People who are on Long Term Disability often receive a very unpleasant letter from their insurance company stating that, for various reasons, the company has decided they no longer meet the definition of being “disabled” as that term is defined in the insurance policy.  This notification usually comes in the form of a long letter which discusses the company’s reasoning, in very complicated language. Unfortunately, the result is always the same–you will no longer receive a check from the company and you are “on your own.”
To almost everyone, this is a devastating blow, as your ability to have enough money to exist has just been taken from you.  The letter will say, on most occasions, that you have 180 days to file an appeal with the company to try to reverse this decision.   Now, unknown to you, the insurance company is hoping that you will file this appeal by yourself, without the assistance of an attorney, because they are betting that you will do so incorrectly, and their decision to cut you off will stand and no court will be able to reverse that decision.  So, the first lesson to be learned from this article is DO NOT FILE AN APPEAL BY YOURSELF!!!!!
You might think that the decision by the company is so outrageous that all you have to do is write a letter to the company and they will see the error of their ways and reinstate your payments. Unfortunately, this is incorrect.  The fact of the matter is that this appeal is your only hope of restoring your benefits, and, therefore, it must be done correctly, with all of the necessary information placed into the appeal document.  Having all of the required information in your appeal is critical because if you lose the appeal and then take your case to federal court, that court can ONLY decide your case on the information that is in your appeal.  You cannot add additional evidence after you lose the appeal.  This situation may very well cause you to lose your court case, terminating your benefits forever.
So, what can your lawyer do that you cannot do?  First, your lawyer will review your entire insurance company file and determine all of the documents that are missing and how to go about getting those documents.  You may require any of the following pieces of evidence to be placed in your appeal:
1.  A new physical examination by a physician who has the correct credentials to write a comprehensive document that will support your claim;
2.  A specific test like an MRI, CAT scan or an EMG which will look for objective evidence to support your claim;
3.  An evaluation by an occupational specialist who can professionally comment on the employment opportunities in your area and whether you are capable of actually performing the necessary work required;
4.  Up-to-date office records from your treating physicians in which there are comments placed that directly address the reasons that the insurance company has given to support cutting off your benefits;
5.  Any other evidence such as photographs, affidavits, etc which may bear on the issues at hand.
As you can see, the appeal is your opportunity to tell your story and you have to tell it completely with all of the necessary documents.  That is why you must know what you need and how to obtain it.  Without this knowledge and action, your appeal will not have the proper opportunity to be successful. Do not play into the hand of the insurance company. Instead, obtain experienced counsel to guide you through this complicated process. If you have any additional questions, call Walker & Hern today.
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