“Can you appeal a long term disability denial yourself? Yes, but it’s not a good idea.” As stated in the above video, this advice may be a rude awakening for many claimants. Why is filing an LTD appeal yourself a bad decision? The reasons become more apparent when you consider things from the insurer’s point of view.
Insurance companies want to reduce the claims they pay out.
By denying a valid disability claim, insurers stand to gain far more than they lose. This is especially true for group claims under ERISA law. If a case ends up in federal court and the judge decides in your favor, all the insurance company is liable for is what they owe you in benefits in the first place.
For private disability claims, at the risk of having to pay punitive damages and other costs, insurers often take that chance and deny legitimate claims. Many private disability cases will involve payouts in the $ millions. If an insurance carrier denies 40 legitimate claims and gets away with half of them, they have saved profits overall.
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Filing an LTD appeal means arguing each reason for denial, item by item
On what grounds did the insurer deny your claim?
To know this, you need to examine the insurer’s letter of denial and identify the reasons why they denied your claim. Then you strategically rebut each reason given for the denial. You also need to anticipate the tactics the insurance company may have used to deny disability benefits unfairly.
If you cannot prove to the insurer how they are wrong, they will never change their decision.
- Did the insurance company say the medical records you provided in your initial claim are inadequate, or allege they never received them?
- Have they used video surveillance to intimidate or coerce you?
- Have they requested information that you cannot reasonably produce?
- Are they ignoring your doctor’s opinions in favor of their in-house physician’s paper review?
- Did they require you to undergo a vocational assessment wherein their examiner “found evidence” that you are not disabled?
- Are they using stall tactics, not returning emails or phone calls, or sending you incorrect forms?
The list goes on. These tactics are intended to frustrate you as well as shorten the amount of time you have to submit the appeal.
Filing an LTD appeal includes assembling the appropriate medical and vocational documentation and preparing clarifying arguments. A successful appeal often requires undergoing additional vocational assessments or other tests. Rarely does a disabled claimant have the knowledge or resources to rebut each reason for denial with evidence that will convince the insurance provider or prevail in litigation.
The insurance company is hoping that you will file the LTD appeal yourself.
There is nothing to keep some insurers from denying your appeal. They hope that after weeks and months of delays and denials, you will give up. If you press on with a lawsuit, the insurance company expects to win the court battle. This outlook often changes when the insurer realizes that a skilled disability law firm is representing your case.
If you are determined to file the disability appeal yourself, make sure the facts of your case can prove you cannot work according to your policy’s definition of “disability,” and can stand up against the insurance company in a court of law.
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Checklist for Filing an LTD Appeal
A successful disability insurance appeal is not merely a letter stating your diagnosis and that your doctor says you are disabled. Disability cases require a fully developed appeal. The burden is on you to prove you are no longer able to work.
Below is a short list of must-dos for filing a disability appeal. Keep in mind that every insurance adjuster is different, and no two conditions, and no two disabled individuals, are alike.
- Follow all time limits and deadlines.
- Request a copy of your policy, and you claim file, and fully review and understand each.
- Provide complete medical records.
- Build your appeal with objective medical and vocational evidence. For example, your case may benefit by obtaining a Functional Capacity Evaluation done by an impartial and experienced third party, to help prove the physical level of work you can or cannot perform as an impaired person.
- Supplement your appeal with current medical opinions and statements from all treating physicians (in addition to your primary)
- Include letters of disability approval from other disability agencies (Social Security, Worker’s Compensation,)
- Enclose written observations from family, friends, co-workers, clergy, and others who can support your claim with personal insights as to how your condition(s) affect your day to day life.
See further disability insurance information regarding LTD appeals.
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Filing an LTD appeal is complicated. Claimants are most often successful when they have strong representation from an experienced disability lawyer. Let us help you get the long term disability benefits you deserve.
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