We take care of fighting for you, so you can focus on what matters most – your health
Long-Term Disability Benefits Legal Services
Arizona Long Term Disability Legal Services
Trying to navigate a long-term disability claim can feel overwhelming, especially when faced with insurance companies that often prioritize profits over people. At Sandstone Law Group, we’re here to guide you every step of the way.
Our experienced attorneys focus on protecting your rights, securing the benefits you deserve, and advocating for you against the tactics insurers use to deny or delay claims.
Whether you live in Phoenix, Tucson, Mesa or Flagstaff, if you’re filing a claim, appealing a denial, or managing your benefits, our Arizona long-term disability lawyers offer legal support tailored to your unique situation. With legal guidance and a commitment to your well-being, we help you focus on what matters most—your health and recovery.
Why Hire an Arizona Long-Term Disability Attorney at Sandstone Law Group
While you can submit your own appeal, doing so is risky. A poorly prepared appellate record can severely hurt your case and impact your chances in court if you have to file a lawsuit.
Avoid Any Pitfalls from the Start
Always consult an Arizona long-term disability attorney before submitting appeals. The strength of a lawsuit depends on the quality of the appeal.
No Fees Unless We Win Your Claim
There are many ways attorneys can charge a client for services. We offer a contingency fee, which means the Firm recovers a percentage of any recovery. One size does not fit all when it comes to long-term disability claims. When determining fees, we take into account your specific case and the work involved.
We’re Here for the Long Haul
Many firms do not provide continued support after winning your case, but we do. We provide you with additional care and protection because insurance companies may try to avoid paying disability benefits after you obtain them.
We Are Experienced in Battling Insurance Companies
Insurance companies want you to give up – they save money when you do. Don’t give up! We routinely go up against insurance companies and know what it takes to get your benefits. With so much at stake to protect your livelihood, don’t go at it alone.
Case Evaluations Are 100% Free
Should we decide to review your case, we will provide an initial consultation at no cost. We treat you with compassion and strive to provide you with an honest assessment of moving forward.
Submitting Your Long-Term Disability Benefits Claim
3 Things You Should Know Before Filing Your Claim
- Every policy or “plan” is unique, so you should review pertinent coverage documents before proceeding in order to understand your benefits.
- Your benefits can be denied or limited based on specific policy terms and provisions, such as mental nervous limitations. Be aware before you file. Insurers will try to trap you in policy limitations.
- Many insurance carriers misrepresent coverage or the governing law, so speak with our Arizona long-term disability lawyers to better understand what laws apply to the insurance company’s conduct. This will help you understand your rights.
We help you avoid potential pitfalls when submitting a disability claim.
When submitting a claim it’s imperative that you understand:
- Your specific coverage. Including whether you possess the correct and complete plan documents, and what it means to be Disabled
- The governing law. Together we’ll determine whether your policy is governed by State law (Insurance Bad Faith) vs. ERISA which impacts how you should submit your claim and your rights in the process
- The insurance company. Each major insurance company tends to have tactics for denial, and one insurance company will use certain tactics more than others, such as by conducting surveillance or sending you to “independent medical examinations.” We know how the insurance companies operate and can help be prepared for the claims process.
Assisting You with Long-Term Disability Benefits Appeals/Denials and Terminations
4 Commonly Made Mistakes When Appealing Claim Denials, or an “Adverse Benefits Determination” in ERISA cases
- Failing to send a written request for all relevant documents before appealing.
- Appealing a denial based on emotion and not facts.
- Appealing in haste or too soon (you may foreclose the ability to present evidence later).
- Failing to gather all documentation that can support your claim.
- Failing to understand your unique policy provisions.
We invest a tremendous amount of time in tailoring a strategy to secure your benefits during the appeals process.
When we represent clients on appeal, we often submit some or all of the following:
- Evidence to support and explain your disabling conditions
- A rebuttal to the insurance company’s reasons for denial
- Exposure of the insurance company’s bias
Do You Need to File a Disability Lawsuit?
Your ability to file a lawsuit depends on several factors. The law that applies to your disability benefits impacts when (and where) you should file a lawsuit. Other considerations include the strength of your claim, whether you have exhausted your administrative remedies, and time limitations.
We take pride in securing the most relief possible for our clients.
Don’t Give Up or Go It Alone. Let Us Fight for Long-Term Disability Benefits You Deserve.
We Handle the Insurance Companies so You Can Focus on Your Health.
If you have any questions about whether you should file a lawsuit, contact us for a free consultation on how to proceed.
Understanding Lump Sum Settlement Offers for Long-Term Disability Claims
Long-term Disability claims are sometimes resolved by settlement. It’s important to seek legal advice as quickly as you can if you receive a buy-out offer, because there are usually short timelines associated with the offer and special considerations in what a buy-out offer means.
Many insurance companies offer to pay a certain amount of your LTD attorney’s fees to help you secure legal advice. There is no risk involved in speaking with our Arizona long-term disability lawyers about the buy-out offer and your options, especially if you do so very soon after receiving an offer.
How to Manage Your Long-Term Disability Benefits Without Interruption
If you are receiving long-term disability (LTD) benefits, you are responsible for managing your claim to avoid an interruption of benefits. Most LTD plans require claims administrators (often the insurance company) to conduct frequent file reviews to see if you still meet the policy’s definition of disabled.
This can include checking in on your medical records, interviewing physicians, completing forms, requesting additional medical exams, and even conducting surveillance on you without your knowledge.
Because of this, you need an Arizona long-term disability lawyer to manage your LTD claim and stay one step ahead of the game. We are here to help you during this process.
Glossary of Key Terms for Long-Term Disability Claims
ERISA (Employee Retirement Income Security Act of 1974)
A federal law that governs most employer-sponsored disability insurance plans. ERISA establishes rules for how claims are handled, timelines for appeals, and limits on lawsuits. While ERISA provides some protections, it has evolved to favor insurers in disability claims, making legal expertise essential. In ERISA cases, you have limited remedies and no right to a jury trial. ERISA cases are complex and the administrative record you develop as part of the appeal is very important to the strength of your claims.
Residual Disability
A type of disability coverage that provides benefits if you can still work but at a reduced capacity due to your condition. For instance, if you can only work part-time or in a less demanding role, residual disability benefits may compensate for the loss of income.
Mental Nervous Limitations
A common restriction in long-term disability policies that limits benefits due to mental health conditions, such as depression or anxiety, to a specific time frame (e.g., 24 months). These provisions vary, so understanding your policy is key.
Bad Faith
When an insurance company acts unfairly or dishonestly in handling your claim. Examples of bad faith include unnecessary delays, wrongful claim denials, or misrepresenting policy terms. Bad faith claims may allow you to seek additional damages.
Independent Medical Examination (IME)
An evaluation requested by the insurance company, performed by a doctor of their choosing. These exams are often used to dispute your medical evidence, so it’s important to be well-prepared.
Pre-Existing Condition
A medical condition that existed before your disability insurance coverage began. Some policies exclude or limit benefits for pre-existing conditions, making it critical to review your policy terms closely.
Total Disability
A sickness or injury that prevents you from performing work. Depending on the policy, “Total Disability” means you are unable, due to sickness or injury, to perform the material and substantial duties of your own occupation, often for a period of time, such as 24 months. Thereafter, the definition often changes to being unable to perform the material and substantial duties of any gainful occupation for which you are reasonably fitted by education, training, or experience. Some policies define “gainful” as earning a certain percentage of prior income (e.g., 60% or 80%). This “any gainful occupation” definition is stricter, and is often used as a basis to terminate a claim after 24 months of “own occupation” benefits have been paid. The definition of total disability varies by policy and can impact the type of benefits you receive. Some policies are strictly “own occupation” policies, allowing you to work in other jobs but still entitled to benefits.
Elimination Period
The waiting period between the onset of your disability and when you’re eligible to start receiving benefits. This period is outlined in your policy and can range from 30 to 180 days or more. Short-term disability benefits are sometimes offered by employers during this elimination period and are sometimes administered by the same insurer being used for long-term disability benefits, except the funding might be different.
Appeal
The process of challenging an insurance company’s denial of your claim. In ERISA cases, appealing is mandatory prior to filing a lawsuit. Appeals often involve submitting new evidence, addressing denial reasons, and adhering to strict deadlines.
Settlement Offer
A lump sum payout offered by an insurance company to resolve a disability claim. While settlements can be appealing, they may not reflect the full value of your benefits. Seek legal advice before accepting any offers.
Present-Value Discount Rate
The discount rate is the interest rate used to calculate the present value of future disability benefits in a lump-sum settlement. It reflects the assumption that money paid today can be invested and grow over time. A higher discount rate reduces the present value of future payments. In settlement negotiations, insurers typically use aggressive discount rates to lower the perceived value of the claim, while we argue for more conservative rates that reflect economic uncertainty and low interest environments.
Standard of Review
In the context of ERISA long-term disability (LTD) claims, the Standard of Review refers to the level of deference a court gives to the insurance company’s decision when reviewing a denial of benefits. This standard of review is “de novo” or an “abuse of discretion,” and the applicable standard should be investigated during the claim. If there’s a conflict of interest (e.g., insurer both decides and pays claims), courts may weigh that conflict as a factor under MetLife v. Glenn, 554 U.S. 105 (2008), even under abuse-of-discretion review.
Vocational Evaluation
An assessment of your ability to work is often used to determine the extent of your disability. Insurance companies may use vocational evaluations to argue that you can perform some form of employment.
Physician Consultant Review (or Peer Review)
A Physician Consultant Review is a non-treating, typically file-based review conducted by a medical doctor retained by the insurance company to evaluate your medical records and offer an opinion on functional capacity, diagnosis, or appropriateness of treatment. These consultants do not examine you in person. Their reports are often used to justify denials or terminations of long-term disability benefits, especially when they conflict with treating physician opinions.
Social Media Check
A Social Media Check is the process by which an insurer or investigative vendor reviews your publicly available social media content (e.g., Facebook, Instagram, LinkedIn) to assess whether posted activities or statements are consistent with reported limitations or claimed impairments. These are typically conducted during disability or insurance claim investigations. While a Social Media Check is intended to identify evidence that could contradict or corroborate the claimant’s reported condition, social media content is often misleading or decontextualized and is not a reliable measure of functional capacity.
Other Income Offsets
In a long-term disability (LTD) policy, this refers to amounts the insurer can deduct from the monthly LTD benefit based on your receipt of certain other sources of income. These typically include Social Security Disability Insurance (SSDI) benefits (both primary and dependent), workers’ compensation, state disability benefits, third-party settlements related to the disabling condition, and certain types of retirement or pension income. The purpose of these offsets is to prevent you from receiving more than a set percentage of pre-disability earnings from combined sources. You can consult with a lawyer to make sure the insurance company is seeking a valid overpayment before you pay them back.
This glossary clarifies complex terms and helps you better understand the language of long-term disability claims. For further assistance, contact Sandstone Law Group for legal guidance tailored to your situation.
Common Insurance Company Tactics to Deny or Delay Long-Term Disability Claims
Understanding how insurance companies operate is crucial when filing or managing a long-term disability claim. While these companies may seem like they’re working on your behalf, their primary goal is to minimize payouts, often at your expense. Here are some common tactics insurers use to deny or delay claims, and how Sandstone Law Group can help you fight back:
1. Misrepresenting Policy Terms
Insurance companies often take advantage of the complexity of policy language to mislead claimants. They may interpret terms like “disability” in ways that benefit them or claim that certain conditions, such as mental health issues, are excluded from coverage. Without a full understanding of your policy, you might unknowingly accept a denial based on these misrepresentations.
How We Help: Our Arizona long-term disability lawyers review your policy in detail, ensuring you understand key terms and provisions. We hold insurers accountable when they twist policy language to wrongfully deny a claim.
2. Requesting Excessive or Unnecessary Documentation
Some insurers make repeated requests for documents they don’t actually need, such as years of prior medical history or additional forms from your employer. This tactic can delay the process and place undue stress on you, sometimes to the point of discouraging you from pursuing your claim further.
How We Help: Sandstone Law Group ensures that only relevant, required documents are submitted. We handle all communication with the insurer so you don’t have to deal with these unnecessary burdens.
3. Conducting Surveillance
Insurers may legally hire private investigators to monitor your activities, searching for evidence to challenge your claim. This could include videotaping you in public, monitoring your social media, or even interviewing neighbors. They may use any activity that seems contradictory to your disability (like carrying groceries or attending a social event) as grounds for denial.
How We Help: We work with you to prepare for potential surveillance, helping you avoid common pitfalls and ensuring your claim remains strong—even under scrutiny.
4. Using Biased Independent Medical Examinations (IMEs)
Insurance companies may require you to attend an IME, claiming it’s a routine part of their evaluation process. However, these “independent” professionals are often hired by the insurer and may provide reports that lean in the company’s favor, downplaying the severity of your condition.
How We Help: We guide you through the IME process, ensuring you’re prepared and that your medical evidence is comprehensive enough to counter biased evaluations.
5. Claiming Pre-Existing Conditions
Insurers often deny claims by saying your disability arose from a pre-existing condition or was not covered by your policy. This tactic relies on vague interpretations of medical history and can be difficult to dispute without expert legal help.
How We Help: Our team compiles detailed medical evidence and challenges any unjust attempts to tie your disability to unrelated pre-existing conditions.
6. Pretending to Be Helpful
Sometimes, insurers will seem cooperative by offering advice or recommendations that might sound beneficial to you. However, these suggestions are often designed to make you drop your claim, accept a low settlement, or fail to submit critical documentation.
How We Help: We handle all insurer communication on your behalf to ensure their tactics don’t jeopardize your claim. We’re on your side—not theirs.
7. Delaying Responses
Insurers may intentionally take weeks or months to respond to your inquiries or paperwork, slowing the entire process. This tactic often frustrates claimants, causing some to give up altogether.
How We Help: Sandstone Law Group applies legal pressure to prevent unnecessary delays. We ensure insurers stick to deadlines and hold them accountable for any stalling tactics.
Why You Shouldn’t Face These Tactics Alone
Fighting back against insurance companies requires a thorough understanding of the law, experience in disability claims, and perseverance. At Sandstone Law Group, we’ve seen every tactic in the book and know how to counter them effectively. With our team by your side, you can focus on your health while we handle the hard work of protecting your benefits.
Don’t be discouraged by these tactics. Contact us for a free consultation and learn how we can help you take control of your long-term disability claim.
Sandstone Law Group – Phoenix Office
Address: 6122 N 7th St suite b
Phoenix, AZ 85014, United States
Phone: (602) 362-9468
When & Why Hire An Attorney
While you can submit your own appeal, doing so is risky. A poorly prepared appellate record can severely hurt your case.
Avoid Any Pitfalls from the Start
No Fees Unless We Win Your Claim
We’re Here for the Long Haul
Most firms do not provide continued support after your case is won, but we do. We provide you with additional care and protection, because insurance companies use tactics to avoid paying disability benefits after claims are won.
We are Experienced in Battling Insurance Companies
Insurance companies want you to give up – they save money when you do. Don’t give up! We routinely go up against insurance companies and know what it takes to get your benefits. With so much at stake to protect your livelihood, don’t go at it alone.
Case Evaluations are 100% Free
Should we decide to review your case, we provide an initial consultation at no cost. We treat you with compassion and strive to provide you with an honest assessment of moving forward.
Get the Help You Need– We’re Here for You.
Case evaluations are 100% free and you are under no obligation to hire our law firm. We will vigorously represent you and not back to insurance companies.
Long-Term Disability Laws & Guiding Rules
Learn more about whether ERISA or Insurance Bad Faith applies to your Arizona case
ERISA / Employee Retirement Income Security Act of 1974
ERISA is a federal law that was enacted to protect participants in employee pension plans and other benefit plans offered by employers. ERISA covers employer-sponsored medical, disability, and other benefit programs. Under ERISA, plan participants and beneficiaries may seek relief for breaches of fiduciary responsibility, denial of benefits, or failure to provide adequate disclosures of plan terms or benefit changes.
Insurance Bad Faith
In Arizona, insurance companies are subject to the common law duty of good faith and fair dealing when handling disability insurance claims that are not subject to ERISA. This duty is less than the fiduciary duty imposed by ERISA, which requires insurers to put your interests ahead of its own, but ultimately provides you with more robust remedies in court.
Frequently Asked Questions
Can I apply for short-term disability or long-term disability through your firm?
Yes, as long as you already have coverage, we can help you submit the necessary “proof of loss,” or claim forms, to initiate a claim. If you have a short-term or long-term disability benefits policy through an employer or that you purchased privately with an insurance carrier, such as Cigna, MetLife, Hartford, Guardian, or the like, we can help you with the process of applying and understanding your coverage.
How do I apply for short-term disability and/or long-term disability benefits through my employer?
Can I work while receiving short-term disability and/or long-term disability benefits?
My long-term disability benefits claim was denied. Why did this happen?
Insurance companies deny or terminate claims for many reasons. One common reason is the purported failure to meet the definition of “disability.” Many long-term disability policies have changes in the definition of “disability” after 24 months of benefits, requiring you to be disabled not just from your “own occupation,” but from “any occupation.” The insurance company will frequently “cherry pick” your medical records, even retain an “independent” medical reviewer to build evidence against you, despite the fact that you’ve never been personally evaluated by that reviewer. Although the road ahead can seem difficult, don’t give up on disability benefits you rightfully deserve. Insurance companies often count on you not fighting your benefits, thus saving them from paying you for the months – and often years – of benefits to which you’re entitled. We’ve secured millions of dollars in benefits for our clients and can help you, too. Contact us, and we will help investigate and explain why this happened and how to can help.
Can the insurance company rely on other doctors’ opinions besides my own doctors?
Should I apply for SSDI?
The insurance company claims they can deduct the amount I’m receiving in SSDI from my monthly LTD benefit amount. Can they do that?
Should I resign from my job if I need to go out on disability?
Can I submit a claim for private disability benefits if I was injured at work?
Does the law require my employer to provide me with private disability coverage?