Has The Insurance Company Denied Your Disability Benefits Even Though You Can No Longer Work?
Unfortunately, this happens all the time. The disability insurance company comes up with reasons why they do not have to pay your long-term disability benefits even though you can’t work because of a serious injury or illness. Once you get a letter denying or terminating your long-term disability benefits (this also applies to short term disability denials) it’s time to start working on your appeal.
Submitting an appeal for the denial of your long-term disability benefits is a lot more than filling out a form or simply telling them that you do not agree with their decision (even though this is what the insurance company would like you to believe).
They want you to file your own appeal, without an experienced long-term disability lawyer, because it will make it easier for them to deny your claim after you appeal and make it virtually impossible to win your case in court. Insurance companies deny legitimate claims all the time, because they know that a certain percentage of people will just give up or try to do it on their own and be over matched, which will save them money in the long run.
Here are five steps we took recently, from a real case, that you can use to help win your appeal:
1) Analyze & Review The Entire Claim File
We sent the insurance company a request for the entire claim file, including 21 specific areas, to make sure we covered everything that could possibly have reviewed on this claim. Like most of our cases, this claim file was between 500 and 1000 pages. We took the time to review and analyze every single page so we can understand the insurance companies basis for the denial. After requesting your claim file, pay particular attention to the terms, conditions, and definitions of the policy itself - these helped guide us in working with the physicians and other experts to develop additional evidence to prove that our client was disabled under the policy and entitled to benefits.
2) Work With Your Healthcare Providers
Making sure your doctors understand the medical evidence needed to support your claim is an important part of a successful appeal.
This is often a difficult part of the appeal because physicians and specialists are extremely busy and often don’t want to deal with these types of issues. Let’s face it, if your orthopedic surgeon says you need a knee replacement but the disability insurance company says there is not enough evidence to show you are disabled, the doctor will just become frustrated and not want to deal with them. We see this a lot, especially when the insurance company sends additional forms to the doctor or calls to request follow up.
We make it a point to take the time with your doctors and specialists to discuss exactly what is needed. We have full-time staff who follow up with doctors offices every day to make sure that they provide the medical evidence neccessary to keep your appeal on track.
Remember, your doctor has never seen the specific terms of your insurance policy and they may think that saying you can’t work or that you are disabled is enough (but it isn't).
3) Interview Witnesses & Draft Statements
Your job may have a very corporate, sanitized job description for your position that does not capture all of the physical or cognitive duties you have. Sometimes it will be outdated or just not accurate, but the disability insurance company may be relying on that to say that you can work.
That’s a good example of why you need to find and interview people who can talk about your job duties, your ability to function, and how your injury or illness has affected your life. We have a process for interviewing people and drafting compelling statements that help tell your story of why you can no longer work. These are often a powerful part of any appeal.
4) Conduct Medical & Vocational Research
Most of the time, the insurance company will have your records reviewed by a nurse or physician consultant who then says you are not disabled. Not only should you investigate the person who holds that opinion, but research your disability in peer reviewed articles, medical literature, widely accepted vocational definitions, and labor market surveys.
5) Do The Legal Research That Will Help Your Appeal
Most long-term disability claims are covered by a federal law (ERISA) with regulations implemented by The Department of Labor. You can use the disability appeals already filed and won in federal court to argue that the insurance company's denial is contrary to the law and won’t hold up in court if they continue to deny benefits.
If You've Been Denied Long Term Disability Benefits, Speak To Our Experienced ERISA Disability Lawyers Today
Filing an ERISA disability appeal is a big undertaking, especially for someone dealing with a serious injury or medical condition, and it combines knowledge and experience in law, medicine and insurance. Remember, these are basic steps to get started on your appeal. Most appeals we file are about 20 pages long (single spaced) and have another 25 to 100 pages of additional evidence in support of our clients’s claim.
Call us today at 202-393-3320 and you'll speak to an experienced member of our staff who can help you stand up to the insurance company.