Here is the situation. You find yourself in a position where you are unable to work because of an injury or illness. Because your employer provides long-term disability coverage in your benefits plan, you file for the benefits you have been promised.
You go through the process of filing for your long-term disability benefits, and though you have never needed these benefits before, you are pretty sure it is an open and closed issue. You are injured, you cannot work, you meet the requirements for these disability benefits.
Then… you are denied. What do you do now? Who can help you? More to the point, how will they be able to help you?
The following are several ways that an ERISA disability attorney will be able to help you in overcoming your long-term disability claim denial.
A Disability Attorney Will Draft a Compelling Appeal letter
A good disability attorney will know how to write a persuasive appeal letter. Your long-term disability benefits appeal letter should thoroughly discuss your claim, the evidence of your disability, where and why your insurer is incorrect, and be crafted in such a manner that you do not accidentally harm your claim more than you are helping it.
Here is our article covering how to Write a long Term Disability Appeal Letter. It’s a great start, and of course, you can reach out to us at any point for help.
Requesting Your Claim File
One of the most important aspects of your disability appeal is going to be including all possible evidence in your final appeal. The reason for this is that once your appeal has been finalized, future decisions on your claim, via a lawsuit (if necessary) will be based on the evidence you submit today. You will not be able to submit additional evidence in the future.
For this reason alone, knowing what the insurance company has reviewed helps you and your attorney know what evidence you may still be able to submit. Moreover, knowing the evidence that the insurance company has on hand will help your disability attorney pick apart their denial in much greater detail.
A Disability Attorney Will Seek All Necessary Medical evidence
A good disability attorney will make sure your file contains all relevant medical evidence from your physician, radiology and surgery reports, and emergency room reports. Your disability attorney will also help you collect any additional evidence you may need including opinions from your doctor(s) on your physical or mental limitations…or both!
If your doctor is unable or unwilling to provide additional testimony on your behalf, then your disability attorney may also be able to help you find a doctor who will.
Arrange Additional Testing
Your disability attorney will be able to determine if you need additional tests done by medical professionals. Some of these tests may prove your disability in ways that you had not anticipated and ultimately add to the growing mountain of evidence that will help you win your appeal.
You may already be aware that your insurer is likely pursuing the same approach on this issue. There is a good chance your insurer will request a Functional Capacity Examination (FCE). If they do so, you need to consult with a long-term disability attorney as soon as possible. You should not undergo testing or evaluations at the request of the insurer you are fighting without having consulted your attorney.
A Disability Attorney Will Organize Third party reports
Your disability attorney will collect compelling third-party accounts of your condition and its inherent challenges from friends and family.
These reports will be first-hand observations about your medical issues and how those affect your ability to work.
For example, if your spouse has to help you in and out of the car, he/she should put that in their report.
Another example would be if your neighbor routinely has to help you carry your groceries because you are unable to lift them.
You can imagine there are a lot of ways these reports can help (or harm) your claim appeal. Having someone in the middle of collecting all this evidence, someone who has a grasp on the overall strategy of your appeal is critical.
Employment Retirement Income Security Act (ERISA)
A disability attorney who is knowledgeable about ERISA knows the ins and outs of what the insurance companies are looking for as well as any tricks they may have up their sleeves. They are also very knowledgeable about the strict guidelines needing to be met and the strict deadlines that need to be adhered to in an ERISA case.
If this is the first time you have ever hear of ERISA, here is an article covering the basics of ERISA covered disability policies.
Meeting All The Deadlines
ERISA lays out very strict deadlines for filing a long-term disability appeal. A good ERISA disability attorney will know these deadlines and help you meet them. They will make sure that all evidence and personal statements are turned in on time. On the surface, this seems like something everyone should be able to do. However, if you take into account all the items talked about in this article, and others that we only briefly mentioned, you begin to see that you do not have a lot of time to get your claim appeal ready and turned it.
Now is the time to reach out for help.