When your Long Term Disability insurance company sends you a letter concluding that you are somehow no longer eligible to receive your monthly benefit check, you must work to reverse this decision. Under the law, the insurance companies allow 180 days to file an appeal to try and convince the company to reverse its decision and start paying your disability benefits again. That being said, keep in mind you are sending your appeal to the same company that just decided that you are not entitled to any benefits and, accordingly, this appeal must be done very, very carefully. What you must realize is that if you lose this appeal, your only chance to reinstate your disability benefits is to file a lawsuit, and the court can only review the documents that are already in the insurance company’s claim file. This means that you cannot add any additional evidence after your appeal is decided. This is why it is critical that your appeal includes everything that will enable the court to decide the case in your favor. In other words, your appeal is your last chance to submit evidence proving that you are disabled, as defined by the policy.
This is where the law firm of Walker and Hern comes into the picture. We know what type of evidence must be obtained and put into your appeal papers to give you the best possible opportunity to reverse the insurance company’s decision. Each case is different, but there are some themes that we come across on a regular basis. Often, we see that clients must undergo a certain type of medical test to try to show, with objective evidence, that your disability is valid. An MRI, a CAT scan, and an EMG are some examples in this area. These tests often can demonstrate with certainty that you have a real disability that cannot be ignored. This type of testing might show an infection in a bone, a severely compromised lung or a permanently damaged nerve that renders you disabled. The insurance company will have a difficult time denying your benefits with this type of evidence, and if they uphold that position, the court will have that evidence to review, which may very well result in a decision in your favor.
Other situations call for us to retain the services of an employment specialist. This issue comes into play when the insurance company maintains that, while you may be somewhat limited due to your physical condition, you are still well enough to hold a job which will pay you enough to make you disqualified for benefits as per the language in the insurance policy. The specialist we retain will review your physical situation and the employment opportunities in your area of the country. Then he/she will give an opinion regarding the insurance company’s position that you are well enough to perform these jobs. We find that very often, our expert completely disagrees with the insurance company’s position, and that disagreement is clearly stated in a comprehensive evaluation document which we include as part of your appeal. Again, we will then have put into evidence effective proof on the central issue in your disability situation. Without this type of evidence, you can very easily lose your case.
Additionally, we will often have your medical condition assessed by physicians we retain and usually, their conclusions are the opposite of those drawn by the insurance company’s physicians. These evaluations are at times accompanied by articles from the medical literature which support your position. Again, we affirmatively put this documentation in your appeal papers, and it is then reviewed by both the insurance company on the appeal and the court if a lawsuit becomes necessary.
The takeaway here is that to give yourself the best opportunity to win your disability appeal, you must identify what type of additional evidence is required, and then obtain that evidence. This is a difficult task, and you are best served by having experienced lawyers doing this job for you.
Remember, for the most part, you only have one opportunity to reverse the decision against you, so you must be certain that you obtain all of the required evidence to present your case fairly and completely.
If you or someone you know is looking to receive long term disability benefits and needs the help of an experienced attorney, contact Walker & Hern today.