Today, we will talk about the three steps you should take if you’ve been receiving long term disability benefits that have been terminated by the insurance company.
The first thing you need to do is request your claim file from the insurance company. Make sure the request is broad and asks for absolutely everything in your file. For example, you may ask for:
“The full disability insurance Claim File together with computer records, correspondence, and attorney or legal department review documents relating to the disability insurance claim and appeal. This includes, but is not limited to, hard copies and electronically generated or stored copies of all documents that reflect the administrative review process and procedures used by the insurance company and its representatives, the insurance company’s benefit manual, medical records, medical reviews, and investigative reports.”
The insurance company typically has up to 30 days to provide you with a copy of the file. This should contain all your medical records, as well as any records that the insurance company requested from their own doctors. It should also contain any surveillance video they’ve conducted and all the information you need to review before preparing your appeal.
Next, you need to prepare a plan for your appeal. Build a case by planning an attack with all the evidence they’ve provided. Firstly, if they hired a non-examining physician to review your file, then you need to challenge any findings that doctor made about your case. Secondly, if they sent you to an “independent” medical examination and that doctor made certain findings, you may need to work with your own doctors to refute some of those findings. Thirdly, they may have provided a vocational assessment, which is an evaluation of the types of jobs you may be capable of doing. You may need to develop your own vocational assessment to challenge theirs. Lastly, perhaps they conducted surveillance, and the footage is either inaccurate or of the wrong person. You should be prepared to challenge what they have on video.
Finally, the third step is to prepare your appeal and submit it. Review the denial letter carefully to determine the deadline to file an appeal, which tells you how much time you have to submit your written appeal. Often, you are given 180 days and you will typically need the entire 180 days. But we have seen situations where an appeal must be filed within 30, 60 or 90 days. Submit all the evidence you’ve prepared and supplement it with your own—this may include updated medical records, assessment forms from your own physicians, and perhaps even affidavits from you, friends, and family.
Another element to filing the appeal is providing legal reasoning as to why their decision was made in error. That’s where we can really assist you. We help challenge the legal rationale behind the decision to deny your claim and provide legal reasoning as to why the decision to terminate your benefits should be overturned.
If you would like assistance from an experienced long term disability attorney, you should request a free copy of a book that I wrote called “The Top 10 Mistakes That Will Destroy Your Long Term Disability Claim.” You can request a free download of the book at www.FreeLTDBook.com or give us a call today at (888) 321-8131. We look forward to hearing from you.