Long-Term Disability Insurance Attorney in New York

Key Takeaways

• Millions of Americans struggle with long-term disabilities that impact their ability to work and live independently.
• Long-term disability insurance serves as a financial safety net, providing income when a disability prevents employment.
• Insurance companies often deny valid long-term disability claims, leaving claimants without critical financial support.
• ERISA regulations add complexity to employer-sponsored disability plans and require careful navigation.
• Working with a long-term disability attorney increases the likelihood of claim approval and successful appeals.

A long-term disability can create severe financial pressure. Income stops while medical expenses continue to rise. The inability to work often causes emotional distress and isolation. Many individuals struggle to maintain housing, support their families, or afford essential needs.

This challenging situation worsens when insurance companies delay or deny valid disability claims. Claimants already struggling must then manage a complex and burdensome appeal process.

The Law Office of Justin C. Frankel, P.C., helps those who face these problems. Our lawyers lead clients through the complex claims process, question wrong refusals, and contend for the disability money they deserve. With a lawyer present, claimants can focus on their health. We manage the legal details of getting their payments.

Why Our Clients Trust The Law Office of Justin C. Frankel, P.C.

The Law Office of Justin C. Frankel, P.C., has built a reputation for effectively representing disability claimants through difficult insurance disputes. With substantial experience fighting wrongful denials, the firm has proven its ability to navigate the complex world of disability benefits.

We Fight Against Unfair Insurance Company Practices

We consistently challenge insurance companies when they wrongfully deny valid claims or engage in tactics designed to frustrate claimants into giving up their pursuit of benefits.

We Have Won Over $300 Million in Compensation for Our Clients

At The Law Office of Justin C. Frankel, P.C., we have recovered more than $300 million on behalf of individuals whose long-term disability benefits were denied or terminated. These outcomes reflect our detailed approach to disability insurance claims and our dedication to guiding clients through complex legal and medical challenges.

We Are a Nationwide Disability Law Firm

We represent clients across the United States, with thorough knowledge of both state regulations and federal laws that affect long-term disability claims, including the critical ERISA provisions that govern most employer-sponsored plans.

Testimonials

“When my Long Term Disability Insurance Company terminated my benefits after receiving them for two years, I thought life as I knew it would drastically change, until I found the Law Offices of Justin C. Frankel. Mr. Frankel and Sr. Paralegal, Christina Panzarella, are NOT your stereotypical attorney and paralegal. They were responsive, extremely knowledgeable, compassionate, and patient. They explained, in detail, the entire process of filing an appeal and managed my expectations with grace. They were accessible to me over the course of 8 months, and frequently checked in on my welfare. Both Mr. Frankel and Christina Panzarella worked many hours to ensure a SUCCESSFUL OUTCOME of my appeal. If you are searching for the most competent duo to fight for your rights, search no further than The Law Offices of Justin C. Frankel, P.C. I am forever grateful for them.” — Lady J.

“When initiating my disability claim, I contacted several attorneys. Justin was the only one who had specific knowledge of my not-so-common condition, gave me endless time and attention during a free consultation, and was completely transparent about his fee structure and estimated costs. I engaged him to handle my STD and LTD claims, as I wanted them executed impeccably the first time to avoid any unnecessary appeals processes. Throughout the process, Justin and his Senior Paralegal, Christina, were incredibly responsive to any questions I had, set realistic expectations on potential outcomes and timelines, handled all paperwork and contact with the insurance company, and ultimately got me approved and paid on my initial claims. Most importantly, they were professional, patient, and calming voices when the stress of the disability and the insurance process were overwhelming to me. I highly recommend Justin Frankel.” — Valerie H.

What Is Long-Term Disability Insurance in New York?

Long-term disability (LTD) insurance provides a partial income replacement when you can’t work for an extended period due to illness or injury. It’s a financial lifeline for those with prolonged medical conditions that prevent employment.

Most New Yorkers get long-term disability coverage through employer-sponsored group policies, but individual policies are also available to purchase. These plans usually replace a percentage of your pre-disability income after a waiting period, during which short-term disability benefits may apply.

Group and individual long-term disability policies differ significantly in their:

• Definition of disability (own occupation vs. any occupation)
• Benefit duration (two years, five years, or until retirement age)
• Elimination periods before benefits begin
• Coverage exclusions and limitations

Understanding the specific terms of your disability insurance policy is critical, as these details determine whether your condition qualifies for benefits and how long payments will continue.

What is ERISA, and How Does It Affect Disability Benefits?

ERISA (Employee Retirement Income Security Act) is a federal law that regulates most employer-sponsored benefit plans, including long-term disability insurance. If your disability policy comes through your employer, ERISA likely governs it, creating a specific set of rules that can significantly impact your claim.

Under ERISA regulations, the appeals process follows strict timelines and procedures. When an insurance company denies your claim, you must exhaust all administrative appeals before filing a lawsuit. These appeals must typically be completed within 180 days of denial, and the evidence submitted during this process becomes the only information a court will consider if litigation becomes necessary.

ERISA (Employee Retirement Income Security Act) is a federal law that governs most employer-sponsored benefit plans, such as long-term disability insurance. If your disability policy is through your employer, ERISA probably applies to it, establishing a specific set of rules that can make your claim much more complicated.

Under ERISA guidelines, the appeals procedure is governed by rigid timelines and requirements. Once your claim is denied by an insurance company, you will have to go through all administrative appeals before a lawsuit can be filed. The appeals usually have to be finished within 180 days of the denial, and evidence presented under this process becomes the only thing a court will hear if a lawsuit is required.

This limited review process renders legal assistance essential at the initial phases of your claim. A disability benefits lawyer can:

• Translate difficult ERISA provisions that impact your case
• Meet all procedural timetables
• Develop a thorough administrative record for possible litigation
• Spot and respond to insurance company strategies that may sabotage your claim

Types of Long-Term Disability Insurance

Group Long-Term Disability Insurance

Most long-term disability coverage comes through employer-sponsored plans that cover multiple employees. These policies typically replace a percentage of your base salary and are governed by ERISA regulations. The claims process follows strict federal guidelines with specific deadlines and documentation requirements. If your claim is denied, you must complete the administrative appeals process before filing a lawsuit.

Private or Individual Long-Term Disability Insurance

Purchased directly from insurance companies, individual policies often provide more comprehensive coverage than group plans. While premiums are higher, these policies usually offer stronger protections, including:

• More favorable definitions of disability
• Non-cancelable terms
• State law protections rather than ERISA restrictions
• Direct legal action options if claims are denied

Association Long-Term Disability Insurance

Professional organizations sometimes offer long-term disability coverage to members at reduced rates compared to individual policies. These plans balance affordability with coverage limitations, often requiring continued membership for benefit eligibility. The governing regulations depend on how the plan is structured, affecting your rights when filing claims or appealing denials.

What Are Disability Buy-Ups, and How Do They Help Highly Compensated Employees?

Disability buy-ups are supplemental insurance policies that bridge the gap between standard employer-provided long-term disability coverage and an employee’s actual income needs, particularly for higher earners. Most group long-term disability plans cap monthly benefits, often creating significant income shortfalls for executives and professionals with substantial salaries.

These supplemental plans function by:

• Increasing the percentage of income replaced during disability (from the standard 60% to 70-80%)
• Raising or eliminating the maximum monthly benefit cap
• Providing coverage for bonuses and incentive compensation not included in base salary calculations
• Offering more favorable definitions of disability than standard group plans

For highly compensated employees, buy-up coverage creates a more adequate financial safety net, protecting lifestyle and financial obligations if disability prevents continued work. These policies may be partially or fully employee-paid, with premiums reflecting the enhanced protection level.

Factors That Affect Long-Term Disability Benefits

When assessing long-term disability claims, insurance providers review a number of important factors that impact benefits and compensation levels. The nature of your medical condition and how it directly hinders you from carrying out job responsibilities form the core of any claim. Insurance adjusters carefully scrutinize whether your condition qualifies under their policy definition of disability, possibly altering from “own occupation” to “any occupation” after some time.

Your physical and mental demands of occupation are compared against your functional impairment. Some more dangerous occupations have a different standard of evaluation than those that are sedentary. Older claimants can receive differential treatment compared to younger claimants under most policies.

Pre-existing condition clauses can exclude or limit coverage for conditions that you had before your policy’s effective date. Your benefits may also be decreased through offsets if you receive income from other sources.

Which Illnesses and Injuries Qualify for Long-Term Disability in New York?

Qualifying for long-term disability benefits in New York depends not on your specific diagnosis but on how your condition prevents you from working. Insurance policies evaluate whether your medical condition impairs your ability to perform the essential duties of your occupation or any occupation, depending on your policy’s terms.

Common qualifying conditions include:

• Musculoskeletal disorders (back injuries, arthritis)
• Cardiovascular conditions (heart disease, stroke)
• Neurological disorders (multiple sclerosis, Parkinson’s)
• Cancer and treatment effects
• Mental health conditions (severe depression, anxiety)
• Chronic pain syndromes

The interpretation of policy language often determines claim outcomes. Terms like “totally disabled” or “partial disability” have specific meanings that vary between insurers. A long-term disability attorney can help interpret ambiguous policy provisions and help compile your medical evidence to clearly demonstrate how your condition meets the policy’s disability definition.

How Does the Long-Term Disability Insurance Claim Process Work in New York?

The long-term disability claim process typically begins after you’ve exhausted short-term disability benefits. First, notify your employer and insurance carrier about your condition. Then, submit a formal claim application with comprehensive medical documentation supporting your inability to work.

Most policies require a waiting period (often 3-6 months) before long-term disability benefits activate. During this time, maintain consistent medical treatment and follow your doctor’s recommendations. The disability insurance company will review your medical records, employment history, and possibly request additional examinations.

For employer-provided plans, strict ERISA deadlines apply at every stage. Missing these deadlines can permanently forfeit your benefits. Insurance companies often request supplemental information or clarification, creating potential procedural traps.

Consulting with a disability attorney early in the process helps avoid common mistakes that lead to claim denials. A lawyer familiar with disability claims can compile proper documentation, meet all deadlines, and prepare for potential challenges from the insurance company.

How Do Long-Term Disability Payments Work?

Long-term disability payments typically replace a percentage of your pre-disability earnings after you complete an initial waiting period, known as the “elimination period.” This period usually ranges from 90-180 days, during which you may receive short-term disability benefits.

Once approved, payments are issued monthly and require ongoing medical verification that your condition continues to prevent you from working. Most policies mandate regular physician statements confirming your disability status.

Your long-term disability benefits may be reduced by other income sources, including:

• State disability benefits
• Retirement plan distributions
• Earnings from part-time work
• Social Security Disability
• Workers’ Compensation

The tax treatment of your disability payments depends on who paid the premiums. Benefits from employer-paid policies are typically taxable income, while benefits from policies you purchased with after-tax dollars are generally tax-free.

How Long Does Long-Term Disability Insurance Coverage Last?

The duration of long-term disability benefits varies significantly based on your specific policy terms. Most policies provide coverage until retirement age (typically 65), while others offer benefits for a set period of 2, 5, or 10 years. The benefit period is clearly defined in your policy documents and represents a critical factor when evaluating coverage adequacy.

Many policies contain limitations for certain conditions. Mental health disabilities, substance abuse disorders, and self-reported symptoms like chronic pain or fatigue may be restricted to shorter benefit periods, often 24 months, regardless of your policy’s standard duration. Some policies also implement stricter definitions of disability after an initial period, requiring you to be unable to perform any occupation rather than just your own profession.

Understanding these time limitations and reviewing your policy language closely helps you prepare financially for potential benefit duration constraints. A disability benefits attorney can help interpret these provisions and plan accordingly.

Is It Typical for Long-Term Disability Benefits to Be Denied?

Unfortunately, denials are extremely common in long-term disability claims. Insurance companies reject a significant percentage of initial applications, often leaving disabled individuals without critical financial support when they need it most. Even well-documented claims face scrutiny as insurers look for reasons to limit their financial obligations.

These denials aren’t arbitrary but follow patterns that disability attorneys recognize and can address proactively. Most rejected claims can be successfully appealed with proper legal representation and strategic documentation. The appeal process requires a thorough understanding of both your policy terms and the insurance company’s specific objections.

Common Reasons for Claim Denial by Insurance Companies

• Insufficient medical evidence documenting your limitations
• Medical records that don’t clearly connect your condition to work restrictions
• Disagreements over whether you meet the policy’s definition of “disability”
• Missed filing deadlines or incomplete paperwork
• Surveillance evidence that insurers interpret as contradicting your claimed limitations
• Policy exclusions or pre-existing condition clauses
• Failure to receive appropriate treatment for your condition
• Inconsistencies in your statements or documentation

What Should I Do if My Long-Term Disability Claim Was Denied?

If your disability claim has been denied, immediate action is critical. Begin by filing a formal appeal within the deadline specified in your denial letter—typically 180 days for ERISA-governed plans. Missing this deadline can permanently forfeit your right to benefits.

Gather comprehensive additional evidence to strengthen your appeal, including:

• Detailed statements from treating physicians directly addressing the insurer’s reasons for denial
• Updated medical records and test results
• Functional capacity evaluations documenting your limitations
• Vocational assessments showing how your condition prevents working
• Personal statements describing your daily limitations

Contact a long-term disability attorney as soon as possible after receiving your denial. Legal representation dramatically improves appeal success rates by confirming procedural compliance and developing a complete administrative record. For ERISA claims, the appeal stage is particularly crucial as it establishes the only evidence a court may review if litigation becomes necessary.

Can I Sue My Insurance Company if They Deny My Long-Term Disability Benefits?

Yes, you can sue your insurance company for denying your long-term disability claim, but specific procedures must be followed. For employer-provided plans governed by ERISA, you must first exhaust all administrative remedies before filing a lawsuit. This mandatory appeals process typically gives the insurance company 45 days to review your case, with possible extensions.

For individual disability policies not governed by ERISA, different legal options exist, often providing more favorable conditions for litigation under procedures set by state insurance law.

The litigation process varies significantly between ERISA and non-ERISA claims:

• ERISA claims are typically decided by a judge without a jury
• The court usually only reviews evidence submitted in the administrative record
• Legal remedies are limited to the benefits owed plus attorney fees

A disability benefits attorney can determine your legal options based on your specific policy type and help prepare the strongest possible case if litigation becomes necessary.

How Can a Long-Term Disability Lawyer Help With My Claim?

A long-term disability attorney provides critical assistance throughout the claims process. When you work with a disability benefits lawyer, they:

• Review your policy terms to identify coverage limitations and requirements
• Collect comprehensive medical documentation that clearly connects your condition to work limitations
• Coordinate with healthcare providers to obtain supporting statements that address specific policy criteria
• Prepare claim forms that present your case in the strongest possible light
• Meet all procedural deadlines that could otherwise jeopardize your benefits
• Challenge inappropriate insurance company tactics, including surveillance and biased medical reviews
• Negotiate directly with insurers to resolve disputes without lengthy appeals
• Represent you through administrative appeals if your claim is denied

Statistics show that claimants with legal representation are significantly more likely to have claims approved initially and on appeal. By involving a disability attorney early in the process, you avoid common pitfalls that lead to denials and position your claim for the best possible outcome.

What to Look for When Hiring a Long-Term Disability Insurance Lawyer in New York

When selecting a long-term disability attorney in New York, focus on attorneys whose practice is devoted to disability claims rather than general practice attorneys. Look for a lawyer with substantial experience handling long-term disability cases similar to yours, particularly those involving your insurance carrier.

Effective communication is essential—choose an attorney who explains complex legal concepts clearly and responds promptly to your questions. Review their track record of successful disability claim appeals and litigation results, which indicates their ability to navigate the system effectively.

The Law Office of Justin C. Frankel, P.C., provides individualized attention to each disability case, with extensive knowledge of both ERISA regulations and individual policy claims. Their attorneys understand the medical documentation requirements for various conditions and maintain established relationships with vocational experts who can strengthen your claim.

A consultation with a prospective attorney should leave you feeling confident in their knowledge and approach to your specific situation.

Contact Our Long-Term Disability Attorney for a Free Consultation

When facing the challenges of a long-term disability claim, professional legal guidance can make a critical difference in securing the benefits you need. The Law Office of Justin C. Frankel, P.C., offers free consultations to evaluate your situation and provide clear direction on your options.

Taking action early in the disability claims process helps protect your rights and increases your chances of approval. Our attorneys will review your policy, assess your medical documentation, and create a strategic plan to support your claim every step of the way.

Don’t let insurance companies deny you the benefits you’ve paid for through years of premiums. Call us today at 888-583-4959 or use our contact form to schedule your confidential consultation and learn how we can help you navigate the complex disability claims process with confidence.