If you have been denied your long-term disability benefits claim, you are not alone. The sad and simple truth is big insurance companies deny legitimate disability claims all the time. They know that after they deny your claim, the burden is on you to appeal and prove how they are wrong.
If you submit a bad appeal or do not follow the rules, insurance companies know they will likely never have to pay your benefits.
To help you understand the disability appeals process, Roy Law Group has created this list of six common oversights and errors often made by people who have been denied long-term disability benefits. Avoiding these mistakes will hopefully help you create a winning appeal and restore your benefits.
6 Common Mistakes to Avoid When Filing Your Appeal
1. Not having a copy of your long-term disability policy to review
If your long-term disability benefits are part of an employee benefit plan, you can usually obtain your policy directly from your employer. If you obtained your policy individually and not as an employee benefit, then you can obtain your policy directly from your insurance company.
Regardless of how you have obtained disability insurance, your policy is a contract and the terms of the contract will be enforced as written, except in very special circumstances. The first place to start when dealing with any detail is to review and understand your policy.
Not sure what kind of disability insurance policy you have? Learn about the differences between an ERISA plan and an Individual Disability Insurance plan here.
2. Sending in your disability appeal before reviewing the claim file
If your disability benefits claim is denied, you will be notified via a formal denial letter. After receiving this denial, you should request a copy of your entire claim file from the insurance company. They will provide it to you, and it will contain all of the information about how your claim was handled.
From the day you initially filed your claim, your insurer has been putting together a claim file on you. This file contains everything the insurance company reviewed before denying your claim including your medical records, opinions from nurses and doctors, your vocational information, and other information.
When reviewing your claim file, you may also be able to determine more detailed information on why your claim was denied, such as if they were missing or misinterpreting a key piece of evidence. The only way you or your disability attorney will know is to get a copy of that claim file and review it thoroughly.
3. Being too hasty to fully appeal your long-term disability benefits claim
When you have been denied, you usually have 180 days to put your appeal together. You do not have to file your appeal the same day you receive a denial of benefits. You should use that time to put together the best appeal possible and to do some of the things on this list, like requesting your policy and claim file and reviewing all the relevant information.
Putting a complete appeal together greatly increases your chance of success. Further, in most cases, your appeal is the last chance you have to submit evidence supporting your claim. In those cases, if you lose your appeal you can file an action in court for judicial review. The court will not allow you to submit any additional evidence for your claim at this stage. If the evidence was not included in the appeal, the judge will never see it.
4. Waiting too long to appeal your long-term disability benefits denial
Under the rules, procrastination will nullify your claim if you miss the 180-day deadline to file an appeal.
Even if you do not miss a deadline, if you wait until the last minute to get your appeal put together, you may not have time to review the policy and claim file and gather all of the necessary information to overturn the denial.
5. Communicating via unverified means (first-class mail)
U.S. Mail is nearly 100% reliable. Always err on the side of caution by sending your correspondences to your insurer via certified mail and always keep a copy for your own files.
Having a certified fact pattern of your communications eliminates ambiguity, especially regarding your appeal where you must submit within 180 days or forfeit your claim entirely. If the insurance company claims they did not get your appeal, then it is your word against theirs. Do not take that risk.
6. Not asking for help
Long-term disability claim appeals get complicated, quickly. There is a very slim chance that you will be able to overcome the denial of your claim on your own. However, doing so without the help of an attorney in this specific area of law is near impossible.
Most importantly, your appeal often is the last chance you have to submit evidence to support your claim. Regulations in this space are written by attorneys, for attorneys. Do not leave your case to chance.
Have you been denied by your insurance provider?
Talk with our team at Roy Law Group. We have been battling disability cases and nothing else, since 2009. We do the heavy lifting so you can take care of yourself.
Contact us today for your free legal assessment.