If your claim for long-term disability benefits has been denied or terminated, the next step is to submit an administrative appeal. These advanced strategies for long-term disability appeals can be expensive and are not used in every case, but they can be highly effective in select cases.
First of all, you might order your own testing to be done. You might have your file reviewed by experts, whether they be medical experts or vocational (job) experts. Let me give you some examples:
One of the things that the insurance company wants to know is what your functional limitations are as a result of your medical diagnosis. Let’s take fibromyalgia, for example:
Fibromyalgia, in and of itself, is a medical diagnosis. What your medical records might not show (and aren’t designed to show) is what your limitations are.
- How does it affect your ability to sit, stand, walk, bend, stoop, and twist?
- Do you experience fatigue?
- How often do you experience fatigue?
- How long can you exert yourself before you need to rest?
- How long do you need to rest before you can resume the activity?
You can see how your medical records aren’t designed to identify those limitations. You can ask your regular treating physician to complete a residual functional capacity (RFC) form or undergo a functional capacity evaluation.
Advanced Appeal Strategies
Functional Capacity Evaluations
That’s where a functional capacity evaluation—we call these FCEs for short—may come into play. In some cases where there’s insufficient objective medical testing, you might obtain a functional capacity evaluation to get a report that identifies your limitations. An FCE can be anywhere from three to eight hours long over one day or two days. It’s a comprehensive test designed to determine your physical limitations.
An FCE will result in a report that shows, based on that testing, how long you can stand and walk, how difficult it is to bend and stoop, and how much weight you can pick up and carry across the room. An FCE report can be used to identify whether you can perform work activities. These tests can cost thousands of dollars and are not appropriate or necessary in every case, but they are one advanced strategy.
Neurocognitive Evaluations
Another example is specific to claims relating to cognitive impairments like difficulty maintaining attention and concentration. Say you have a traumatic brain injury or something like that, and we’re trying to identify what kind of limitations you have, then you might have a neurocognitive test that’s been performed by a physician. This is a comprehensive medical exam where you meet with the physician for two, three, or four hours. Then, based on the testing performed, they can issue a report that identifies your cognitive deficits. That report can be critical in showing why you’d be limited in your ability to perform work activities.
Neuropsychological Testing
Another type is neuropsychological testing. This is similar to neurocognitive testing, but neuropsychological testing is more along the lines of how one’s depression, anxiety, or post-traumatic stress disorder results in limitations, which might impact one’s ability to work.
Vocational Assessments
Another advanced strategy is to order vocational testing, where you might have your file reviewed by a job expert. They will interview you, identify your job, get your job description from your employer, and try to determine whether that description is consistent with how the job is performed in the national economy. They’ll interview you to determine what your duties and responsibilities were on the job. Then, they will look at any opinions set forth by your doctors, such as the FCE, or if your doctor filled out another report identifying your limitations. They will then give an opinion as to whether they think you could work in the type of job you’ve done in the past or maybe some other kind of work, given the impairments identified in the literature. That type of report can be highly influential in showing the insurance company why you should be entitled to benefits.
Specialized Literature and Studies
Finally, let’s say that there might be some specialized medical literature or studies out there. We come across this with my clients who have rare diseases, diseases that their own doctors never heard of until they addressed this patient. You might introduce some medical literature or studies that have been performed to show how people with your type of condition are impaired. This is another relatively advanced strategy to get the insurance company to change its mind.
The Ortiz Law Firm Can Help You Utilize Advanced Strategies For Long-Term Disability Appeals
If you’d like to talk to someone about how we can assist you in developing this type of strategy in your case, I encourage you to give us a call at (888) 321-8131. We have successfully resolved thousands of long-term disability cases and want to help you with yours.
