Many employees in Chicago and throughout Illinois have employer sponsored long term disability insurance coverage and wonder when is the right time to involve a long term disability lawyer to help with the claim. Insurers will often tell you that you do not need a lawyer until you need to file a lawsuit. The truth is, you can file a lawsuit and manage it on your own, called pro se, but it is just as advisable to handle a dispute with an insurer in court as it is to do so before the claim is ready for litigation, due to the notion that courts review relatively closed records of claims for benefits in ERISA § 502(a) lawsuits. A good example of how litigation can go wrong when handling your own internal appeal of a claim denial appears in a recent case from Florida.
In Ramdeen v. Prudential Life Insurance Company of America, No. 6:15-cv-139, 2016 U.S. Dist. LEXIS 20631 (M.D. Fla. Feb. 19, 2016), Mr. Ramdeen worked as a Vice President of Bank of New York Mellon and suffered from a stroke, which incapacitated him for several months. He returned to work six months after the stroke for several years, though his employer made accommodations for him by reducing his responsibilities. After a few years of working, Ramdeen’s cognitive impairments and weakness caught up with him, and he was no longer able to continue the working. He filed a claim for long term disability benefits without a lawyer, and the insurer denied the claim. Rather than getting a lawyer to help with the appeal, Ramdeen attached the most recent medical records and sent in a short appeal. The lack of strategic planning from a long term disability attorney was fatal to Ramdeen’s claim. Prudential upheld the denial, forcing Ramdeen to sue under ERISA § 502(a).
The Court agreed with Prudential and left Ramdeen empty handed. The court explained that Ramdeen failed to show why he was able to work for several years after his stroke, but not now. Ramdeen appeared to take for granted that his earlier stroke would show he is disabled. But he needed to tell more of story than that which was in his medical records. We have helped stroke victims obtain and keep disability insurance benefits after suffering such a tragic event. Instead of navigating these waters alone, if your claims for long term disability insurance has been denied, speak with an experienced ERISA long term disability attorney today.