Ltd

[CarolLP]

What is the name of your state? Georgia

I have a LTD claim, that was denied for FMS/CFS. I wish to appeal. I talked to an attorney and he said he would do it for 33.3% of gross recovery if not taken to court, but 40% of gross recovery if it goes to court. I have a good solid case with 3 years of documentation and expert doctors opinions confirming my disability. My question is this, does these amounts seem reasonaable and customary? Does the "gross recovery" mean he will get the 40% of the settlement, plus 40% of my monthly benefits as well til my benefits end? If so doesn't this seem like alot? Thanks everyone. I know nothing about this and need help.

 

[CIAA]

Dear CarolLP, we are not attorneys and don't give legal advice. Based on our insurance experience, these percentages look normal in that they are about the maximum that can be charged and most won't do it for less.

If this is Employer related insurance regulated by ERISA, and it sounds like it is, your attorney will have his/her "hands full" and will spend countless hours researching and preparing your case. How the appeals are handled is crucial in an ERISA case. In many of these ERISA cases, the opinion of the SSD and all of your doctors carries no more weight than the insurance company's opinion. Your attorney will be aware of this. If you are serious about fighting the denial you will definitely want an ERISA attorney.

It is a lot of money, but it's better than 0. You also need to ask about "expenses" which you will usually pay out of the award BEFORE the 60/40 split and can be several thousand dollars, and this is also normal.

Finally, your last question depends on the contract you have signed with the attorney. If it is simply for the "recovery of unpaid benefits due", then pehaps the split is not applicable to future benefits, but this is probably doubtful....you should discuss this with your attorney, but in doing so, keep in mind that 100hrs x $250= $25,000.

Finally our expeience has also shown that in these cases many do not get the help they really need and end up loosing the benefits to which they are entitled.
Hope this helps and good luck

 

[CarolLP]

LTD

Thank you for your response, it was very helpful in my making the decisions I needed to make.