Even if your claim for long-term disability insurance benefits has been denied, there is still hope. Many successful long-term disability claims are turned down initially. Personal Injury Lawyer Brad Parker says, “The insurance companies will routinely deny claims in hope that the claimant will just go away. It’s a matter of business practice. They will go to great lengths to find anything they can to deny a claim.”
With patience, perseverance and the help of an experienced attorney, the chances for a successful appeal greatly increase. “When clients receive a wrongful denial letter, I advise them to follow the instructions in the letter to a T. I also instruct them to file their appeal in a timely manner. I’ve helped many clients recover compensation for the long-term effects of their injuries,” Brad says.
Steps for Appealing a Denial Letter
- Carefully review the denial letter. Note the reasons why your initial claim was rejected and any additional information that you might need to get your claim approved. The letter should explain how and when to file your appeal. Don’t miss the deadline. That’s the quickest way to sabotage an otherwise worthy claim.
- Thoroughly read your insurance policy. Obtain a copy of your long-term disability policy from your company’s human resources department or your insurer. Requests for plan documents, along with all correspondence with your insurance company, should be sent through certified mail with return receipt requested.
- Hire an attorney. In most cases, long-term disability claimants will wait until receiving their denial letters to hire an attorney. It’s advantageous to work with a lawyer while filing the initial claim. He or she will work to put your case in the best light possible, often by obtaining additional medical evidence or soliciting opinions from your doctors or vocational experts. Moreover, many insurance companies and plan administrators, whether fair or not, seem to take a disability case more seriously when you are represented by counsel.
Finding Favorable Evidence
The courts have been clear that all evidence favorable to the claimant must be addressed. This is helpful when attempting to prove that the insurance company has been capricious in denying a claim. It's essential to stack the record with favorable evidence before exhausting your insurer's internal appeals process.
Inquire which tests could help. The more objective medical evidence you provide, the better your chances will be. Insurance companies commonly say a lack of objective evidence is the basis for denying a claim. Reach out to your claims representative to see if further testing, such as scans, MRIs, X-rays or blood tests, would help your case.
Request letters or expert testimony. Certain types of non-medical evidence, such as written observations from friends and family members concerning your limitations, can bolster your case. Vocational evidence can be particularly helpful if you have an "any occupation" LTD policy, which defines disability as the inability to engage in any job, not just your current one.
Collect missing records. Insurance companies will often fail to obtain all the medical records relevant to your claim. You will have to find out which records were used to decide your case initially. If anything is missing, inform your claims representative and ask for confirmation as to when the records were requested and are received.
Ask your doctors for supporting written documents. You should ask your treating physician and specialists to provide written opinions about your work-related limitations caused by your medical condition. If you're working with an attorney, he or she will be able to craft specific questions to your doctors based on the circumstances of your case. Some doctors may charge a relatively small sum for completing LTD paperwork, but this is usually a worthy investment.
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