While it is certainly possible to file your own appeal for a long-term disability insurance denial, this process can quickly become overwhelming and complicated (especially when paired with the pains of chronic illness). As attorneys experienced in insurance law, we have become experts in spotting common reasons for insurance denials, and understanding exactly what needs to be done to overturn such a decision.
A successful appeal is critical to obtaining disability benefits. We can assist you in gathering specific facts and evidence essential to proving your disability claim.
How An Attorney Can Help:
1. Making sense of your policy
Understanding the language and terms of your disability policy can be quite a challenge. A common question asked by our clients is “will I be able to sue the insurance company for all the emotional distress they have caused me?” Depending on how you obtained your disability insurance, the answer to this question will be very different.
We are available to read through your policy and help you understand exactly how you are covered under the terms of your plan. (And, if retained, we do not charge for this, it is all part of our services wrapped into a contingency fee agreement. You only pay a fee if we are successful in getting your benefits!)
2. Time limits for your appeal
Your denial letter might specify that you have a maximum number of days to appeal an adverse determination regarding your disability claim (usually 180 days, but possibly as short as 30 days). If you miss this deadline, there is a very high likelihood you will lose your ability to file a lawsuit to have a judge decide the merits of your claim.
We can help you understand and keep track of deadlines.
3. Communicating with your insurance company
We understand how challenging and overwhelming the prospect of trying to get answers from your insurance company can be. We advise that you try to stay off the phone as much as possible! All communication should be in writing, in traceable forms such as certified mail, fax or e-mail. If you can't prove it, it never happened! Although it’s not always possible, if and when you are on the phone try to get the name, title, phone number and email address of everyone you talk to. Speaking with different insurance representatives can become confusing and overwhelming.
When working with clients, we take on the complicated task of communicating with your insurance company…so that you don’t have to.
4. Proper evidence for total disability for your “own occupation” or “any occupation”
In order to receive long term disability benefits, you must satisfy your insurer’s definition of disability, and you must make sure that your doctors and care providers understand how to articulate your medical condition. It is important to understand this because most disability insurance policies will use two disability standards, based on the length of your disability. These standards include:
- “Own occupation” – You will be required to prove that your illness or injury prevents you from performing the material duties of your own occupation, not necessarily the job as you were performing for your employer. Many policies limit this definition to the first 12 or 24 months of disability benefits.
- “Any occupation” – After the specified “own occupation” period, you will have to show that your illness or injury prevents you from performing any occupation, usually considering your education, training, and experience. Sometimes the policy will limit the any occupation definition to “gainful” occupations. Meaning the ability to perform an occupation where you would earn a wage at a specified level, or commensurate with your station in life.
We can help you provide your insurance company with evidence of your disability …according to their standards.
5. Making the subjective, objective
Insurance companies often deny claims based on “lack of objective evidence.” For those suffering with “invisible illnesses,” this becomes a tricky situation. You should know that treatment notes from your physician are considered clinical documentation that should help to satisfy any need for objective verification. Thus, it is critical that your treatment providers accurately record your symptom severity against a clear baseline. Medications and therapies should also be fully discussed. In addition to treatment notes, you can objectify your disability with written support from your employer, family members, or any friends who have experienced the disabling nature of your illness. Plus, it is not always sufficient to simply show that you have a disabling disease. You must also objectify how the disease restricts and limits you from performing in a work environment.
We are available to assist you in providing objective evidence for your claim.
Managing an appeal on your own can be risky if you are not physically or mentally capable. If the case becomes too complicated to handle on your own, you may want to seek out advice from a professional. Kantor & Kantor has a team of experts that work on a on a contingency fee basis, which means you only pay if we obtain a benefit for you. We understand the struggle of living with a chronic disease, and we are here to help. For questions about your long term disability claim, call (800) 446-7529.