If you filed a long-term disability claim and were denied, don’t give up hope. You can, and should, appeal a long-term disability insurance denial. Below, we outline steps to build the best case for your appeal. To learn more, speak to an Ocala FL long-term disability attorney at CJ Henry Law Firm, PLLC today.
Filing an administrative appeal may be your last chance to include information to support your case. If you leave something out, you may not be able to add anything for future litigation.
You have 180 days to file an appeal. Take this deadline seriously. If you miss the date, the insurance company and the court may refuse to review your case.
Prevent the insurance company from claiming they never received your information by requiring proof of receipt. Send the appeal two ways, such as by FEDEX and a fax or digital copy.
It’s important to have a good relationship with your physician because he or she may have to fill out a questionnaire or write a narrative for your appeal. If your doctor requires a fee for his or her time, pay it. If your physician doesn’t ask for a fee, offer to pay one anyway. It shows you value their time and they will probably reciprocate the respect.
There is a chance you’ll be under surveillance sometime during your disability claim process. If the insurance asks for an IME or an FCE, it’s more likely the insurance company will check up on you. Surveillance is generally done over three consecutive days, but you may be watched the day before and/or the day after your exam. Have someone drive you to and from the exam and be sure to go directly home after your appointment.
Here are things you should not do when you decide to file an appeal for denial of long-term disability.
You may be angry, anxious, or upset that you received a denial of your disability claim. That’s not a good time to respond to the denial. Resist the temptation to fire back a letter expressing outrage. ERISA gives you 180 days to file an appeal. Use the time wisely. Compose yourself and gather a complete, convincing appeal case. Most disability insurance companies only allow you one appeal. If you use it up in a moment of anger, you may forfeit your case.
You’ll receive internal notes from the insurance company. Don’t ignore them. Even if there are pages and pages of dense text, it’s worth reading it carefully. SOAP (which stands for subjective, objective, assessment, and plan) notes have valuable information you can use to build a solid appeal’s case. They may contain reports from the insurance company’s physician, a vocational consultant, or notes from your physician. Work with a disability attorney to prepare your appeal. He or she will review the notes and advise you about the best way to respond to any concerns.
When you file a disability claim, the insurance company looks at medical and vocational information. The medical review is information about what you can and cannot do because of your disability. The vocational information is about how your disability prevents you from performing your previous work, or any work. Give these two aspects of your claim equal consideration. Your lawyer can obtain a vocational report as a guide.
Your physician is a busy person. He will probably be willing to work with you on a long-term disability appeal. Don’t irritate them by calling them over and over. Compile all the information you need and send it all at once. If several weeks go by and you haven’t received feedback, it’s perfectly acceptable to call and leave a message. Remind your physician about your upcoming submission date and ask if there are any questions. Be respectful of their busy schedules.
Bring a friend, family member, or preferably a nurse, with you to your IME or FCE exam. Having a second person with you will reduce the likelihood that the insurance company’s physician will misrepresent the results of your exam or interpret the results in a way that will hurt your case. Your companion can take notes during the exam for future reference.