How A Disability Lawyer Can Help Win Your Appeal
You gave the insurance company all the medical records you have. Your doctor told them you were unquestionably disabled from your job. There was no way you could keep working. A claim denial seemed unthinkable.
But, here you are. The insurer denied your claim saying you did not submit sufficient objective evidence of disability. You feel cheated, trapped, angry, and a lot of other things we can’t describe here. You’re worried about supporting yourself and your family. You can’t return to work, and now you must figure out how to submit an appeal to the insurer.
We understand. You need someone who can advocate for you, help navigate the complex appeals process, and protect your rights. You can’t afford to go at it alone any longer. You have one chance to appeal the denial – you don’t want to squander it. APPEAL GUIDE
Riemer Hess has been helping disabled professionals and executive clients win their long term disability appeals for over 25 years. We win 3 out 4 of the disability appeals we handle, and focus on providing each client with first class customer service.
Here’s how we do it. Our disability attorneys will listen to your concerns, review the evidence in the record, and develop an individualized strategy to change the claim dynamic. We then will submit the strongest appeal possible on your behalf rebutting all the reasons for the insurer’s denial. PROVEN STRATEGIES
Our strategy will be designed to:
- Reduce your stress level;
- Change the claim dynamic;
- Ensure you have strong, objective evidence to support your appeal;
- Address and rebut all the reasons for the insurer’s denial; and
- Maximize your chances of approval.
When our disability attorneys prepare your appeal, we make sure the insurance company takes your case seriously. Our approach bolsters your claim for a potential future litigation, while substantially increasing your chances of approval by the insurance company.
Our tested approach has helped hundreds of disabled professional and executives in the NYC tri-state area. Just look at the difference our approach can have for individuals like “Do-It-Alone-Debra” and “Protected Patrick.”
Debra is a 51-year-old marketing vice president who’s been working for the same Fortune 500 company for the past 10 years. Over the past decade, Debra became well-respected throughout her company for her ingenuity, strong leadership skills, and hard work. Thanks to Debra, the company was always one step ahead of the competition.
Knowing Debra’s worth, the company consistently rewarded her with handsome compensation and well-deserved recognition. She felt more than accomplished and fulfilled in her role.
Debra, however, had a secret. She had been suffering from Crohn’s disease, a serious gastrointestinal disorder, for many years.
While her condition was previously well-controlled by dietary changes and anti-inflammatory medications, she began to experience more frequent and severe flare-ups over the past year. As Debra’s symptoms worsened, they started to seriously interfere with her work and attendance.
Realizing she needed to go on disability, Debra decided to leave work and file a long term disability claim. To her surprise, the claim was denied.
Unfortunately, Debra made the fateful decision to file an appeal without an attorney. The decision would come back to haunt her.
Unsure where to start, she figured she should submit some new evidence. She called the claims representative and asked what to submit, but the representative was rude and unhelpful.
Without any guidance, Debra submitted the following with her appeal: (1) five pages of new medical records; (2) a note from her doctor stating she is “disabled”; and (3) a cover letter asking the insurance company to reverse its decision.
Once the insurance company received Debra’s appeal, it sent her file to an “independent” doctor for review and comment. Of course, the doctor was anything but independent – he had a direct conflict of interest and an incentive to help deny Debra’s appeal. Unsurprisingly, the doctor found there was nothing preventing Debra from working.
Several weeks later, Debra received a letter in the mail – her appeal had been denied.
With no plan, no help, and no understanding of her rights, Debra was devastated. The only remaining option was to pursue lengthy and costly litigation.
Compare Debra’s story to that of “Protected Patrick,” who sought the assistance of Riemer Hess before filing his appeal.
Patrick is a 55-year-old sales vice president for a major pharmaceutical company. He spent years building his reputation and generating top revenue, gaining the respect of his competitors and peers along the way. His accomplishments and success became an integral part of his personal identity.
Unfortunately, Patrick suffered a serious car accident at the height of his career, which left him with progressively worsening back pain and knee pain. Patrick wasn’t sure what his future would hold, but he knew he wanted to keep working for as long as possible.
The next few months weren’t easy for Patrick. He struggled more and more at work as his pain progressed. Traveling for work and sitting at his desk for long periods of time became nearly impossible. By the end of the workday, Patrick was in severe pain and completely drained of energy. He could feel his quality of life and work spiraling downward.
Patrick knew he had to leave work and file a long term disability claim. To his surprise, his claim was denied.
At this point, Patrick made the smart decision to hire a long term disability attorney. Recognizing how high the stakes were, he contacted Riemer Hess, a firm in New York City that represented professionals and executives like Patrick.
After carefully reviewing Patrick’s policy and denial letter, Riemer Hess met with Patrick to learn more about his situation and discuss obstacles to overcome. The biggest obstacles they identified included lack of recent medical evidence and a damaging report from one of the insurance company’s “independent” doctors.
Riemer Hess immediately sprang into action by developing a personalized plan to file a strong appeal for Patrick. The strategy included:
- Obtaining a functional capacity evaluation to objectively demonstrate Patrick’s physical limitations;
- Obtaining, organizing, and reviewing Patrick’s orthopedic medical records;
- Obtaining updated diagnostic testing to document Patrick’s back and knees problems, including updated MRIs.
- Guiding Patrick’s orthopedist in reviewing and responding to the insurance company’s “independent” doctor;
- Helping Patrick prepare an affidavit about his disability;
- Handling all communications with necessary parties, including the insurer; and
- Filing a detailed and well-supported appeal letter on Patrick’s behalf.
Riemer Hess immediately got to work. Knowing that evidence was key, Riemer Hess went above and beyond to obtain everything Patrick needed.
First, Riemer Hess referred Patrick to a qualified physical therapist to perform a functional capacity evaluation. When the results were ready, Riemer Hess carefully reviewed the report to ensure it was supportive.
Second, Riemer Hess gathered all of Patrick’s relevant medical records, including the updated MRIs. After organizing and reviewing Patrick’s records, Riemer Hess contacted his orthopedist to guide him in preparing a written response to the insurance company’s “independent doctor.”
Third, with the help of Riemer Hess, Patrick’s orthopedist provided a written response that: (1) attacked the insurance doctor’s credentials and reliability; (2) pointed out inconsistencies in the insurance doctor’s report; and (3) provided a detailed assessment of Patrick’s restrictions and limitations while referencing the new functional capacity evaluation and updated MRIs.
Fourth, when Patrick’s orthopedist was done, Riemer Hess carefully reviewed the written response to ensure it thoroughly addressed the insurance company’s concerns.
Fifth, Riemer Hess helped Patrick prepare an affidavit which explained the progressive nature of his pain and how it prevents him from working. The affidavit supplemented the basic information Patrick previously provided on his claim forms – thus, giving Patrick the opportunity to explain his side of the story.
Sixth, once Riemer Hess had strengthened Patrick’s appeal with as much supportive evidence as possible, the firm prepared a detailed appeal letter which: (1) summarized the supportive evidence; and (2) addressed the insurance company’s concerns and errors.
Seventh, Riemer Hess filed the appeal on Patrick’s behalf and continued to follow-up on the insurance company’s review. After a few weeks, Riemer Hess learned the insurance company had sent Patrick’s file to a new “independent” doctor for review.
Riemer Hess immediately demanded a copy of the report and the opportunity to respond. The insurance company obliged. After helping Patrick’s orthopedist in prepare a second response, Riemer Hess continued to follow-up with the insurance company about status.
A few short weeks later, Patrick’s appeal was approved. His benefits were paid immediately.
Patrick felt so relieved – he couldn’t imagine going through this process without guidance or help. He even decided to hire Riemer Hess to protect his ongoing benefits going forward.