As an attorney who regularly represents individuals with long term disability insurance claims, I am passionate about securing these benefits for my clients. Fighting long term disability insurance companies is challenging. Not only can they deny your claim without notice and then wait while you go without needed benefits, long term disability insurance companies also have a number of legal advantages in the appeal process.
If your long term disability insurance benefits claim has been denied you will typically need to file an appeal within 180 days of the denial. This is a difficult process, especially if you are suffering from both a disability and the loss of a major income source. The stress of this situation can be overwhelming, so it’s easy to make mistakes. I want to point out the worst mistakes you can possibly make so you can avoid them.
1. Ignore the Deadline to Appeal Your Disability Claim
The worst thing you can do when your long term disability claim is denied is ignore the appeal filing deadline. In most cases you only have 180 days (or about six months) to gather evidence and file your appeal. The long term disability insurance company will not tell you that the internal appeal is your last opportunity to add evidence of your disability to the official record. If you miss the deadline to file your appeal, your best evidence will not be allowed in Court.
2. Don’t Involve Independent Experts
Speaking of evidence, make sure to submit reports from experts to support your long term disability claim. Two of the most common and important reports are a functional capacity evaluation report and a vocational expert report.
A functional capacity report comes from a standardized, objective test performed by a physical therapist. You will be tested on your ability to perform job-related tasks, such as lifting, pulling, pushing, standing, and sitting. The physical therapist uses this evidence to determine your ability to work. This report offers the best objective evidence of your true restrictions and is invaluable in a long term disability appeal.
After obtaining a functional capacity report, you may also need a vocational expert to evaluate your claim to challenge the insurance company’s report. Often the long term disability insurance company will use its own vocational expert in denying your claim, but this “expert” may base her report on bad facts or incomplete medical information. Your vocational expert will have all the facts and can explain why you are not able to work. If the long term disability insurance company denied your claim based on a vocational report, you most likely will need a vocational report of your own to win the appeal.
3. Don’t Order the Insurance File
Okay, you are going to meet the appeal deadline and are ready to submit strong evidence supporting your claim. But what exactly are you trying to prove to the long term disability insurance company? That’s an important question and one not completely answered in the denial letter. Sure, the denial letter will tell you some reasons why your claim was denied, but in order to get the full story, you need to order the administrative file from the long term disability insurance company.
The long term disability insurance company’s administrative file contains loads of information about why your claim was denied. You will find the actual reports from their reviewing doctors explaining exactly why they do not believe you are disabled, as well as any surveillance or other factual information used to deny your claim. Additionally, if the long term disability insurance company used a vocational expert, the file will contain his report.
The long term disability insurance company will not give you this insurance file unless you ask. Once you have it, however, you are in a position to dispute factual issues the insurance company got wrong. You can also ask your doctors or other experts to specifically address the issues cited in your claim denial. If you file your appeal without the long term disability insurance company’s file, you are really shooting in the dark.
4. Don’t Talk to Your Doctor About Your Long Term Disability Claim
One of the most common causes of claim denials is your treating doctor failing to speak with the long term disability insurance company’s doctor. The situation is even worse if your doctor does a poor job explaining your medical limitations. When pursuing a long term disability insurance claim, let your doctor know a doctor from the insurance company may be contacting him. Ask your doctor to please take this call and explain your restrictions in the same way he has been explaining them to you. You would be surprised how often treating doctors fail to take a call from the insurance company’s doctor. By not taking the call or not explaining your restrictions over the phone, your doctor hurts your chances of receiving the benefits you are owed.
Related: When you review the insurance company’s file as part of your appeal, check to see if your doctor said anything to the long term disability insurance company’s doctor. Often this will help you understand why your claim was denied. Talk to your doctor about this. If necessary, have your doctor draft a letter responding to these issues.
5. Appeal Your Claim Without A Long Term Disability Attorney
Finally, if your long term disability insurance claim is denied, please contact an attorney to discuss your appeal as soon as possible. Working with an attorney familiar with the rules and how long term disability insurance companies operate will give you the best chance to win your appeal and secure your long term disability insurance benefits.
When clients contact me after the internal appeals are complete, it is frustrating because I know there often was crucial evidence not submitted as part of the appeal. You may think this is not a big deal because that evidence can be submitted later in Court, but this is not true. A big advantage for the insurance company is once the internal appeal is over, additional evidence cannot be submitted later in Court. This means you are locked in to whatever information and evidence was presented to the insurance company as part of your appeal.
You Can Speak With a Long Term Disability Insurance Attorney at No Cost
If your long term disability claim has been denied, I will speak with you for free to discuss your rights and the best approach for your appeal. I offer representation on a contingent fee basis, meaning you will not pay me unless we win your claim appeal. Don’t make the mistakes discussed in this post. If your claim has been denied, please contact me for a free consultation.
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