Colorado Long-Term Disability Lawyer
You paid for disability and health coverage so a diagnosis wouldn’t cost you your income too. Then the insurer said no. We handle the appeal, build the medical record, and make the policy pay what it promised.
The short answer
A long-term disability lawyer challenges benefits that were denied, delayed, or cut off: running the required appeal, gathering the medical and vocational proof the insurer says is missing, and bringing an insurance bad faith claim when the denial was unreasonable.
Deadline
Appeal windows are set by the policy and usually run in months. The clock to sue is longer, and the policy’s own fine print can shorten it.
First question
What should I do the week the denial letter arrives?
Read the letter for two things: the stated reason and the appeal deadline. Insurers write denials to a template, and the reason is usually one of four: you don’t meet the policy’s definition of disabled, the evidence is “subjective,” the condition was pre-existing, or a form was late. Each one has a different answer, and the deadline tells you how long you have to build it.
Then ask, in writing, for the complete claim file and every document the decision relied on: the policy, the reviewing doctor’s report, any surveillance, the vocational analysis. Insurers rarely volunteer the file, and what’s in it usually tells us more about the denial than the letter does.
Get your treating doctor writing a narrative instead of checking boxes on the insurer’s form: sitting tolerance, lifting limits, concentration over a full workday, and why the file reviewer’s conclusion is wrong. A denial answered with a doctor’s letter has to be answered in turn.
And call us before the appeal goes in. A one-page appeal that says “I disagree” gets filed and forgotten. The appeal with the doctor’s letter and the claim file behind it is the one that gets paid.
How it happens
Four ways insurers end a disability claim.
Disability insurers end benefits through small choices about what counts as proof, and those choices run through the same four places.
1
The definition switch
Most policies start by asking whether you can do your own job. Often after the first couple of years, the question changes to whether you can do any job at all. Nothing about your condition changed. The definition did, and benefits end the same month.
2
The paper review
A doctor who never examined you reads a stack of records and concludes you can work. Insurers call it an independent review. Your treating physician’s notes get one line; the file reviewer’s opinion gets the decision.
3
“Subjective” symptoms
Pain, fatigue, migraines, the cognitive fog after a brain injury — real conditions that don’t show on an MRI. The denial letter calls them unsupported by objective evidence, as if the lack of a picture were the same as the lack of a disability.
4
Surveillance and the form
A two-minute clip of you carrying groceries. A daily-activities form where you mentioned helping a friend move. Neither says anything about sustaining a full workday, and both show up in the denial as if they did.
Recognize your claim in one of these? That’s usually where the case starts.
Plain answers
How does long-term disability insurance work in Colorado?
In plain terms: you become unable to work because of illness or injury, you wait out an elimination period the policy sets, and the insurer then pays a monthly benefit that’s typically a share of your salary, for as long as you stay disabled under the policy’s definition or until the benefit period ends.
Every clause in that sentence is a place the insurer can push back. The policy defines what counts as disabled, and your doctor’s opinion is evidence measured against that definition. The policy also defines which salary counts — overtime, bonuses, commissions. And the benefit is reduced by offsets: Social Security disability, workers’ compensation, sometimes other income. Insurers often require you to apply for Social Security precisely so they can subtract it.
And the definition moves. Own-occupation coverage asks whether you can do your job. Any-occupation coverage asks whether you can do any job your education and experience reasonably fit. Many policies switch from the first to the second partway through the claim, and that switch is where a claim that was being paid can suddenly stop.
In our practice the claims that survive are the ones where the treating doctor wrote a narrative (sitting tolerance, lifting limits, concentration over a workday) instead of checking boxes on the insurer’s form. If you want the long version, we wrote a step-by-step appeal guide for exactly this.
What insurance do you keep while on long-term disability?
Usually less than you’d expect. Many disability policies include a waiver-of-premium provision, so the disability coverage itself continues without you paying for it while you’re on claim. Check yours; the waiver often has its own waiting period.
Health coverage is the harder question. If your health insurance came with a job you can no longer do, losing it in the middle of the condition that disabled you is the second crisis in these cases, and the one people don’t see coming. Continuation coverage and a special enrollment window on Colorado’s marketplace are the usual bridges, and both have short deadlines that start the day the coverage ends.
Bring us the denial letter and the policy.
Those two documents tell us what the deadline is, what the insurer thinks is missing, and how far its reading strays from the policy. Twenty minutes usually tells us whether you have a case.
Results
What an insurer’s first answer is actually worth.
Three results from our insurance practice. Each one started with an insurer confident the policyholder would take the first answer.
$22.2M
appraisal award · property insurer
The insurer valued the loss at roughly $80,000 and topped out under $500,000. Appraisal ended with an award of $22.2 million.
$6.75M
settlement · hail claim underpaid
A hail claim the insurer underpaid by millions. Days before trial, it paid every dollar we demanded.
$2.3M
settlement · wrongful refusal to defend
A home builder’s liability insurer refused to defend it. The insurer paid $2.3 million to settle.
Past results don’t guarantee future outcomes.
Appeals
How do I appeal a denied health insurance claim in Colorado?
Two rounds, in order. First, an internal appeal — you ask the insurer to take a second look, in writing, with new evidence attached. If it still says no, Colorado gives you an independent external review by a reviewer the insurer doesn’t employ. That decision binds the company. The Colorado Division of Insurance runs that process; the Division’s own guide to appealing a health denial walks through both rounds and their deadlines. Read it the day the denial arrives. The clock runs from then.
One qualifier: the Division’s external review covers plans the state regulates. Your insurance card and the policy documents tell us whether yours is one of them.
What goes in the appeal is the same either way: the denial’s stated reason, the medical-necessity criteria the insurer used (you’re entitled to ask for them), and a letter from your treating physician answering those criteria point by point. An appeal that says “I disagree” gets filed. An appeal with a doctor’s letter attached has to be answered.
How do I appeal a denied or terminated disability claim?
In writing, inside the window the denial letter gives you, with evidence the insurer hasn’t seen. The letter names a reason, and the appeal answers that reason specifically. If the insurer says the evidence is subjective, you send objective testing where it exists and a treating-physician narrative where it doesn’t. If it says you can do another job, you send a vocational opinion on the jobs it named. If it relied on a paper reviewer, your doctor answers that reviewer by name.
Build it like a trial exhibit: updated records, a functional capacity evaluation when the limits are physical, a neuropsychological evaluation when they’re cognitive, and statements from the people who watch you try to get through a day. The insurer’s file reviewer wrote three pages. Your appeal should make those three pages look thin.
Indeed, most people learn this after they’ve sent a one-page appeal on their own and lost. If the insurer still says no after a real appeal, Colorado law lets you sue on the policy, and when the denial was unreasonable the insurer owes two times the covered benefit plus your attorney fees.
Where your claim stands
Which kind of denial are you holding?
Disability and health denials fail in different places and get answered differently. Start with the page that matches yours.
Disability insurance claims
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Own-occupation fights, paper reviews, and the definition switch: how a denied or terminated LTD claim gets rebuilt.
Health insurance denials
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Medical-necessity denials, prior authorization, and the internal-then-external appeal that binds the insurer.
Appeal an insurance denial
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The step-by-step guide: what to request, what to attach, and the deadlines that started when the letter arrived.
The honest answer
When does a disability denial become insurance bad faith?
The standard is reasonableness. Colorado law says an insurer may not unreasonably delay or deny a covered benefit. An insurer is allowed to disagree with your doctor. It isn’t allowed to ignore your doctor, treat a reviewer who never examined you as gospel, or sit on a claim for a season while your mortgage comes due. When a court finds the denial unreasonable, Colorado law doubles the covered benefit and adds your attorney fees on top of what the policy owed.
We’ve built a whole page on how that case gets made: insurance bad faith in Colorado.
Do I need a lawyer for a disability or health insurance claim?
Not always. If the insurer is paying on time, you don’t need us. We’ll say so. The claims that do need us have a gap: benefits cut off at the definition switch, a denial built on a doctor who never saw you, a health plan calling your surgeon’s recommendation not medically necessary.
The economics run your way, too. We take these cases on contingency. Colorado’s fee-shifting rule puts your attorney fees on the insurer when its denial was unreasonable. And other lawyers retain Nelson as an insurance expert witness on how claims should be handled.
Here’s what the first month looks like. We request the full claim file and the policy. We calendar every deadline. We get your doctors writing narratives instead of checking boxes, and we take every call from the claims examiner so nothing you say in a bad week gets used against you. You focus on your health. We handle the insurer.
Your lawyer
Nelson Waneka
Nelson has handled disability, health, and insurance bad-faith cases across Colorado since 2010 — tried insurance cases to Garfield County juries, argued at the Colorado Court of Appeals, settled in the rooms where most claims actually resolve. Best Lawyers has named him “Lawyer of the Year” for Insurance Law twice. Insurers recognize his name on the pleadings. That matters more than it should. And he’s spent his whole career on one side of the table: the policyholder’s.
Best Lawyers “Lawyer of the Year,” Insurance Law (2×) · Chambers USA ranked · Colorado Super Lawyers Top 100
Based in Glenwood Springs. Serving the Western Slope: Aspen · Vail · Grand Junction · Montrose · Basalt — mountain-town claims handled by a mountain-town firm, not a Denver satellite.
From our clients
“We somewhat naively thought we could take care of things ourselves but quickly realized that we were being taken advantage of and really not capable of understanding legal speak. That is when we contacted Nelson. He immediately put us at ease, explaining things in plain English. I cannot tell you how much handing the situation over to Nelson changed an ugly situation into a minor annoyance.”
Google review · Kristy Greenwood
Your policy made a promise. We make them keep it.
No fee unless we recover