10 Questions About Disability Insurance Claims For J.J. Conway, ESQ.
How would you describe your typical client?
Our clientele is quite diverse. We represent as broad a range of clients as you can imagine. Since our litigation practice focuses on employee benefits — like disability insurance disputes – we serve people of all ages and backgrounds. Presently, we are handling the disability insurance claims of everyone from line-workers to senior management of corporations. We represent managers, nurses, clerical support, and just about every occupation you can imagine. We also represent executives and professionals such lawyers, doctors, nurses, and college professors who have had health issues and problems with their disability insurance contracts.
Who is your success rate in disability insurance cases?
We enjoy a high percentage of cases resolved to our clients’ satisfaction. We want our clients satisfied. “Client satisfaction” is the standard by which we measure our success. Sometimes this means achieving a courtroom victory. Sometimes, it means helping achieve a fair settlement.
Our success level is attributable to two primary factors. First, our cases are directly affected by level of preparation devoted to them. Most litigation cases do settle. The difference in settlement values is based on the level of preparation. The more preparation time spent on a case, the better the result.
The second factor is based on our singular focus on winning the case. We have heard successful college basketball coaches use an expression that pretty much sums up our litigation philosophy, we “hate losing more than we enjoy winning.” We have returned millions of dollars to our clients through judgments, verdict, and settlements. This was based on preparation, hard work, and a dedication and knowing the case inside and out.
Is there something to which you attribute your success? Can you provide some examples?
First, we listen. When we speak, we try to ask the right questions. Second, we are totally accessible to our clients thanks to the state of technology today. All email messages and telephone calls are returned in a day. We try to educate our clients about the law, what it says, and what it means to their case. We firmly believe that a client should never be in doubt as to where their case stands. We insure this by emailing copies of all documents filed or received in a given case. We prepare regular email messages with updates on settlement talks. The clients receive their own copies of court rulings in their cases.
What may a client expect if you take the case?
In its most basic form, the legal relationship is a partnership. That is why I like that our firm’s motto is “conquer tomorrow.” We need to achieve our future desired result together. We do ask that clients be involved in the process by supplying us with timely documentation and evidence gathering. When the client is involved, the case tends to be more a more fulfilling experience. We would never presume to know the facts better than our clients. Our clients will notice that we will be constantly rechecking or confirming of facts to make sure we have it right. . .every time.
Do most cases really settle?
Yes. It is a reality in law that both sides typically want to control the outcome and not leave a major legal claim to chance. The problem is we never know which cases will settle and which cases will not. Take the case of DeLisle v. Sun Life. In our view, Ms. DeLisle had an extremely strong claim against her insurer for ERISA disability benefits. This insurance company, however, fought her claims before two different federal judges, losing before both judges. The company then appealed the decision to the Sixth Circuit Court of Appeals, and having lost there, asked the entire Court of Appeals to overturn the case which it refused to do. In the process the insurance company hired two different huge law firms to fight this claim. Delisle took seven seven years. Who could have imagined this? And, yet in another case, the claim could be paid in 45 days. The only way to firmly address this reality is prepare every case as if it is going to judgment. There is no substitute for this level of preparation.
Can individuals file administrative appeals on their own?
The short answer is ‘yes.’ The answer should be ‘no.’ While an individual may file his or her own ERISA or LTD appeal, they should be represented by legal counsel. The reason is that, if a lawsuit is eventually filed, the lawsuit is about appeal. The court case will focus on the contents of the appeal. So, whether it is with our firm or another law firm, we believe an administrative appeal should be prepared by legal counsel.
What evidence is needed for a successful appeal?
The medical file is obviously the most important evidence. There is also other information, expert reports, vocational assessments, and the proper presentation of administrative agency decisions, such as Social Security. The appeal should address, directly, the reasons the claim was denied in the first place.
What is the standard fee charged to your clients for their representation? Is the fee the same for everyone?
Each case is customized based on the needs, goals, and objectives of the client. We are a people-centered firm which happens to practice law. That means we look at the situation the same way we would wish to be treated if we needed professional services.
Let’s break this down a bit further.
In the typical case, we are able to estimate what the damages might be. A client who is unable to work because of their health may need to have the legal services rendered on a contingency-fee basis. This is sometimes called the “no-win, no-fee” arrangement. In these cases, the firm is paid an agreed upon percentage of any financial recovery based a judgment, settlement, or the securing of a monthly benefit.On the other hand, a client who is able to afford the case on an hourly basis may look at the damages and see that paying by the hour is more suitable. Either way, we strive to make it work for the client.
What distinguishes you from other law firms practicing in the area of disability insurance?
I think we bring a unique set of skills to a case that other firms may not possess. First, my personal litigation background in law is rooted in complex commercial litigation and employment law. With this background training, I have been able to see the overlap among employment, employee benefits and contract law. I was trained in the commercial litigation context. Given my background in employment law, I learned about the different occupational demands of positions in the workplace – often because the cases required a precise analysis of job duties. These three areas come together in disability contract and ERISA disability cases.
What do you expect of your clients?
Two things in every case. Honesty and patience. We need to know everything, completely and honestly at the beginning. We also need to ask for a bit of patience. The legal process can be challenging, but in the end, if we keep pushing, we usually end up in the right place.