Colorado Long-Term Disability Insurance Attorney

In Need of an Experienced Long-Term Disability Insurance Lawyer in Colorado?

Long-term disability insurance is supposed to replace your income when a serious medical condition keeps you from working. For many Colorado workers and professionals, that coverage represents years of paying premiums with the expectation that it will be there when they need it.

When a claim is filed and the insurance company says “no,” the gap between what the policy promised and what the insurer is willing to pay can be financially devastating. McDermott Law, LLC represents Colorado residents whose long-term disability claims have been denied, delayed, or terminated, helping them understand their coverage and pursue the benefits they are owed.

Led by Shawn E. McDermott, an attorney with more than 30 years of experience in disability insurance law, the firm focuses exclusively on disability and similar insurance disputes. Call (303) 964-1800 for a free consultation on your denied claim.

What Is Long-Term Disability Insurance?

Long-term disability insurance is income replacement coverage that pays a portion of your earnings if a medical or mental condition prevents you from working for an extended period. Most policies replace between 50 and 70 percent of your pre-disability income. Benefits begin after an elimination period, typically 90 to 180 days after the onset of the disability, and can continue for a defined number of years or, in most cases, until retirement age.

The coverage is straightforward in concept. In practice, the details of the policy, particularly how the insurer defines disability and what it requires to prove it, determine whether a claim gets paid.

Employer-Provided Group Disability Plans

Most Colorado workers who have long-term disability insurance received it through their employer as part of a benefits package. These group plans are usually governed by a federal law called the Employee Retirement Income Security Act, commonly known as ERISA. ERISA sets specific rules for how claims must be handled, what the appeal process looks like, and what a claimant can recover if the insurer wrongly denies benefits.

Understanding that your employer-provided disability plan is an ERISA plan is important because it means the rules are different from what you might expect from a typical insurance dispute. The remedies are more limited, the deadlines are strict, and the administrative appeal process with the insurance company carries more weight than it would in most other legal contexts.

Individual Disability Insurance Policies

Some people, particularly physicians, dentists, attorneys, executives, and other professionals, purchase disability insurance directly rather than relying on an employer plan. These individual disability insurance policies, sometimes called IDI policies, are governed by state insurance law and the specific terms of the contract rather than ERISA.

Individual policies often provide stronger protections than group plans, particularly around the definition of disability. Many IDI policies use an own-occupation definition that pays benefits if you cannot perform the specific duties of your own profession, even if you could theoretically work in some other capacity. That distinction can be enormously significant for a surgeon, dentist, or other specialist whose ability to work depends on specific physical capabilities.

How a Long-Term Disability Claim Works

Filing a long-term disability claim requires submitting a claim form, an attending physician statement, and supporting medical records to the insurance company. The insurer then reviews the submission and decides whether the medical evidence supports disability under the terms of the policy.

The review process is internal. The insurance company evaluates the claim using its own staff and, in many cases, retained medical reviewers who assess the records without ever examining the claimant. If the insurer approves the claim, benefits begin after the elimination period. If it denies the claim, it must provide a written explanation and information about the appeal process.

Approved claims are not necessarily stable. Insurers conduct periodic reviews of ongoing claims and can terminate benefits if they conclude the medical evidence no longer supports continued disability. One of the most common review points is the 24-month mark, when many group policies change the definition of disability from an own-occupation standard to an any-occupation standard. That transition is a frequent trigger for termination and is worth understanding before it arrives.

The Own-Occupation to Any-Occupation Transition

Many group long-term disability policies pay benefits for the first 24 months if the claimant cannot perform the duties of their own specific job. After that period, the policy switches to a stricter standard: benefits continue only if the claimant cannot perform any occupation for which they are reasonably suited by education, training, or experience.

That shift in definition gives the insurer significant new grounds to argue that benefits should end. A claimant who genuinely cannot return to their previous job may still find their benefits terminated on the basis that they could, in theory, perform some lower-skill or sedentary work. Whether that argument is valid depends on the policy language, the claimant’s actual functional limitations, and the vocational evidence.

What Goes Wrong During a Long-Term Disability Claim

Disability claims can go wrong at the initial filing stage or, just as commonly, after benefits have already been approved and are being paid. The issues that arise tend to fall into recognizable patterns.

Medical Evidence Disputes

The most common point of conflict is between what the treating physician documents and what the insurance company’s internal reviewer concludes. Insurers frequently argue that medical records do not establish disability under the policy definition, particularly for conditions that do not produce clear objective findings on imaging or lab tests. Fibromyalgia, chronic fatigue syndrome, chronic pain, autoimmune conditions, migraines, and mental health diagnoses are especially vulnerable to this kind of challenge.

When the insurer’s reviewer reaches a conclusion that conflicts with the treating physician’s opinion, that conflict does not resolve itself. It needs to be directly addressed, usually through detailed physician opinion letters that tie the medical findings to the policy’s specific disability definition rather than just restating the diagnosis.

Independent Medical Examinations

Insurance companies can require claimants to attend a medical examination with a physician selected by the insurer. In some cases, the examining physician has an established history of conducting these evaluations for insurers and may produce findings that diverge significantly from the treating physician’s assessment. IME reports are frequently used as the basis for terminating ongoing benefits, and addressing those findings is often central to any appeal or litigation strategy.

Surveillance and Activity Monitoring

Some insurers use surveillance or social media monitoring as part of their claim review process. Video or photographs of a claimant engaged in activity that appears inconsistent with the claimed disability may be used to support a termination decision. A single moment of activity captured on video rarely reflects a claimant’s actual sustained functional capacity, but addressing that evidence effectively requires placing it in the full context of the medical record.

Benefit Terminations After Long-Term Approval

A claimant who has been receiving benefits for years is not protected from termination. Insurers have the right to conduct ongoing claim reviews, and those reviews sometimes result in termination even when the claimant’s underlying condition has not improved. Unum, in particular, is known for conducting regular reviews of its long-term claimants as a standard business practice. When a termination happens after years of approved benefits, it is often a significant shock and frequently a strong candidate for appeal.

The ERISA Framework for Colorado LTD Claims

Most employer-provided long-term disability claims in Colorado are governed by ERISA, which means the legal rules differ substantially from what most people expect. The critical points are worth understanding before a claim is denied.

After a denial, ERISA claimants typically have 180 days to file an administrative appeal with the insurance company. That deadline is strict. What goes into the appeal record, the documents and medical evidence submitted during the appeal process, is generally all a court will review if litigation becomes necessary. Evidence developed after the appeal is typically not considered by a judge, which is why the appeal itself is the most consequential stage of the case.

If you have received a denial of an employer-provided disability claim, the Colorado Disability Insurance Denial Claims page covers the appeal process in detail.

Colorado Law and Individual Disability Policies

For claimants with individually purchased disability policies, Colorado state law applies rather than ERISA. Colorado Revised Statutes section 10-3-1115 and section 10-3-1116 require insurers to handle claims in good faith and provide additional remedies when they do not. When an insurer unreasonably denies or delays payment of a covered benefit, these statutes may allow recovery of two times the covered benefit amount and attorney fees, in addition to the benefits owed.

The application of these statutes depends on the specific facts of each case. They apply to non-ERISA policies only. Employer-provided ERISA plans are not subject to Colorado bad faith laws.

How McDermott Law, LLC Handles Long-Term Disability Claims

The firm’s work on any LTD case starts with the policy itself. Policy language is the foundation of everything: what the insurer is required to pay, how disability is defined, what the claimant must prove, and what procedural requirements govern the claim. A careful reading of the policy, alongside the denial letter if one has been issued, often reveals where the dispute is actually located and what evidence will be most relevant to resolving it.

Shawn McDermott has spent more than 30 years working through these disputes. The firm handles only disability and insurance matters, which means the experience is focused on exactly the situations that come up in LTD claims. Common areas of work include:

• Reviewing policies to understand the disability definition, any applicable definition changes, and procedural requirements
• Working with treating physicians to develop opinion letters that speak to the policy definition rather than just the diagnosis
• Obtaining functional capacity evaluations to document physical or cognitive limitations with objective testing
• Building ERISA appeal records before the deadline, including all medical, vocational, and policy evidence relevant to the claim
• Pursuing litigation in federal court when ERISA appeals are denied or when individual policy disputes cannot be resolved at the claims level
• Evaluating Colorado bad faith claims for individually purchased policies where the insurer’s conduct may have been unreasonable

The goal is always to put the strongest possible case in front of whoever is making the decision, whether that is the insurance company or a federal judge.

Insurance Companies That Process Long-Term Disability Claims

Most group long-term disability insurance in Colorado is issued by a small number of large carriers. Understanding how each insurer generally manages its claims helps when evaluating a denial or preparing for a review.

New York Life (formerly Cigna Insurance / LINA)

New York Life acquired the disability insurance division previously underwritten by Cigna through its subsidiary Life Insurance Company of North America (LINA). Claimants who had policies with Cigna will now receive denial letters and communications from New York Life. The claims review approach for this block of business emphasizes objective medical evidence, which can disadvantage claimants with conditions that are real and documented but not easily captured in imaging or lab results. The own-occupation to any-occupation transition is applied actively, and vocational analysis is used to argue that claimants can perform alternative work after the 24-month mark.

Hartford

Hartford is one of the largest group disability carriers in the country and insures many Colorado employers. The 24-month definition transition is a common point of dispute in Hartford claims. Hartford also conducts regular ongoing claim reviews and uses independent medical examinations and surveillance as part of its review process. Claimants with Hartford policies who have been receiving benefits for one to two years should be aware that a termination review may be approaching.

Unum

Unum insures a large volume of group employer plans and is distinctive for its systematic approach to ongoing claim management. Long-term Unum claimants should expect periodic file reviews throughout the life of their claim. Unum’s internal medical reviewers conduct detailed functional capacity assessments that sometimes conflict with treating physician opinions, and those assessments are a frequent basis for termination decisions on claims that have been paid for years.

Other carriers that regularly appear in Colorado LTD disputes include Standard Insurance Company, Sun Life, Lincoln Financial, Prudential, Aetna, Mutual of Omaha, Guardian Life, Berkshire, The Principal, Reliance Standard Life, and MetLife. The approach to any given claim depends on the insurer, the policy type, and the specific facts of the denial.

Nationwide Representation Including Colorado

McDermott Law represents disability claimants nationwide, including throughout Colorado and the Rocky Mountain region. Because most disability insurance disputes are governed by federal ERISA law or insurance contracts, the firm handles cases by phone and video conference and does not require in-person meetings regardless of where the client is located.

Colorado clients include those in Denver, Colorado Springs, Boulder, Fort Collins, Greeley, Longmont, Loveland, Grand Junction, Pueblo, Castle Rock, Durango, and communities throughout the state. The firm also represents claimants in Kansas, New Mexico, Nebraska, Utah, Wyoming, Oklahoma, and Montana.

If your claim was denied anywhere in the country, call (303) 964-1800 to discuss your situation.

Talk to a Colorado Long-Term Disability Attorney

McDermott Law, LLC offers free consultations for Colorado LTD claimants. Whether your claim has just been filed, is under review, or has been denied, call to discuss your situation at 303-964-1800. Free consultation. No fee unless we win.