Answers to Your Questions on Injury and Disability Cases in DC, MD and VA
We make it easy. Send us a confidential, secure, no obligation message right now.
At Donahoe Kearney, we know you're in an unfamiliar and unfair system after a serious injury or illness. We've seen too many people get taken advantage of byt the insurance company after a serious injury or illness. So we've published books, guides and reports and answered hundreds of questions that have helped thousands of people just like you.
Here are some of the questions people have when they first contact us about D.C., Maryland and Virginia medical malpractice, serious car accidents, long term disability insurance claims, or workers compensation. We try to provide as much information as we can based on our experience helping people stand up to insurance companies after a serious accident or injury in D.C., Maryland and Virginia.
Since every person is unique, you probably have questions or need specific information about the legal process when there is an injury or death in your family. We make it easy for you, so contact us to talk it through. We'll schedule a free no obligation, secure and confidential zoom call (or regular phone call) and give you all the information we can.
Call us today at 202-393-3320.
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Can I Win My Long Term Disability Appeal If I Don't Have a Definitive Diagnosis?
What Is A Definitive Diagnosis And How Can I Get One?
We've heard this story - your story - time and time again. You've been injured or diagnosed with a serious illness. You are worried that your injury or illness will prevent you from working. You head to your doctor and he confirms your worst fear - you are not going back to work. You have a long term disability insurance plan sponsored by your employer. So you call human resources and get the claim forms. You fill out all the paperwork and send in your medical records, first for short term disability and later for long term disability.
Everything seems smooth. You're approved for short term disability and your long term disability application goes off without a hitch.
However, what nobody told you is that the insurance company makes the decision on whether or not you receive any benefits. And they deny your your claim, stating that you don't have a definitive diagnosis. This is the first time you've heard that phrase - how can you corrrect the error?
A definitinve diagnosis is a test that produces concrete results that will tell you whether or not you have a certain condition or diagnosis, such as MRI's, blood tests, biopsies, etc. Definitive diagnoses are clear-cut confirmations that you have a certain medical condition. But not all medical issues have a way to measure by definitive diagnosis.
I Don't Have A Definitive Diagnosis. What Comes Next?
If you have any type of chronic pain conditon, mental health issue, gastrointestinal issue, etc. you probably don't have a definitive diagnosis. Your diagnoses has come over time and a results of many tests and studies, which are more like indicators than diagnoses. But your long term disability carrier is telling you that if you can't get definitive support for your injury or illness, you can't get long term disability benefits.
You may try to contact the insurance company and correct the error, thinking maybe they made a mistake and they just need more information or records. You may try to argue and spin your wheels. The insurance company knows this and that's why they have only given you 180 days to appeal their decision. They are counting on you wasting time, trying to get them to change their decision. They are counting on you not calling an experienced long term disability lawyer who will tell you that denial was their plan from the very start.
If your long term disability claim has been denied, contact our experienced long term disability lawyers today at 202-393-3320 to get started on your appeal. Don't delay - you only have 180 days to appeal their decision. Don't waste it trying to handle the appeal on your own. We make it easy to get started - call 220-393-3320.
Can I Win My Appeal Without A Definitive Diagnosis?
Yes it is possible to win your appeal without a definitive diagnosis as long as you have an experienced long term disability lawyer like Frank Kearney someone representing you. Without a long term disability lawyer, your fight for benefits against the insurance company can be an impossible battle. The odds are highly stacked against you and the law that governs your policy heavily favors the insurance company and allows them wide discretion to deny claims.
But just because you don't have a firm diagnosis doesn't mean that you shouldn't get the benefits you are entitled to. But on your own, it's virtually impossible to win an appeal. Fighting back with an appeal is a lot more than filling out a form or sending an email. That's why you need the help of a long term disability attorney like Frank Kearney. His approach combines his experience in workers comp, medical malpractice and insurance litigation in order to write a persuasive appeal on your behalf. This appeal will include testimony, medical evidence, etc as a legal brief that gets submitted to the judge.
What Can An Experienced Long-Term Disability Lawyer Do For Me?
We have seen numerous cases where people have not been able to go back to work and being denied benefits because of the unfair discretion allowed to the insurance company. After being denied, our clients come to us and we win them back benefits as well as ongoing benefits while they are unable to work. We are able to do this becauase we know exactly how to beat the insurance company at it's own game.
Contact Our Experienced Long Term Disability Lawyers Now
Are you ready to fight for what you need? Are you ready to take a stand against the companies that did you wrong? Don't be intimated by the insurance company. Donahow Kearney fights for you to make sure that you get what you need. We understand that the system works against people who need it most. Don't let it happen to you. Don't fight the battle alone. Call us at (202)-393-3320 today. We make it easy to get started.
How Do I Appeal Long Term Disability in DC?
After being denied long term disability benefits in DC, your appeal is critical.
If you received a letter from your long term disability benefits insurance company denying or terminating your benefits, click here.
We will review the insurance company denial letter and give you a specific 5 point plan for the appeal at no charge and with no obligation. It's both free and confidential. We implement these plans, and greatly expand on them for our own clients.
The insurance company letter denying your benefits should be specific.
The long term disability insurance company has to tell you why they denied or terminated your benefits. Sometimes this is because they had a "peer review" - a doctor somewhere far away who has never seen you but has reviewed your medical records and says you can go back to work. Maybe they quote the terms and definitions of your insurance policy, saying things like "you are no longer disabled under the policy" or you "do not fit the definition of disabled." Maybe they have vocational evidence that shows you can be working at another job or surveillance evidence that they say shows you do not have the restrictions your doctors have put in place.
Regardless of the reason, here are 6 steps you should take immediately after you receive that letter.
Mark your calendar - you probably only have 180 days to appeal
Most private long term disability insurance policies provided by your job or purchased on your own are governed by a federal law (ERISA) and have a 180 day time limit to file an appeal - if the appeal is denied you can then file your case in federal court, where a federal judge will scrutinize your appeal.
Even if your policy is not governed by ERISA, it probably has a 180 day time limit. Don't wait on any of this - this is not much time given the amount of work you need to do for your appeal. If you don't file in time, you may be out.
Request a copy of your policy
You need to see the terms and definitions as they are set out in the ilong term disability insurance policy - that is what the insurance company is using to evaluate your claim.
Request a copy of your complete claim file
The insurance company has to give this to you, but be careful how you phrase your request. The claims files we request for our clients have 28 categories of information we ask for.
Request a complete copy of your medical records
You'll need this from every doctor or hospital you've been to for medical treatment for your injuries or condition that prevents you from working.
Talk to your doctor about your disability claim
Your doctor's input and analysis could be critical and he or she will not know how the insurance policy defines disability, light duty, even your occupation. So you need to schedule time to explain all of this to your doctor. We talk to treating physicians, specialists and consultants for our clients.
Send us a copy of the letter that denied your long term disability benefits
We'll analyze it for you and give you a 5 point plan for your appeal. There is no risk or obligation with this offer and it doesn't mean we will agree to work with you, but we hope it will get you started in the right direction if you decide to research, draft and file your own appeal.
Ready to work with an experienced long term disability attorney?
We make it easy for you. Just call us at (202) 393-3320 to get started.
Why Did Hartford Deny My Long Term Disability Claim?
Long term disability claim for healthcare worker denied in DC.
I just got off of a zoom call with a nurse working at a hospital in DC. Nurses, and all healthcare workers really, have a heavy duty, physical job. They have to lift and turn patients, move heavy medical equipment and respond to patient emergencies.
So it's no surprise that many nurses have back and neck conditions caused by lifting and turning patients who are obese.
And these conditions often result in herniated discs in their back or neck, with pain, numbness and tingling running down their arms or legs. When it gets really bad, they can't work because they can't lift or carry enough weight to perform proper patient care.
When you can't work due to a medical condition you can apply for long term disability benefits.
That's exactly what this nurse did. She applied for short term disability first because of her medical condition, and when that ran out, applied for long term disability.
She received a bunch of forms from the hospital's long term disability insurance company, Hartford, and completed the forms and sent them in. Hartford wanted more information from her doctors and sent her additional forms on this.
Medically, there wasn't much of a dispute that she couldn't do the work, but there was a problem.
Her pain management specialist, providing her with ongoing, monthly appointments to address the pain and radiculopathy caused by her condition, would not complete the form. His office policy was to "not get involved in disability or legal claims." The form was 1 page, probably 7 or 8 things to fill out, that could have been copied from her medical chart.
What can you do to help yourself get long term disability benefits?
This nurse just needed some guidance to stand up to the insurance company now that she was in a long term disability process that favors insurance companies (most cases are governed by a federal law ERISA that gives insurance companies discretion to determine eligibility for benefits - because of this, you really need an experienced long term disability attorney to file a thorough appeal - ours are about 30 pages long plus another 50-70 pages of exhibits).
So we had her go to her primary care physician, a doctor she knew well, to review all of her medical information.
She also had a Functional Capacity Evaluation done - a physical test that measures how much you can lift, carry, walk, etc. - that indicated she had limitations on her physical activities, so the doctor could review that as well as a basis for her opinion that the nurse could not return to work.
The insurance company's initial response was disappointing - it was clear this nurse couldn't work and had the medical evidence to back it up - even if her pain specialist wouldn't complete a simple form.
Get advice from a DC long term disability lawyer
You shouldn't have to go it alone - call us today at 202-393-3320 to get started on a plan so you can get the long term disability benefits you need to be secure, in control and independent.
And if you received a letter denying your long term disabilty benefits, fax that letter to 202-393-3324 or email it to [email protected] and we'll contact you with a specific plan for your appeal.
Did Mutual of Omaha Deny Your Long Term Disability Claim?
Mutual of Omaha Denied Your Long Term Disability Claim in DC
As long term disability lawyers, we know that as a high income earner, you've relied on Mutual of Omaha or another insurance company to provide long term disability benefits while you can't work due to an injury or medical condition. Usually there are two instances when they deny or terminate your long term disability benefits. When they make this decision, Mutual of Omaha or your insurance company will send you a letter informing you.
Here are two common situations involving long term disability benefits being denied, and what to do about it.
Mutual of Omaha denies your initial application for long term disability benefits.
After a serious injury or illness that left you unable to work, you probably applied for long term disability benefits, either through a private policy you purchased and paid the premiums on, or one provided by your company or employer.
If the policy is provided by your company or employer, your HR specialist will usually get you the application and forms you need to get started, and you'll get a packet of information from Mutual of Omaha, (and this is true whether you're applying for long term or short term disability benefits. ,
One of your first steps is to get a copy of your long term disability insurance policy from Mutual of Omaha.
The long term disability benefits policy will include all of the terms, conditions and definitions that apply to the policy, or insurance contract, and information you need to apply for disability benefits. You want to analyze that insurance policy and understand all of the policy provisions.
Mutual of Omaha will usually call you to get information adn probably send you forms for you to fill out, asking for information such as:
- Work History
- Health History
- Job Description
- List of health care providers
- How the injury or medical condition occurred or when you were diagnosed
They will also include an Authorization for the Release of Medical Records. Once you sign this form, it will give the insurance company the right to obtain your medical records and information to verify your medical condition or injury and the fact that you are disabled because of it, and it may allow them to talk to your physicians as well (you want to avoid this if you can).
It's critical to work with your doctors throughout the long term disability process.
Mutual of Omaha, like other disability insurance companies, will have specific definitions of disability, what conditions are covered, and for how long. Its important to analyze the policy and then work to educate your doctors so that they understand the terms and conditions (for our clients, we meet with and talk to physicians, specialists and expert consultants).
If your doctors are like most practicing physicians, they will only take a minute to look at a form or listen to you about this - or they will delegate it to a staff member. Let's face it, most doctors already think they know what it means to be disabled and they often don't give a lot of support for the opinions they put in their medical reports.
The reality is, they don't understand your disability policy definitions and don't have the time to review the policy.
Many doctors want to help, but they end up hurting your claim for long term disability because they use the wrong definition, or include medical conditions that are secondary but may limit your ability to get disability benefits. It's hard work convincing them, even though they mean well.
Here's a common reason Mutual of Omaha and other insurance companies deny a claim for long term disability.
This is another problem with just sending a form to your doctor and expecting he will take care of it for you.
After completing and sending in your application for long term disability benefits, signing everything and requesting the supporting medical evidence from your doctors, you think you're done.
But you're just getting started.
When Mutual of Omaha, or any long term disability insurance company, doesn't receive all of your information, they will write to you asking for more time to gt it (almost all long term disability cases are covered by ERISA, a federal law, that has deadlines and regulations for when claims need to be filed and decided by).
It is your responsibility to get Mutual of Omaha the medical records and other information they request for your long term disability claim - you can't rely on your doctor's office to comply with their request. And even if Mutual of Omaha requests it for you, it's not their responsibility to do this for you.
Naturally, we take care of this for our long term disability clients.
Remember, if you don't get those medical records to Mutual of Omaha on time, they can deny your claim for long term disability benefits. Unfortunately, many people with legitimate medical conditions and injuries that prevent them from working don't realize what they need to do about it, and when.
What to do when Mutual of Omaha denies your claim for long term disability benefits.
ERISA is the federal law that governs most long term disability insurance claims and, in addition to the statute and federal case law decisions, has a set of implementing regulations with requirements both you and the insurance company need to comply with.
First, Mutual of Omaha will send you a letter telling you that your claim for long term disability has been denied. The letter should review the evidence they had, what they reviewed, what actions they took (for example, having your medical records reviewed by a doctor of their choosing). The letter will set out the long term disability insurance policy definitions, terms and conditions that they say apply to your specific situation, where to send your appeal and the date it is due (under ERISA, that is 180 days from the day you receive the letter denying or terminating your benefits).
There have been recent regulations that have extended the filing time limit due to Covid, but an appeal requires significant work, analysis, medical testing, working with medical specialists, preparing witness statements, vocational evidence, legal analysis and drafting, so you want to get started right away.
Get an Experienced Long Term Disability Lawyer to Analyze the Letter Denying Benefits.
If you received a letter denying or terminating your long term disability benefits, our team will review and analyze your denial letter absolutely free of charge, with no obligation whatsoever, and will outline some of the steps you need to take to generate the strongest and most persuasive appeal you can.
Once you have this valuable resource, you can use it as a basis for drafting and filing your own appeal (it's a lot more than just filling out a form). Eventually you may be in federal court (ERISA is federal law) where a federal judge will decide the case based on the appeal you filed and the evidence you submitted to support it.
Fax or Email Us the Letter You Received that Denied or Terminated Your Long Term Disability Benefits
To send us a letter you received from Mutual of Omaha or any other long term disability insurance company, just email it to [email protected] with the subject line: Denial Letter, or fax it to us at (202) 393 - 3324.
Or call us today at (202) 393 -3324 to get our valuable resources and to get started.
The Long Term Disability Claims Rep Says I Have to Show Proof of Disability to Continue Benefits. What Does That Mean?
Proof of Disability in Long Term Disability Claim
After you have been awarded long term disability benefits, most long term disability insurance companies require you to show proof of ongoing disability, and sometimes it is called "proof of loss". Some of that will depend on your specific long term disability policy, but there are some common requirements, such as:
- the long term disability company (Mutual of Omaha, Hartford, Guardian, Reliance, etc) will have internal guidelines for reviewing your claim.
- the insurance company can require you to provide proof of disability at certain points (usually every 45 - 90 days or so)
- the insurance company can require that you are under the care of a physician
- the insurance company can send you to one of their doctors for an evaluation
How Do You Prove Disability in Your Long Term Disability Claim?
The first thing to do is to make sure your doctor understands the physical and mental aspects of your job, so that your doctor can address all of the relevant restrictions and limitations from your medical condition or injury. Its a common misperception, but your doctor doesn't necessarily have to say you are "disabled" or that you can't work at the job.
But the doctor does have to provide the limitations on your functioning (and those limitations or restrictions should lead to the conclusion that you can't do that job). Here's an example of how restrictions and limitations match up with your job duties:
As a bank manager, your duties may include things like supervising employees, verifying cash counts, making decisions, using judgment, interacting with the bank's customers, scheduling deposits. But a severe concussion has impacted your ability to think clearly, to make decisions, to process information quickly, to remember things clearly and to follow directions.
The physician treating you for post concussion syndrome should be able to address whether you are able to make decisions at a pace appropriate for a bank manager, whether you have memory loss, altered or affected judgment.
Usually your long term disability insurance company will have a form for the doctor to complete. And its important that you meet with your doctor to make sure the doctor understands all of your symptoms and problems with functioning. And that should also appear in your doctor's records.
Is Proof of Loss Different than Proof of Disability?
That really depends on your long term disability policy. Some insurance companies use the terms interchangably, or as an initial determination of whether you are disabled according to the policy. So proof of loss may require you to provide:
- Evidence of your income, such as tax returns or W-2s
- Medical information - doctor's reports, diagnostic tests, treatment notes, etc.
- Evidence of Other Income Benefits (social security disability for example)
- Most policies will also require you to apply for Other Income Benefits like social security disability because they can use those to reduce the amount of long term disability benefits thay have to pay.
In addition, the long term disability insurance company can have you examined by a physician or other specialist of their choice (such as a vocational rehabilitation counselor or functional capacity evaluator) or interview you, as part of the Proof of Loss determination.
How Can a Long Term Disability Attorney Help You Prove You are Disabled?
As long term disability attorneys based in Washington, D.C., we talk to people who are struggling with keeping up with the insurance company's endless demands on them and their doctors to continue to prove they are disabled - often a consulation with a long term disabilty attorney can get you on the right track.
And a common way to deny long term disability benefits is for the insurance company to say you do not have sufficient limitations or restrictions, so aren't disabled as defined by the policy.
If your long term disability benefits are denied or terminated by the insurance company, you only have one chance to appeal - getting a long term disability attorney, one experienced with working with physicians and other experts you'll need to prove your claim, is a smart choice.
Call us today at (202) 393 - 3320 with your questions on long term disability benefits in D.C. We're here to help.
My Long Term Disability Benefits Were Denied and I Need to Appeal. Should I Get an Attorney to Appeal?
Get the Right Lawyer to Appeal Your Long Term Disability Denial
Do you need a lawyer for your long-term disability appeal? The answer is almost always yes.
If you have been denied long term disability benefits or your benefits have been terminated, and you have a serious medical condition or injury that prevents you from working, you probably have too much to lose by trying to appeal yourself.
And under ERISA (the federal law that governs most long term disability plans provided as an employee benefit through your job) your appeal is the most critical component. Here's why your appeal is so important:
- The appeal goes to the disability insurance company that just denied or terminated your benefits (that sounds crazy that the same company gets your appeal, but that is the inital step).
- You can add evidence - medical records, opinion letters, reports from experts and specialists, diagnostic test results, etc. that supports the fact that you cannot work due to your illness or injury, and that the insurance company will have to consider.
- You need to argue your case in your appeal, based on the law and the analysis of the insurance company's decision to deny benefits under the policy and their denial letter.
- You can add witness testimonials from people who know your condition, what you are going through, and what your job requires
- You can rebut the evidence the insurance company used to deny or terminate your long term disability benefits - did they have a physician review your records, do they have surveillance video they say shows you can work, do they think your job is physically less demanding than it is, or that you could work in another, similarly defined job?
- Your appeal is part of the administrative record that a federal judge will use to decide your case for long term disability benefits if your case goes to court.
There are certain types of cases that people can handle on their own, especially if they have a minor injury (and we tell people that every day). But this isn't one of them.
If you have a medical condition, illness or injury that is severe enough that you can't work for 6 months, it is probably permanent and may prevent you from working for the rest of your life, even with good medical care and treatment.
That is a lot of income to replace - which is why you have long term disability insurance that you either purchased or were provided by your company as part of your employee benefits and compensaton package.
And most people don't know how complex and difficult long term disability cases are (most lawyers won't even handle these cases). But don't risk everything you've worked hard for on a system that combines law, medicine, regulations, and insurance - get the right lawyer to help you and your family, so you can focus on getting better.
Get The Information and the Help You Need Today
You're making a big decision for yourself and your family, and we are here to provide the information you need to make the right choice. Download our free report Claim Denied: The Ugly Truth About Long Term Disability today at no cost or obligation. After reading this free report you will be 100% more prepared to navigate your future with a long term disabilty claim.
Ready to Speak to An Attorney Today?
We're here to help, so call us today at (202) 393 - 3320 to talk about your long term disability issue. We have a number of options to help you wherever you are in the process, even if you're just applying and have questions or concerns. And if you received a letter from your insurance company denying or ending your long term disability benefits, send that to us at [email protected] and we will review it at no charge, in confidence and with absolutely no obligation. We'll give you options and what we think your next steps should be based on the specifics of that denial letter.
If I Appeal My Long Term Disability Case, Or If It Goes To Court, Will I Have to Testify in Court?
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 a 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:
If Your Claim For Long Term Disability Benefits is Denied or Your Ongoing Benefits Are Terminated, You First Have to Appeal That Decision.
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 To The Insurance Company 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, depostions 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 Be Able To Testify in Court.
Again, most policies fall under ERISA but some are private, state law contracts. If you have an 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 discovery, including your deposition. And if the case goes to trial you may testify in court.
Download Our Free Report To Get The Information You Need Now
If you're just getting started in the process, you need the right kind of information to make good choices for yourself and your family. We have a free report you can download and read to better understand what will happen if your claim is denied and the dangers of handling the claim on your own. Download this free report now.
Talk To A Long Term Disability Attorney in DC
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 [email protected] We'll give you or 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.
How do the smartest executives working in DC get long term disability benefits when they can't work?
Getting Long Term Disability Benefits After A Serious Illness or Injury.
If you're like most executives working in DC you've worked really hard for your entire career to make a difference and provide for your family.
You had absolutely nothing given to to you. You paid your own way. You earned it.
But what happens when a medical condition or serious injury keeps you from working and you suddenly need long term disability benefits?
First, you have to realize that, even though you may have paid premiums for a long term disability policy for many years, the policy gives your disability insurance company a lot of discretion in how to decide your claim for benefits - it's obviously written to favor the insurance company.
So you don't want to take any chances. Don't give the insurance company the opportunity to deny or terminate your long term disability benefits because you don't know any better.
You don't want to get taken advantage of. You don't want to lose everything you've worked hard for.
How Do I Appeal a Denied Long Term Disability Claim?
If your claim for long term disability was denied, you need to formulate evidence and write your appeal as if a federal judge was deciding your case based on the appeal and the evidence you submit.
Once your benefits are denied under a long term disability plan covered by ERISA (the vast majority of long term disability policies are governed by ERISA) you only have 180 days to file your appeal with the insurance company. This is not just some form you complete - it's an opportunity to add evidence in support of your claim, so you need to work with medical experts, specialists, vocational experts, medical researchers and others to make sure you have the medical evidence (testing, physician reports, expert opinions, medical literature, etc.), vocational and occupational evidence you need.
This is critical because if your appeal is denied by your insurance company (that's who the appeal goes to), the next step is to file your case in federal court (in D.C., the U.S. District Court for the District of Columbia) where a federal judge will decide your case without witnesses or discovery - the decision in your case will be based on the administrative record, including your appeal and everything submitted with it.
In our complex medical malpractice cases, we always say the best way to get a good settlement is to prepare for trial, so we do an incredible amount of work before the case is ever filed in court. The same concept applies here - everything you do should be done to persuade a federal judge and to build your case at the appeal stage.
If a lawyer tells you to wait until you file the case in court, so the other side doesn't know what is coming, or to wait and take the depositions of your doctors, or that you have an aooprtunity to develop your case during discovery - then that lawyer doesn't know ERISA disability cases.
It's Best To Get a Long Term Disability Attorney Working For You Early in the Process
The best way to win a long term disability appeal is to identify all of the additional evidence that supports your disability, analyze the policy, work with your physicians and other specialists and experts to develop additional support that you are disabled under the policy, draft personal statements from you, co-workers and others who have witnessed the effects of your medical condition, analyze the legal weaknesses in the insurance company's decision to deny your benefits, and draft an appeal that incorporates all of the facts, law and medicine.
No matter how successful you are, once you have a serious injury or medical condition, this is an almost impossible task.
Let Our Experienced Long Term Disability Attorney Take This On For You
We start by analyzing the insurance company's position in denying or terminating your long term disability benefits and give you the next steps that can help. And we work with you, your family, your doctors as well as other experts and specialists to put your appeal in the best position to get you the long term disability benefits you deserve.
Call us today at (202) 393 - 3320 to get started.
What Do I Need To Do To Get Ready To File For Long Term Disability?
What To Do Before Filing For Long Term Disability
First and foremost, 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, 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, construe everything that isn't 100% clear in their favor.
Why You Need To Review Your Medical Records First
There is 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 could be what your job is, how long you've had the injury or condition, what caused it, 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.
The records aren't complete - there are visits, labs, tests, etc. that are not in your medical chart.
Your doctor isn't 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.
Medical Providers And Insurance Companies Have Completely Separate Agendas
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, 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, 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.
You Stand To Lose A Lot If You're Not Careful About Managing Your Medical Records. Call Us Today For Help
If you 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. If you want more information on how to prepare for your ERISA long term disability claim, or want to talk it through, just call us at (202) 393-3320.
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 file 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.