Chicago employees with employer-provided long term disability insurance often ask if they need a nearby lawyer to appeal the insurance company’s denial, or can hire a national firm and just hire a local attorney when it is time to file a lawsuit in court under ERISA § 502(a). It’s quite risky to work with a lawyer who is not where the evidence is, in large part because the appeal is like your trial, and your one and only chance to put forth all the evidence you can supporting your claim. By the time you get the insurer’s final denial, it’s too late to submit new evidence or get creative. There is far more a good long term disability lawyer near you can do to generate convincing evidence than ones far away who just get your medical records and send your doctors template forms.
One claimant recently learned a hard lesson when he tried to bring up evidence in court that could have been submitted with his appeal, but was not. In Cruz v. Reliance Standard Life Insurance Co., No. 18-0974, 2021 WL 601827 (D.N.M. Feb. 16, 2021), Plaintiff was a surgeon suffering from generalized anxiety disorder and cyclothymic disorder. Reliance Standard denied the long-term disability claim and his appeal. When Cruz sued for his benefits, he wanted to introduce into evidence a medical opinion from a non-examining physician that Cruz was disabled and additional progress notes from one of his doctors. The court disallowed the additional evidence in litigation, explaining Cruz failed to meet his burden of showing it was impossible to have submitted those pieces of evidence earlier. Without the additional evidence, Cruz lost the case and wound up without his disability benefits being paid.
What these evidentiary rules mean is that the long-term disability appeal prior to going to court is really like the trial, and the subsequent litigation is more like a trip to the appellate court. If you’re going to go to trial, it would be wise to hire a good lawyer, and one who can gather and create the kind of evidence trial lawyers do. We love to meet with our clients (masked and socially distanced during the pandemic, of course) and explore creating visual evidence, meet and talk with their doctors, and interview family.
If you are in Chicago or anywhere in Illinois, and an insurance company denied your long-term disability claim, contact a Chicago long-term disability lawyer to determine how to best approach your appeal and create a strategy for success!