits that he or she is entitled to and eligible for and for as long as that may be. As such,
we encourage you to contact us by phone at 770-865-8654 or 813-363-6664, by email at juliericelaw@outlook.com, or by the Contact Form on our website and with a copy of your disability policy for a free legal consultation to discuss either your current or potential disability claim. We look forward to helping you.

3.) Business Overhead Policy

A Business Overhead Policy is typically referred to as a “BOE” policy. We have many clients with BOE policies and have found that the most challenging issue with this type of policy occurs when the business is shut down or sold since the language in the policy may then prohibit the eligibility of benefits. For example, we may receive a call from a client who has sold his/her business and now wants to collect under the BOE Disability Policy. To meet this demand, we have created some unique strategies that will allow our clients to capitalize on and maximize benefits of the BOE policy instead of lose those benefits. For example, if a business owner is selling her/his business due to a long term disability the owner should always take into consideration the BOE benefits and how said benefits may factor into the final sale price of their business. Just one example may be if the claimant has a building lease that she or he is obligated to pay $ 5,000 for 12 more months, then the BOE may be able to pay for this lease obligations if the claimant and the business remain liable for the lease payments. Furthermore, if the claimant owns the building being leased, then there is a potential of $ 60,0000 additional disability income for the claimant. As with all insurance policies it is imperative that you seek legal advice from an experienced professional such as one of our Disability Attorneys before assuming that any such relationship can exist without a complete understanding of the law and the insurance policy in place. We are happy to speak with you so feel free to call on us to discuss your particular situation: 770-865-8654.

4.) Disability Buy-Out Policy

A Disability Buy-Out Policy is the type of Long-Term Disability Insurance Policy that is purchased with the intent that if one partner becomes disabled then the other partner(s) can buy out the disabled partner for her or his share of the company. One requirement of these types of policies is that the Claimant must be Totally Disabled for at lease one-year (12 months), and that the buy-out itself take place in accordance with the buy-sell agreement that the partners have agreed upon between themselves. een the partners.
In the many times that we have represented clients in this buy-out arrangements and policies, the more common issues that we have encountered are:

a.) The buy-sell agreement agreed to by the business partners was drafted and agreed to a long time ago and no longer reflects the current status or market value of the business.
b.) There is not buy-sell agreement and the issue becomes whether or not the business can even draft such an agreement after the actual date of disability.
c.) The buy-sell agreement values the shares at a price that the Disability Company disagrees is the accurate price of the shares of the business and that the business shares are worth less so the Disability Company does not want to pay in accordance with the amounts set forth in the buy-sell agreement.
d.) It is clear that the amount of Buy-Out Disability Coverage is Not Sufficient, but it is not clear whether or not the disabled partner must sell all of her or his shares as a way to recover benefits under the buy-out policy language.


5.) Third-Party Administrators


It is becoming more and more of a common practice in the Disability Insurance Industry for a Disability Insurance Company to hire a Third-Party Company to Administer Claims for Disability Benefits. As a result, a company that is not the company that sold you the Disability Policy will be the company that decides whether or not you receive benefits under your policy. On such example is a company by the name of Disability Management Service, Inc. (“DMS”). DMS states on their website that they are a full service third party administrator and consulting firm specializing in the management of individual and group disability claims. DMS further states: “Disability benefit eligibility determinations are seldom black-and-white. Moreover, disability is rarely static in nature. People recover and return to work. Or, they remain disabled and adapt. Sometimes their conditions worsen. DMS focuses on the importance of early and proactive involvement with every disability claim, using a team-oriented approach. DMS claim professionals often interact with treating medical providers, specialized clinical experts, medical consultants, vocational specialists, forensic accountants, investigation professionals and legal advisers to gain a comprehensive understanding of each claim. DMS has access to the expertise of a national network of Independent Medical Examination providers, Peer Review experts, and Functional Capacity Evaluation professionals who help in the assessment of impairment and its impact on the claimant’s capacity to work. Our thorough, objective process ensures that new claims receive a fair assessment of benefit eligibility and active claims are appropriately managed for the duration of the disability.”

Disability Insurance Companies hire companies such as DMS for a number of reasons such as, for example, the insurance company that sold the policy does not have a claims handling department and/or it is believed that it is cost effective to outsource the handling of the disability claim. Our Disability Attorneys have handled many claims with DMS and companies such as DMS. It is important to not that whether the original Disability Insurance Company handles the disability claim or a Third-Party Administrator handles the disability claims that the goal is the same for every disability claim examiner and that is to look at an application for disability benefits with a goal of returning the claimant to work and therefore denying benefits at some point. There are several third-party administration companies throughout the country. For example, disability insurance companies such as Trustmark Insurance Company, are forming subsidiary companies (TrustmarkDisabilityAdvisors.com) in order to administer claims for other disability insurance companies. If you have a question about a Third-Party Administrator handling your claim, then you may contact us by phone at 770-865-8654 or 813-363-6664 or by email at juliericelaw@outlook.com or on the Contact Form on our Website.

AS WE BEGAN TO SHARE WITH YOU, WE HAVE A VARIETY OF SERVICES AVAILABLE TO ASSIST YOU WITH YOUR DISABILITY INSURANCE NEEDS. WE HAVE EXPLAINED HOW WE CAN ASSIST YOU IN A VARIETY OF WAYS IN THE APPLICATION PROCESS AND NOW WE WILL CONTINUE TO EXPLAIN HOW WE CAN ASSIST YOU IN OTHER AREAS OF YOUR DISABILITY INSURANCE NEEDS.




2.) We Can Offer Representation during an Appeal of a Denial of a Disability Claim (ERISA)


If you apply for Disability Benefits under your ERISA Governed Long-Term Disability Plan and you are Denied, then you, and the plan, are governed by ERISA regulations. The ERISA regulations require that the insurance company establish and maintain a procedure whereby a claimant shall have a reasonable opportunity to appeal an adverse benefit determination to an appropriate named fiduciary of the plan, and under which there will be a full and fair review of the claim and the adverse benefit determination.
Your disability plan will provide language as to whether or not you must file one or two appeals, before you can file a lawsuit. The insurance company is required to maintain an internal appeal review process so that the insurance company employee reviewing each appeal is completely independent of the employee that originally denied your claim. The idea is that a claimant is supposed to receive a full and fair review by the insurance company when an appeal is filed. The terms of your long-term disability plan will specify the number of Appeals that are required and the total number of Appeals that a claimant may file.

An insurance company can not require the filing of more than two appeals. The information submitted in an ERISA disability Appeal is extremely important, as all of the documents submitted become part of what is known as the “administrative record”. In the event that your ERISA appeal(s) are denied and a lawsuit is filed, the court in most cases will be limited to their review of the administrative record. ERISA does not allow for a jury trial, therefore if a lawsuit is filed it will be decided by a Judge.

A non-jury ERISA trial is usually a disadvantage for a claimant, because the Judge does not get to hear live testimony and the Judge is basically just reviewing documents. When submitting an Appeal it is essential that a claimant submits every piece of information in support of a claim for disability benefits that the claimant would want a Judge to consider. Our Disability Attorneys, therefore, prepare all of our client’s appeals in anticipation that a lawsuit may be filed if the Appeal is denied. In order to present the client’s appeal in a light most favorable to the insured, our Disability Lawyers work very closely with the clients and their treating physicians, to ensure that the appeals are submitted with an overwhelming amount of information and detail.

Furthermore, in most disability appeals, our Disability Attorneys will retain a vocational expert in order to determine what vocational skills a claimant can perform in light of the claimant’s medical restrictions and limitations. The vocational expert will also perform a labor market study in order to determine the availability of specific jobs in a particular market. In some cases, our Disability Lawyers will retain a medical doctor to review all of our client’s medical records and make recommendations regarding additional evidence that would strengthen our client’s claim.

ERISA provides extremely strict guidelines and deadlines for disabled claimants seeking disability insurance benefits under their group policies. If sufficient information is not submitted within these timelines, a claimant may be forever barred from introducing the documentation to prove their disability. The disability insurance company is required to give a claimant 180 days from the date of initial denial to submit a first appeal. While 180 days seems like a long time to prepare a disability appeal, most of this time is required to submit an appropriate appeal so no time should be wasted. The appeal process is timely because it often takes time to receive all of the claimant’s medical records and to review the entire claim file provided by the disability insurance company.
Additionally, if a claimant undergoes additional medical treatment or diagnostic testing during the 180 days, it will generally improve the claimant’s chances of winning an Appeal by providing this new medical information.

The disability insurance company has 45 days to respond to a claimant’s Appeal, however they may request an extension for good cause. Our Disability Attorneys understand the importance of trying to obtain benefits for our clients in an expedient and efficient manner. Frustrating as it may seem, the disability carrier will not tell you what is necessary to perfect your claim. Moreover, group disability income policies are drafted with ambiguous and confusing contractual terms. These ambiguities provide insurance companies with multiple reasons for delaying and denying disability income benefits. Furthermore, most policies provide the insurance company with full discretion in deciding whether sufficient information has been provided by claimants prior to approving a claim. Given the complexity of the legal issues involved and the tendency of insurance companies to vigorously defend claim denials, evaluation of any potential legal claim on behalf of an insured should be handled by a law firm experienced in ERISA disability insurance claims such as our affiliated, experienced and successful Disability Attorneys
Attorneys Dell & Schaefer are available to provide you with a free consultation and review of your long-term disability policy. Please keep in mind that there are time deadlines with ERISA disability claims and we must have sufficient time to evaluate your claim and take the appropriate legal actions on your behalf.

3.) We can Offer Representation during an ERISA Disability Lawsuit


Our Disability Attorneys have extensive experience and success in litigating ERISA Long-Term Disability Claim Denials. As described herein above, in a disability claim governed by ERISA a lawsuit can not be filed until all administrative remedies have been exhausted. Most long-term disability policies governed by ERISA require at least one appeal to be submitted before a lawsuit can be filed. Unlike an individual disability policy, the federal court has jurisdiction over all ERISA long-term disability cases.

One of the most challenging aspects in an ERISA disability lawsuit is the standard of review that a Federal Court will apply when reviewing a long-term disability denial. The most favorable standard of review for a claimant is a de-novo review. A de-novo review essentially means that the judge will conduct an independent review of the entire administrative record and make a determination as to whether the claimant is entitled to disability benefits. The least favorable standard is the abuse of discretion standard which means that the judge can only reverse the insurance company’s denial of benefits if he or she believes that the denial of benefits was wrong and the insurance company acted arbitrarily and capricious. Essentially, the Judge must find that the insurance company acted unreasonably in order to reverse a disability denial. The Judge will determine which standard of review to apply depending on whether or not the subject long-term disability policy contains a “discretionary clause” that grants discretion to the insurance company to interpret the terms of the disability policy and determine eligibility for benefits, and if the insurance policy contains such discretionary clause, then the Judge can use the standard that is the least favorable to the claimant in the review and that is the abuse of discretion standard rather than the de-novo review which is the most favorable standard of review for the claimant.

There are currently multiple states that have sought to ban the use of discretionary clauses in disability policies. Unfortunately, most employer provided long-term disability ERISA policies contain discretionary clauses, which means that the abuse of discretion standard is commonly applied by federal courts throughout the country. Despite this seemingly uphill battle, our Disability Attorneys have successfully utilized multiple legal strategies to defeat discretionary clauses and obtain a de-novo review of our client’s case.

Notwithstanding, there are significant differences between a lawsuit filed pursuant to an ERISA long-term disability plan versus an individual disability income policy. Unlike a lawsuit filed for failure to pay disability benefits pursuant to the terms of an individual disability policy, an ERISA claimant is not entitled to a jury trial. An ERISA disability lawsuit will be resolved by a Judge and in most cases the decision is made via the filing of a summary judgment motion. Another ERISA disadvantage is that it is difficult in most federal circuits to receive an award of attorney fees for the prevailing party in an ERISA disability case. Furthermore, unlike most individual disability policies, ERISA regulations do not allow any claims for bad faith or punitive damages for an insurance company’s wrongful denial of long-term disability benefits. Essentially, if a disability insurance company looses at an ERISA trial their only exposure is payment of past due benefits and possibly interest and attorney fees. It is a misfortune of justice and pro-insurance company law that there are no legal tools such as bad faith or punitive damages available to punish insurance companies for their denial of ERISA governed long-term disability insurance claims. There are certain ERISA regulations that provide for civil fines or penalties due to an employer or insurers failure to provide plan documents or comply with certain ERISA reporting requirements; however these penalties are inconsequential for most large disability insurance companies. This further reiterates the importance of retaining a competent, experienced, and successful Disability Attorneys to represent you if you are going to file a lawsuit seeking a disability payment under an ERISA disability policy. Despite the difficulties in these cases, our Disability Lawyers have successfully and consistently litigated numerous ERISA long-term disability denials throughout the country and we are available to provide you with a free consultation to discuss your options; and you may reach us by phone at 770-865-8654 or 813-363-6664; by email at juliericelaw@outlook.com; or on the Contact Form on our website. We look forward to speaking with you about your claim today.
4.) We can Offer Representation during a Non-ERISA Disability Benefit Denial a/k/a a Private Insurance Company Disability Denial

A disability claim denial by a disability insurance carrier does not mean you are not entitled to long term disability benefits. When you buy a disability income policy from an insurance company, you and the insurance company enter into a signed contractual agreement. If you become disabled according to the terms of the disability income policy, then the carrier must pay the claim. A long term disability insurance denial may be a breach of contract. Therefore, if your claim for long term disability benefits has either been delayed, denied, or your monthly benefits have been cut-off, our Disability Attorneys can provide you with multiple options.

Some disability benefit denials do not require the filing of a lawsuit against the insurance company. In those cases, our Disability Attorneys may open the lines of communication with the disability insurance company and have a disability claim denial re-evaluated. In addition, our Disability Lawyers can submit a detailed demand letter in response to the disability denial letter. This demand letter will address the medical and legal issues of your claims as well as the strengths of your claim, thereby giving the insurance company a last chance to pay disability benefits prior to the filing of a lawsuit. A disability denial letter must clarify all of the reasons that an individual disability claim has been denied. If it’s appropriate, then, in some cases we are able to mediate and meet with the insurance company in order to reverse a disability claim denial without the need to file a lawsuit. If the investigation of a long term disability insurance denial reveals that the insurance company did not have a good faith basis for the LTD denial of your claim, a written complaint with the appropriate State Department of Insurance and Department of Finance may be instituted. This action is required in most states in order to preserve a claim for bad-faith. Not every state allows a claim for bad-faith, however.
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The final option is to file a lawsuit against the disability insurance company for breach of contract in either state or federal court. Our Disability Attorneys have litigated disability cases against every major disability insurance carrier in the country, and have extensive knowledge and experience regarding any and all defenses that the insurance companies will raise in attempt to not pay disability benefits. Furthermore, insurance companies respect our Disability Lawyers’ abilities and are aware that we are relentless in the pursuit of our client’s claim. An individual claim denial will ultimately be decided by a jury.

All of our Disability Attorney litigation clients are represented on a contingency fee basis, which means we do not charge any attorney fees or cost unless we make a recovery for our clients. Disability income lawsuits are very heavily litigated and usually require hundreds of hours of time. Due to the complexity, risk and hours involved in litigating a disability benefits denial, we intentionally limit the number of cases we handle and are selective in the cases that we pursue for litigation. In a long term disability denial case we realize that our client’s future source of income is at stake, and we are committed to quickly obtaining disability benefits that have been wrongfully denied by a disability insurance company. If your claim has been denied, you are waiting for a claim decision, or your monthly benefits have been cut-off, our Disability Attorneys will provide you with a free consultation and evaluation of your claim for disability benefits so call us at 770-865-8654 or 813-363-6664; by email at juliericelaw@outlook.com; or by the Contact Form on this website.

5.) We can Offer Continued Representation and Monthly Disability Claims Administration and Handling

When an individual is approved for long-term disability benefits, the insurance company has the contractual right to continually evaluate a claimant’s eligibility for disability benefits. In other words, a disability insurance company can deny benefits to a claimant at anytime, regardless of how long the claimant has been receiving benefits. Once approved for disability benefits, most disability insurance policies require a claimant to submit monthly claim forms in order to prove continued eligibility. Additionally, some carriers will require an Attending Physician Statement on a monthly basis from the claimant’s treating doctor.

Our Disability Attorneys provide on-going legal representation for individuals that have been approved for long-term disability, in which we are the exclusive point of contact between the disability insurance carrier and our client. The carrier sends all written correspondence and any request for documentation to our office. It is our responsibility to make sure that all claim forms, attending physician statements, medical records, financial documents, or any other documents are provided in a timely manner to the insurance company, so as to protect our client’s disability benefits. Furthermore, our representation ensures a claimant that they always have a lawyer backing them up and ready to take legal action if the disability insurance company tries to deny benefits. Disability insurance companies will jump on any opportunity to deny a claim, therefore it is important that every document sent to the insurance company is reviewed and scrutinized. A mistake as simple as checking a box saying that you can lift 15 pounds instead of 5, could be reason for the insurance company to deny a claim. The medical records of your own doctor also need to be closely reviewed as there could be detrimental information in your records from a recent office visit.

Disability insurance companies frequently deny claims when a new claims examiner takes over the handling of your claim. For example, we recently received a call from a claimant that Prudential insurance company denied after paying for 18 years. The woman had a brain injury, and Prudential felt that she was better because she could go to the mall and go shopping with her husband For most of our clients, we understand that your long-term disability insurance payment is your only source of income. Most clients that hire us for the application process will continue to have us represent them throughout the duration of their claim. Please contact us if you would like more information about our monthly claim handling services. You may contact us by phone at 770-865-8654 or 813-363-6664; by email at juliericelaw@outlook.com; or by the Contact Form on our website.

6.) We can offer Representation during Lump-Sum Disability Policy Buyout Negotiations

Insurance companies sell disability insurance polices with the hope that they will never need to pay monthly benefits to an insured. Once an insurance company becomes obligated to pay an insured monthly disability benefits, the insurance company is losing money. In effort to cut their losses, most disability insurance companies are always interested in the opportunity to buy-out an insured’s disability policy for a one-time lump sum amount. Our Disability Attorneys have represented hundreds of individuals in an effort to obtain the maximum lump-sum buyout possible. We work closely with actuaries, financial consultants and treating physicians in order to maximize a buy-out offer.

Every insurance company has their own methodology and formulas for determining the value of an insured’s disability income policy. As a result of handling buy-outs with almost every disability insurance company, we are well aware of each company’s valuation methods. There are multiple factors involved in determining the value of an insured’s disability income policy. Some of the factors that insurance companies will consider are:
▪ the life expectancy and mortality of the insured;
▪ the current corporate bond rate;
▪ the likelihood that the insured will remain totally or residually disabled;
▪ the amount of insurance company reserves for the specific policy;
▪ the present value of future monthly disability benefits;

In every lump-sum policy buyout, the insurance companies will make an offer that is discounted to present value dollars. This means that if the future value of an insured’s disability payments in 15 years would be $900,000 ($5,000 a month multiplied by 180 months), then the present value is the amount of money an insured needs today at a stated interest rate in order to equal $900,000. Assuming a $5,000 monthly benefit, 15 years of remaining payments, and an interest rate of 5%, then the present value of $900,000 would be $450,000. This means that if you deposited $450,000 in the bank today and received an interest rate of 5%, then you would have $900,000 15 years from today. The present value amount is always less than future value. As a general rule money will double every 15 years at an interest rate of 5%. Insurance companies will never pay 100% of the present value, since there is no financial benefit to them to do so. They will however, use the previously stated factors in arriving at a buy back amount.

Lump sum buy backs are not advisable for everyone. However, they often make sense for an insured for the following reasons:
▪ cash received is often tax free to be invested as you desire;
▪ no risk of future denials or uncertainty of upcoming benefits;
▪ monthly benefits end at the death of the insured;
▪ cash received now can be used for estate planning or new venture;
▪ no longer subject to insurance company solvency;
▪ ability to try a return to work without insurance company scrutiny.

If you are interested in pursuing a lump-sum disability buyout contact our Disability Attorneys by phone at 770-865-8654 or 813-363-6664; by email at juliericelaw@outlook.com; or on the Contact Form on this website to make sure you are receiving the maximum buy-out possible. We work closely with actuaries and financial consultants in order to maximize your buy-out so get in touch with us today before making a final decision.





7.) Class Action Lawsuit

A class action is a case brought against a company whose actions have damaged a group of people in a similar way. A single person who has been injured may bring a class action on behalf of everyone who has been harmed. It is common, however, after the action has been started, for many other injured people to join the class action lawsuit and become class members. Several long-term disability class action lawsuits have been filed against Unum alleging the company has purposely denied disability benefits or terminated claims of disabled policyholders. One of our affiliated Disability Law Firms is currently working on a class action lawsuit against one of the world’s largest disability insurance companies for their failure to comply with ERISA regulations.

8.) Total vs. Residual Disability Analysis


You must understand the intricacies of your long-term disability income policy to know if you are totally or residually disabled in your occupation. Do not allow a disability insurance company to confuse or mislead you. Many long-terms disability income policies provide for both total and residual (partial) disability benefits. In such disability policies total disability is usually defined as the inability to perform the substantial and material duties of your occupation, or some variation thereof. Residual disability is often defined as the inability to perform one or more duties of your regular occupation, or the inability to perform these duties for as much time as before, and you have suffered a loss of at least 20% of your pre-disability income.

These provisions seem strikingly similar, but they are not. Often, a claimant may fit both the total and residual disability definitions. In such situations, an insurance carrier will attempt to claim that the claimant is residually disabled and not totally disabled. Many claimants automatically assume that if they are working at all they are not totally disabled, but they must be partially or residually disabled. However, this is often not the case and not the protection that a claimant has been paying premium dollars for. Many insurance carriers utilize such ambiguous language in writing disability income policies because claimants, unfamiliar with contract interpretation, will often rely on the carrier’s reading of the policy. However, it is important to note that in most states, ambiguous contract language is decided in favor of the insured. Many individuals are not aware of this fact and thus, look to the writer of the contract for clarification, their insurance carrier.

The reasons insurance carriers would rather pay residual disability benefits rather than total disability benefits are simple. Most disability policies provide that an individual with a partial disability will only be paid through the age of 65, while an individual on total disability benefits may be paid for the duration of the individual’s life. Moreover, partial disability benefits are based on the percentage of pre-disability income lost. Thus, an individual receiving residual, rather than total disability benefits may receive a reduced benefit or no benefit at all if his monthly income exceeds a certain percentage of pre-disability earnings. Finally, in the event of a buyout of the disability policy, an individual would be more apt to surrender his or her contract for a smaller settlement, if the individual’s disability were deemed partial rather than total. This practice saves insurance carriers hundreds of millions of dollars each year. One of our affiliated Disability Law Firms resolved a claim for a dentist that dealt with the issue of a disability insurance company claiming he was entitled to residual disability but not total disability.

9.) Co-Counsel Nationwide

Our affiliated Disability Attorneys, Lawyers, and most Law Firms are licensed to practice in Federal Court throughout the country and upon motion and approval by the local court, will work as consulting trial counsel in any state or Federal court. Due to the diversity of citizenship and the amount in controversy, most cases are handled in federal court. Our affiliate Disability Attorneys and Lawyers welcome the opportunity to work with co-counsel and continue to protect the rights of insured’s that have been wrongfully denied disability insurance benefits. Due to the complex and specialized knowledge required to handle a long-term disability income claim, many of our cases are referred to us by other lawyers throughout the country. We have established relationships with attorneys throughout the country that we work very closely with. On a case by case basis we pay referral fees to referring attorneys in accordance with local bar association rules regarding fee-sharing. If you are attorney that would like to establish a referral relationship with our law firm, then please contact us by phone at 770-865-8654 or 813-363-6664; by email at juliericelaw@outlook.com; or by the Contact Form on this website. We look forward to hearing from you soon.