Clients frequently ask “when is a good time to get an attorney involved in my claim?”  If cost were no concern, we would always advise that an attorney should be involved right from the beginning.  An attorney can shed light on the meaning of complicated policy or plan provisions, identify the kinds of evidence necessary to convince a claim administrator (or court) to approve a claim, provide advice regarding applicable state and federal laws, and may be aware, through contact with many clients, of emerging insurance company practices that suggest bad faith or may be suitable for a class action lawsuit. 

For example, many of our clients are surprised to learn that individual insurance policies impose a “duty of cooperation” that requires that he or she respond to all reasonable requests by the insurance company.  This may include providing “private” or “sensitive” information, such as tax returns or psychotherapy records;  participating in personal interviews or a deposition; allowing claim personnel into your home; and allowing yourself to be examined by a health care professional retained by the insurance company.  Although there may be steps to take to protect yourself from or limit such intrusions, a broad failure to “cooperate” can result in a court throwing out your claim, even if the claim is valid and fully supported by the evidence.  

In ERISA cases, because of the importance of the administrative record to any ensuing court action, attorney assistance during the claim reconsideration process can be crucial.

We try to provide flexible levels of service to accommodate the different functional and financial needs of our clients.  If a client feels able to write an appeal, we can participate in an advisory capacity -- providing initial suggestions and then commenting on draft versions of the appeal.  If a client is able and willing to do leg-work, such as obtaining medical records, this can reduce attorney time dramatically.  Similarly, client questions presented by letter, fax and e-mail, can sometimes be more efficient and cost-effective than doing so by telephone.  Finally, in certain appropriate cases, a contingency fee arrangement may be mutually satisfactory (rather than a straight hourly billing arrangement).  Such an arrangement may not reduce the amount of fees ultimately paid, but may postpone the fees until an award or settlement is achieved.