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How to Win Your Long Term Disability Appeal - 5 Do's and Don'ts

Disability Wiki.

Here are five do's and don'ts that will help you win your long term disability appeal.

DO’S

  1. Submit a Comprehensive Appeal.  An administrative appeal is your last opportunity to submit evidence in support of your claim. Any evidence not submitted during the administrative appeal process generally is not admissible in a future litigation. When you retain Riemer Hess's disability attorneys in New York, we make sure you take advantage of this opportunity and submit any additional documentation that will support your claim.Disability Attorney Winning Long Term Disability Appeal
  2. Timely Appeal the Insurer’s Denial. If your appeal is submitted after the 180-day deadline, the private disability insurance company may refuse to review your claim.  In that case, it is unlikely that a court will review your case.  In other words, the late appeal could be treated as a statute of limitations violation making it difficult, if not impossible for you to prevail in court. Contacting our disability attorneys early in the appeals process will help ensure that we have enough time to file a comprehensive appeal on your behalf.
  3. Request Proof of Receipt.  Insurers often assert they never received documents sent to them.  Because of this, and because the deadline for an appeal is so important, we always send appeals to insurers in a manner where we will be provided proof of receipt.  We generally send an appeal letter by FEDEX and by fax for added comfort.
  4. Maintain a Good Relationship with Your Doctor. During the appeal process, we most likely will need to ask your doctor to answer a questionnaire, prepare a narrative report and comment upon the report of the insurer’s doctor. In other words, we will need your doctor’s cooperation and help.  Although most doctors will not demand payment for this help, we recommend that you offer to pay the doctor for his or her time.  The offer goes a long way in creating good will.  Moreover, even if the doctor does charge for his or her time, it is worth the cost.  That way, we will obtain a professionally prepared report rather than a half-hearted one.
  5. Be Cognizant of Surveillance.  While you always should be cognizant of surveillance, you should be particularly wary if the private disability insurance company sends you for an Independent Medical Examination or an FCE. The insurer will know exactly when and where you will be on the day of the examination.  Since insurers generally conduct surveillance over the course of 3 consecutive days, you should also be careful the day before and the day after the examination. It is a good idea to have a friend or family member drive you to and from the exam, and for you to go directly home following the examination.

DON’Ts

  1. Submit An Immediate Appeal.  While you likely will be outraged by the denial or termination of your LTD benefits, you should resist the impulse to immediately submit an appeal.  ERISA provides you with 180 days to appeal for a reason.  It takes a lot of time to compile all of the evidence and information you will need for a comprehensive and successful appeal.  Most private disability insurance companies only give one appeal.  If you use up that appeal quickly without proper preparation, your chances of succeeding in a future litigation will be greatly diminished.
  1. Ignore the Insurer’s Internal SOAP Notes.  While an insurer’s internal notes can be quite voluminous, typed in a small font size, and difficult to follow, they should not be ignored. The internal notes often contain details of your telephone conversations with your claim representative or the insurance company’s nurse. They may contain the report from the insurance company’s file review physician, notes from a vocational consultant or notes from the insurer’s doctor’s telephone conversation with your treating doctor. The internal notes also may contain certain admissions by the private disability insurance company that could help your claim. The our disability attorneys in New York spend a lot of time reviewing the SOAP notes so that we could address any concerns raised in them, and have you or your doctor address any misstatements contained in the notes of telephone conversations.
  1. Forget About the Vocational Aspect of Your Case.  In any disability case, there are two aspects evaluated by the insurer – the medical aspect and the vocational aspect. Therefore, you not only must prove that your medical conditions cause restrictions and limitations, but you also must show that, given your restrictions and limitations, you are unable to perform the duties of your own or any other occupation for which you are qualified by education, training or experience.  At Riemer Hess, our disability attorneys in New York generally obtain a report from a vocational expert to make this connection and help prove your case.
  1. Bother Your Doctor Too Often. Treating doctors often are more than willing to help their patients by writing rebuttal or narrative reports and working with you to submit the documentation necessary to prove your case. However, doctors are very busy and often get annoyed if you keep bothering them.  At Riemer Hess, our attorneys try to submit a single request, or make an appointment to speak with your doctor to discuss your claim or complete a form.
  1. Attend an IME or FCE Unaccompanied.  The insurer’s doctors have the tendency to misrepresent your statements or their physical examination findings. Therefore, it is always a good idea to attend an IME or FCE with a nurse, friend or family member who can take notes and witness the examination.  A nurse often is your best option as they have medical training, and will be able to identify what types of examinations or maneuvers are being performed. At Riemer Hess, our disability attorneys in New York routinely use a nursing service to provide a nurse to attend the IME or FCE with you.

 

Consult our Disability Attorneys in New York Regarding Appeal Do’s and Don’ts

If you have any further questions regarding appeals, we can help. Our knowledgeable disability attorneys will dedicate the time and energy you deserve. Call them today at 212 297 0700.

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