How do I request my claim file after I’ve been denied long term disability?


After you receive a denial letter from your long-term disability insurance company, one of the first things you should do is request a complete copy of your claim file.

Why you should request your claim file after your long-term disability benefits were denied.

The claim file should contain all of the information the insurance company used to deny your claim for long-term disability benefits – many times the claim Request Your Claim File If Denied Long Term Disabilityfile will be several hundred or more pages long. And it’s a critical piece in the evaluation of your appeal – and remember, filing a well-written, thorough appeal with additional medical records, reports from specialists and experts, research, medical literature, vocational information, and persuasive evidence is absolutely critical. It will be used by the insurance company to decide your appeal, and then by a federal judge if your case is filed in court.

An appeal of the denial of long-term disability benefits is not just filling out a form or writing a letter!

Since you only have 180 days to file an appeal, you should request the claim file as soon as you can, and the insurance company can not charge you for this, it is free of charge.

Under ERISA, the insurance company has 30 days after your request to send the claim file to you.

How should you request your long-term disability claim file?

First, carefully review and analyze the letter denying benefits that you received from the disability insurance company as to why they say you are not entitled to benefits for your injury or medical condition. Many of these will have an address you can write to with your request, but call the person who signed the letter for the insurance company – you may be able to email or upload your request instead of mailing it.

As long-term disability lawyers in Washington, D.C., we draft a specific request for the claim information that requests 15 – 20 types of documents and materials, and we do this as soon as someone hires us to review their denial of long-term benefits. We know the clock is ticking and we want to get to work on your appeal!

Get help with your long-term disability claim in DC

As long-term disability benefits lawyers in DC, we offer a range of services to help with your long-term disability claim. If you’ve been denied long-term disability benefits, call us today at (202) 393 – 3320 for a free, no obligation, confidential review of your denial letter so we can analyze your specific situation.

If you’re thinking you should apply for long-term disability but haven’t yet, we offer consultations (now by video) to review your situation and provide a strategy to help you through the application process as well.

What To Do Before Filing For Long Term Disability Steps To Take To File For Long Term Disability

First and foremost, get a copy of your long-term disability policy from your employer. It’s critical that you understand the definitions, terms, and conditions in that policy before filing your claim for long-term disability benefits.

Get a complete copy of your medical records from your physicians. Some doctor’s offices will give you only the physician notes or reports, some will charge you or have some copy service charge you for this, and some staff members don’t want to deal with it. But whatever the situation, be assertive in getting everything in your medical chart – office notes, labs, orders, prescriptions, referrals, etc. You need to see these before the disability insurance company does, and you have to know what your doctors are saying about your condition or injury and your ability to work before you file for long-term disability benefits.

You’re injury or condition is legitimate – you’re not trying to hide anything. But remember, the insurance company is going to do everything they can to deny or stop your disability benefits, and construe everything that isn’t 100% clear in their favor.

Review Your Medical Records Before You File Your Claim

You would be surprised at how many people don’t review their medical records.

There could be a mistake in the records (this happens frequently, and with electronic medical records and auto-fill on the computer, the mistake gets automatically repeated in every office visit). Examples of common mistakes we see in medical records could be what job you hold and the physical aspects of the job, how long you’ve had the injury or condition, what caused it, and what your limitations really are.

Your doctor may not know what “disability” really means under your long-term disability insurance policy – in other words as it is defined in your specific policy – not the common, dictionary, or medical definition. Remember, it is your job to educate your doctor regarding the terms and conditions of your policy! We do this for our clients and we work with physicians, experts, and consultants all the time.

The records may not be complete – there are visits, labs, tests, etc. that are not in your medical chart.

Your doctor may not be a specialist or doesn’t have specific expertise with your specific injury or condition and some of his notes could be misinterpreted by the insurance company. It’s not that he doesn’t understand your condition and that you can’t work, but that his notes are vague, general, or not very specific.

Long-term disability insurance companies will try to use your medical records against you.

Keep in mind that none of this really matters as far as your medical treatment goes – and that is what your doctor is focused on. Many doctors are squeezed by health insurance reimbursements and view documentation as one more thing they have to do – but it’s critical for your long-term disability claim. Obviously, you want a copy of your records so you can identify if you have any of these issues before you file your claim, and so you can take steps to correct them by talking to the doctor, getting a follow-up exam, and a second opinion, etc.

In every case, the disability insurance company will review these records closely, looking for everything they can (any mistakes, inconsistencies, omissions, etc.) they can use to deny benefits. The insurance company will have their own medical consultants and experts review your records – and you can bet they are trained to look for every inconsistency, mistake, or anything that is vague or doesn’t specifically describe your injury, condition, and inability to work. Your medical condition and inability to work are real and legitimate, so make sure your medical records are good enough to satisfy the insurance company under the policy and qualify for benefits.

Our Experienced Long-Term Disability Attorneys Can Help​

If you don’t understand your long-term disability insurance policy or don’t review your medical records and just send them to the insurance company, you may set yourself up for a denial of your claim – that’s what your long-term disability insurance company is hoping for. Our experienced long-term disability lawyers can guide you through the process so you can get your case off on the right track and avoid having your claim denied.

If you want more information on how to prepare for your ERISA long-term disability claim, or want to talk it through, call us at (202) 393-3320 or chat with someone right now. We make it easy to get started. And we give you a plan.

After Long Term Disability Benefits Are Stopped, You Need To Appeal.

If you’re disabled and can’t work due to a serious injury or medical illness and you’ve been denied long-term disability benefits through your employer (or a private long-term disability policy if you have one) or you were receiving long-term disability benefits and these were terminated, you need to file an appeal.

You should have gotten a letter from your long-term disability insurance company (like Reliance, Mutual of Omaha, Guardian, Hartford, etc.) that tells you that you have the right to appeal.

They make it sound easy to file an appeal. But what does it really mean?

Caution: An Appeal Is Your One Shot To Win Long-Term Disability Benefits.

Under a federal law called ERISA that governs employer-sponsored long-term disability benefits, the long-term disability company has to send you a letter (we usually call this a denial letter) that sets out all the reasons why they denied your claim and say you are no longer disabled.

Some common reasons disability insurance companies use to stop your benefits:

  • You no longer meet the policy definition of disabled
  • You have not provided evidence of your limitations and medical restrictions
  • You can perform some material duties of your regular occupation
  • An independent medical examiner or medical records reviewer says you can return to work

But Why Is The Appeal To The Insurance Company So Important?

Because it is your one chance to add to the record – to add all of the information and evidence that supports your claim for continuing (or starting) your long-term disability benefit. And you only have a limited time to appeal – the rule is 180 days if your disability policy is covered by ERISA, but the deadlines were extended by the Department of Labor due to the Coronavirus emergency.

How Do You Appeal If You’ve Been Denied Long-Term Disability Benefits?

First, you need to request a complete copy of your claim file – all of the information the disability insurance company has. This will usually include the long-term disability insurance policy, medical records, claim forms, job description, disability forms, claim notes, correspondence, emails, recorded statements, everything in your file, whether you or your doctors provided it, your employer did, or the disability claim reviewers created it.

Under ERISA regulations, you are entitled to the complete file (there are penalties if the insurance company fails to provide the file). We typically request 18 – 25 topics or categories of documents, electronic and paper. That is usually somewhere between 400 – 1000 pages of information and evidence.

Once you’ve analyzed the insurance policy and all of the evidence in the file (pay special attention to the denial letter), you’ll need to add evidence – depending on your medical condition and disability, that may be done by working with outside consultants, medical experts, and specialists.

Why Is The Appeal So Important In Long-Term Disability Benefits?

The appeal is critical because, under ERISA, you have the right to sue the long-term disability insurance company in federal court.

But that means a federal judge will decide your case. ERISA doesn’t provide for a jury trial or discovery like most civil cases where someone is injured. Instead, the judge will decide the case based on the record the long-term disability insurance company had – and that record includes your appeal, so you need to put all of the evidence you have into the appeal.

That requires a lot of work, analyzing legal, medicine, and insurance law and working with outside experts and specialists.

How Long Should My Appeal Of The Denial Letter That Ended My Long-Term Disability Benefits Be?

This is going to depend on a lot of factors, of course. But we just filed a long-term disability appeal (after our client’s long-term disability benefits were discontinued after an insurance medical examiner said she was not disabled.

That appeal was 20 pages (single spaced) of analysis and argument and we included another 90 pages or so of additional exhibits and evidence.

Do You Need An Experienced Attorney To Appeal Your Long-Term Disability Claim After It Was Denied?

Yes – there is just too much to do to prepare an appeal. You need to work with a lot of different experts and specialists to give yourself the best chance of winning the appeal and getting your long-term disability benefits.

Even the late Justice Ruth Bader Ginsburg called ERISA unjust and increasingly tangled – what more proof do you need?

Call us today at (202) 393 – 3320 to see how we can help you with your long-term disability benefits.

Why Do I Need an Experienced Long-Term Disability Lawyer if My Claim is Denied?

You’ve got a serious illness or injury and can’t work – no one questions that. So you apply for long-term disability benefits. And you’re getting benefits for What To Do When Denied Long Term Disability with Guardianawhile, but then you get a long, professional letter from the insurance company and it says they are now denying your claim. You want to know if you need a lawyer, or if you can handle this on your own.

The Short Answer To This Question Is to Get a Lawyer Who Handles ERISA Disability Cases.

Here’s why – If your group disability policy was provided by the company you work for, it is probably subject to ERISA. If you have an ERISA disability claim (most policies are governed by ERISA, a federal law) you have tight and unforgiving deadlines, on top of a standard that makes these cases difficult on you. As a start, here are some of the procedures and deadlines you’re probably dealing with:

  • Your appeal is due 180 days after you receive the denial letter
  • The insurance company has 45 days to respond (and they can get an extension of 45 days)
  • Your appeal goes to the insurance company (the same one that just denied or terminated your benefits).
  • If the insurance company doesn’t change its mind, reverse itself, and award benefits, your next step is to file a lawsuit in federal court.
  • The federal judge assigned to your case will decide based on the administrative record (which is the appeal you filed).
  • The standard of review the judge uses is probably discretionary so the judge will likely just be deciding whether the insurance company’s decision was reasonable.

If you’re dealing with these deadlines you need someone to focus on your appeal. This is not just filling out a form or sending in your doctor’s note. It is working with medical and vocational experts, gathering and formulating evidence, interviewing witnesses, and analyzing, and drafting your best arguments.

Our Experienced ERISA Long-Term Disability Lawyers Can Get You the Help You Need Today
Give us a call at (202) 393 – 3320 so we can review your denial letter and you can learn more about the next steps to take.

You Probably Won’t Have To Testify In Court If Your Long Term Disability Appeal Is Denied.

Most long-term disability insurance policies provided by an employer as part of your employee benefits or compensation package are governed by federal law, ERISA (Employee Retirement Income Security Act), so if there is any litigation on your claim for long-term disability benefits, it will be in federal court.

Here’s how it works:

After A Denial Of Long Term Disability Benefits, The First Step Is To Appeal

Appealing a denial of long-term disability benefits is difficult, especially for someone who can no longer work and is dealing with the effects of a serious injury or medical condition (which the disability insurance company doesn’t believe or doesn’t believe prevents you from working).

Your appeal to the insurance company is the most critical step in the process.

It is much more than completing a form or sending in some medical records from your doctor. You need to analyze your long-term disability policy – the definitions, terms and conditions, exclusions and limitations, etc. – will help you get started on what you need to prove.

You need to analyze the denial letter and request a complete copy of your claim file from the insurance company (which may be hundreds and hundreds of pages – make sure you specifically ask for everything).

If your long-term disability insurance policy is an ERISA policy, there are regulations that govern how the insurance company evaluates and decides your appeal. As you know, the insurance policy is written by the insurance company – not only does the policy favor the insurance company, federal courts have routinely ruled in favor of disability insurance companies based on a number of factors set forth in the policy, including the standard of review the Court uses.

If Your Appeal Is Denied, You Can Sue The Insurance Company In Federal Court

Once your appeal is denied, you can file a lawsuit to get the long-term disability benefits you are owed. But there is a critical difference between an ERISA disability lawsuit and a case involving any other serious injury or medical condition – a medical malpractice case or trucking accident case, for example.

Under ERISA, the federal judge who decides your case will decide it based upon the administrative record – that is, everything your long-term disability insurance company had when it denied your appeal. There won’t be any discovery, depositions, or additional evidence. You won’t have a jury trial.

That record will include everything you submitted as part of your appeal – so you have to make it count. That’s why we focus on the appeal, on generating all of the medical, vocational, and other evidence necessary to prove that you are disabled as defined by your specific policy. While this would not include testifying in court, we interview you (and others with knowledge of your medical condition and job) extensively to prepare a powerful statement as part of our evidence.

Unfortunately, we’ve turned away people with legitimate, serious medical conditions who are ready to file their case in court because they did not properly and thoroughly file an appeal – and there won’t be enough evidence, or the right kind of evidence – for the judge to rule in their favor.

If Your Long Term Disability Insurance Policy Is Not Governed By ERISA, You May Testify in Court

Again, most policies fall under ERISA but some are private, state law contracts. If you have a disability insurance policy that isn’t covered by ERISA, you may be able to sue the insurance company in state court, like almost any other case, and have discovered, including your deposition. And if the case goes to trial you may testify in court.

Speak To An Experienced Long-Term Disability Today

If your long-term disability benefits have been denied or terminated, fax us your denial letter from the insurance company. We’ll review it for free, in confidence, and with absolutely no obligation. Just send it to clientexperience@dkllp.com. We’ll give you our thoughts on what you should do next.

And we offer different levels of service depending on your needs – maybe you are just applying for long-term disability and only need to consult with us for an hour or two, or you’ve been denied and need to research, draft, prepare and file an appeal.

We’re happy to help. Call us today at (202) 393 – 3320 to get started.

The Truth About Insurance Adjusters

You were in a serious accident or fell seriously ill and you can’t work. You file first for short-term disability, and then long-term disability down the road. You will be assigned to an insurance adjuster who will contact you to collect more information about the accident or illness. The adjuster will probably ask for pictures of the accident, medical records, incident reports, and anything else that they can use to evaluate the situation.

However, you need to know that a long-term disability insurance adjuster from MassMutual or Guardian, or any of the other disability insurance companies is someone that the insurance company hired to analyze the damages from the accident. Is he going to be looking out for your best interest? Would he put you in a fair and unbiased light so you can receive reasonable compensation from your insurance policy?

NO. Essentially, the insurance adjusters, especially disability insurance adjusters, have the task of minimizing the amount of money their companies have to pay out in benefits, even though you have faithfully paid your premiums for years. They are trained to look for ways to deny legitimate claims – and ERISA disability insurance policies are written to favor the insurance company, not you. And these insurance adjusters will use anything they can get to try to downplay what actually happened so that the insurance company doesn’t have to pay you what you’re entitled to.

What To Do When Dealing With Insurance Adjusters

Well first off, read your disability policy and get it analyzed by a lawyer if you need to, to make sure your medical condition or injury is covered under the terms of the policy, and for how long it’s covered and what you have to prove to the insurance company about your level of activity – like whether you need to prove you can’t do your job, or any job, and how all of that is defined in the policy. If you’re on long-term disability, make sure that you are faithfully getting medical treatment, know how to talk to your doctor about your long-term disability claim, and order our free consumer guide to get started setting yourself up for success.

Next, remain calm and use common sense. After experiencing something as traumatic as a serious injury or illness, you’re probably extremely stressed and shaken. But you need to know that insurance adjusters are waiting for you to do or say something that they can use against you. Don’t post your personal info on social media or try to tell your friends everything is great when your injury or medical condition has you down – insurance companies are trolling social media looking for “evidence” that you are exaggerating your symptoms or are able to work.

Confused After a Long-Term Disability Denial? Download Our Free Book

Make sure you know what to do and what not to do. For more information, read our free report “Claim Denied- The Ugly Truth About Disability Insurance.” Download it online to learn the ins and outs of how to handle your ERISA long-term disability case and if your injuries are serious or your claim has been denied, you need a lawyer, how to choose the right lawyer to represent you.

Contact Our Experienced Long-Term Disability Lawyers Today To Help Answer All Your Questions

Call us today at (202) 393-3320 to find out how to protect yourself. And if you have been denied long-term disability and received a denial letter, you may have only 180 days to file an appeal – this is a lot more involved than filling out a form. Contact us today and we’ll give you a free analysis of your denial letter to get you started.

What Is A Notice of Controversion and What Does It Mean For My Case

After an insurance carrier denies a claim for benefits they will file a Notice of Controversion, which is a form that states the reasons why the claim has been Ways to Contest a Bad Decision By Your Workers Comp Adjusterdenied. In DC, insurance companies are not obligated to pay workers’ compensation benefits initially, and there’s no initial award or award order entered. They can voluntarily pay benefits if they believe it is a compensable claim. However, they can also stop paying these benefits at any time for any reason unless you obtain a Compensation Order to force a carrier (insurance company) to pay your benefits.

You Can Contest a Notice of Controversion Either by Filing for Informal Conference or Formal Hearing.

An informal conference is essentially an attempt to resolve issues informally, meaning no court reporter, or witnesses, no testimony is taken under oath. An informal conference is mediation with a claims examiner who will issue a recommendation within 30 days of the conference date. The claims examiner will attempt to resolve the issue amicably or encourage the parties to do so. If that’s not possible, the claims examiner will issue a memorandum of informal conference or a non-binding recommendation.

While a lot of lawyers will request an informal conference after their client’s claim is denied, that’s not how we like to do it. We take the more aggressive approach and often go straight to a formal hearing.

Why Do We Choose a Formal Hearing Instead of an Informal Conference?

If you can’t work due to your injury and aren’t getting paid or compensated by your employer, it can be extremely frustrating dealing with the slow workers’ compensation system. It can take months to get a hearing date and even after the hearing it can take more months to get a decision. An informal conference recommendation is not binding on the parties; so even if you win, legally they don’t have to pay your benefits. All they have to do is request a formal hearing. And you just lost 3 or 4 months where you weren’t getting paid.

That’s why we go straight to a formal hearing. In a formal hearing, discovery is required (which is a legal term for full disclosure) and at the end of the process, whatever the judge decides is binding. This means that if you win the formal hearing, the insurance company will be legally required to pay your benefits.

Plus, a formal hearing decision is binding – it adds pressure to insurance companies to pay you because even if they appeal the Formal Hearing decision, the employer and insurance carrier must pay the benefits while the case is on appeal. There are many different factors that can either help you get your worker’s comp benefits earlier or delay your process. And insurance companies, who have dealt with thousands of workers’ compensation cases like yours, know all of the tricks and tactics to lower their costs by denying your benefits.

Do You Need Help Now With a Contested Claim?

Want more information on how to fight this unfair battle? Order Protect Your Rights: The Ultimate Guide to DC Workers’ Compensation by clicking here or call us today at (202)393-3320 to order this guide. This book has tons of information about how to deal with a workers’ compensation case and what your rights are as an injured worker. And we’re providing it to injured workers in the DC metro area for absolutely no cost or obligation. Call today at 202-393-3320 while supplies last.

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