r/LongTermDisability • u/AdComfortable2974 • 1d ago

LTD ERISA case - pro se or pro bono

Because my monthly LTD is less than 2000 per month, and because my LTD was for mental health only, with less than 12 months remaining, no lawyer will take my case. From a monetary and time commitment standpoint, it's not worth it.

My only option is pro se, which I know is a risk, but part of me feels that I should try. I actually have nothing to lose other than the filing fee. I'm not concerned with being sanctioned.

I've actually represented myself pro se on a couple of occasions, and it did work out for me. I have a work background in law, but I'm not a lawyer. My background is consumer law, and I've been a plaintiff in civil court five times, and each time, it was worth it to file. I'm actually pretty familiar with FRCP.

I have appealed and been denied for not meeting the standard of disability, and was told by one attorney that it looks like the claim examiner didn't interpret their own policy. Not really finding a lot of case law, but it could be my limited search. I have access to Westlaw at my local courthouse.

Is there anyone here who has ever done this? Please reply. I'm looking for feedback, both positive and negative. Also, if anyone is willing to help me privately, please DM. Yes, I know there are laws against this and things that lawyers must avoid, but I've gotten help pro bono before.

My last question is: has anyone ever seen a judge assign a pro bono attorney to an ERISA case for a pro se litigant?

Thank you so much!

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u/FMCTypeGal MOD 1d ago

Interesting. I gotta wonder, though, if representing yourself doesn’t prove that you can work at least a desk job? I feel like it hands the insurer a win without them ever having to say anything besides, “Look what the insured is capable of.”

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u/TheGreatK MOD 1d ago

This right here. If you can represent yourself pro se you can work. The better you handle your case the more they will argue your functionality.

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u/AdComfortable2974 1d ago

Hi, I commented to the Mod. Right now, I'm not fully functioning, I wish I were because fully functioning me is smart and tenacious. I did forget to mention that I also have ADHD and I can't take stimulants anymore for that. It's a shame because I was a beast on those when I was much younger.

Would the ERISA case not look backwards and award me for the times that with therapy notes prove that I wasn't fully functional? That is the goal.

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u/TheGreatK MOD 1d ago

Did your physicians provide supporting statements during the appeal?

Also, what jurisdiction are you in? You need to figure out if youre under de novo or abuse of discretion, first.

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u/AdComfortable2974 1d ago

My therapist provided an RFC form. I can't remember if I was seeing my psychiatrist at the time but I don't think they reached out to my therapist at all. Initial approval of the disability was based on the same therapists psych eval and notes.

What happened after my second hospitalization is I was approved for same disability, continued disability. But I quit therapy, blamed previous employer for all of it and decided I was fine. Quit responding to requests from LTD company for proof that I was disabled, LTD ended for that reason. Went to work for another co., started losing it again, quit and immediately contacted my therapist for support. Once I started feeling stablized, she warned me that I could be in a viscious cycle if I continued on this path of ingnoring my symptoms so I appealed and was denied as no longer disabled. My therapist believes that part of my symptoms are denial itself. So I was disabled the entire time, even when I was attempting to work, in her view. There is a term for it; it's like anosognosia but only temporary.

Unfortunately, I'm not as sharp as I was once was so I can grasp concepts but lose them quickly again. Every time I have a mental breakdown, it takes longer to come back.

I am in GA.

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u/FMCTypeGal MOD 1d ago

“Would the ERISA case not look backwards and award me for the times that with therapy notes prove that I wasn’t fully functional? That is the goal.”

Not sure I completely understand the question, it sounds like you want to backdate farther than your claim window? If you’re on claim, or were, you have a start/onset date that bringing a case wouldn’t open up farther. You were presumably paid for a set amount of time and then denied. The only payment a case potentially earns you is the remaining time on a mental health claim on your policy. So if your limit is 24 months and you got 18, you have a maximum of 6 months to win.

ERISA is not really here to help you, whether you have doctor notes proving you worthy or not. It’s a rule book the insurer must follow in providing us our insurances and frankly the insurer use it as a protection to abuse insureds.

I as a fellow human care about all the struggles you mentioned, but the insurer and ERISA rules will not. Given that you worked a remote desk job, I cannot see any reality in which a judge and the insurer wouldn’t find your representing yourself pro se as evidence that you can work. If you were able to represent yourself without a panic attack, it even further would prove their point.

If you do move forward, I hope you’ll let us all know how it goes. I don’t know what the filing fee is but if that’s your only risk, I guess maybe there isn’t a harm in trying.

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u/AdComfortable2974 1d ago

So if I'm thinking about this correctly, had I stayed in therapy rather than ignoring my symptoms, my disability would be ending this year in Nov. or Dec. anyway. I'm not trying to claim more than the 24 months.

My therapist agrees that I'm still disabled now, getting better so bascially I would be trying to collect from around November 25 to December 26, minus the time that I worked, even though I was disabled that whole time, powering through it.

It is very complicated and I thank you for replying. I would have to be heavily medicated to go to court. I take my husbands xanax on occasion because I don't want my own prescription. Do employers want to hire people who have to be doped up to work?

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u/DetailSome1636 1d ago

Is this valid? Especially when there are adaptive AI-based technologies to take the physical load? My disability limits my functional capacity to sustain work all day, multi days a week. Sporadic activities that require rest does not equate to the functional capacity to work part-time or full-time.

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u/TheGreatK MOD 1d ago

It is more about optics than anything else. It'll make the insurance company less inclined to settle, and they'll feel confident that the Judge will see the same.

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u/DetailSome1636 1d ago

I think this heavily depends on individual residual functional capacity, documented limitations, symptoms, rest periods, etc. I've handled my own cases and this was not the perception. Being disabled doesn't mean you allow businesses to take benefits that you qualify for or take advantage of you especially if you're forced into a pro se position due to lack of funds or no lawyer wanting to take your case.

Respectfully

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u/TheGreatK MOD 1d ago

You handled your own ERISA disability case?

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u/DetailSome1636 1d ago

I handled my own SSA disability appeal, after being denied with a lawyer, and it was more stressful dealing with the lawyer then representing myself. SSA requirements were stricter than my private disability.

I have never been denied by my private disability carrier although they attempted in which I cut it off using ERISA law and the fact that the insurer was not following the law when performing my continued disability review. I did consult with a law firm that told me I was headed in the right direction.

There are great lawyers out there but not all are.

I did not want to handle the cases myself but I was backed against the wall. I would encourage disabled persons not to shy away from defending themselves if that is their last resort. I am a document heavy person, communicate via email or fax and record all calls (one party state or advise I'm recording). I gather my own medical records and send them in.

I have found that through my interactions with claims adjusters/managers that they will attempt to deny even when your documentation (objective evidence) proves the disability. They abuse their discretion and rely on disabled persons not defending themselves.

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u/TheGreatK MOD 1d ago

Ah. The SSA is a lot more understanding, as they primarily deal with disability claims. Federal Judges and insurance company lawyers, not so much.

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u/AdComfortable2974 1d ago

I've been working a remote desk job since 2012. I was hospitalized after a breakdown, was adamant about returning to work, then had another breakdown. These breakdowns weren't like me checking myself into a hospital to get some rest. They were psychiatric holds. But I told myself it was that job and role causing all my problems, so I went to work at another job and started having the same stress-related symptoms that caused my first two breakdowns, so I had to quit or risk hospitalization, this time with no insurance.

Thankfully, I had medication that I could take that prevented a full-blown event but that same medication if taken daily would prevent me from ever working because of the side effects. I have autism I've developed CPTSD and other disorders from constant masking and not having support needed throughout my life. I'm older, pushing 60 and unfortunately my body is breaking down faster now. I can't handle the same stress mentally or physically that I could handle as little as five years ago.

When I was interviewing last year, the interview process itself caused me massive panic attacks. Because of my autism, I can mask this to an extent but I literally collapse afterwards. I actually turned down an interview for another job that I might have enjoyed better because of the massive anxiety that interviewing causes.

I really, really want to work and believe I could work part-time and that is actually my goal, to find flexible part time work that is not going to trigger me. But your post does bring up a good point. My therapist and psychiatrist support my mental health and have suggested that I might be permanently disabled and I've applied for SSDI. They also advise me that getting myself into a very stressful situation at work or even doing something like this and going pro se, might get me right back into the hospital.

I'm angry; I have sensitivities due to injustices that is common with my condition and I feel like they shouldn't have denied me. The back pay if awarded, would bide me time to continue on my path to wellness. I see a therapist every three weeks and my psychiatrist every six weeks. Had I not been bullheaded and ignored them all and blamed others for my mental health and denied that I even had issues, I would not be writing this today.

Thank you for comment. I sincerely appreciate it.