Can someone successfully represent themselves in a long term disability claim? The answer to that question will likely depend upon the stage of the claim itself. We asked Ron Dean, a California attorney who has been engaged in employee benefits litigation primarily on behalf of participants for over 30 years, to offer advice to those thinking about going the road alone. Here’s what he told us:

It’s ok most of the time at the initial claims level, but it’s especially difficult at the appeals level. They may be able to do it on their own if they follow simple rules and think of it, not just from what they know, but what they need the insurance company to know. So, if the ERISA (the Employee Retirement Income Security Act) claim is denied, then you get an appeal. You want an attorney involved in the final appeal process because one of the quirks of ERISA is that when you go to court, the only evidence you can submit to the court is evidence submitted during the claim and appeal process.

So, if you handle it on your own and you don’t get the right evidence in, an attorney isn’t going to be able to help you once you get to court because the record is closed and the evidence that was submitted is the only evidence allowed. I’ve seen a lot of cases lost, perfectly good cases, because the evidence wasn’t submitted during this administrative appeal.

Don’t leave anything to guess work

Dean’s recommendation to applicants is to do a great job on the original claim form. He says, “Don’t leave anything go to guesswork. Make sure all your evidence is in. Make sure that every doctor is on board; don’t leave until later anything that could be submitted now. That’s a very strong recommendation because you’re trying to get that claim paid without having to hire a lawyer. The last thing you want to have to do is hire a lawyer; but if you have to, you have to.”

If you’ve been denied valid long term care benefits, consult with an experienced ERISA attorney to discuss your situation and evaluate your options. Consultations are free, without obligation and strictly confidential.