Your long term disability appeal should be in writing and clear as to its intent. For example, you may start your appeal letter with a sentence like, “Please accept this letter as my formal appeal of your adverse decision dated [date of denial/termination letter].” You should make your appeal letter more of a cover letter, telling the insurance company why you disagree with its decision and what medical evidence the claims handler will find in your appeal packet that will change the denial into an approval.
Remember: any information you fail to submit with your disability appeal may never be heard or considered by a court of law in a lawsuit or litigation. If your appeal is denied, you may not have another opportunity to submit new evidence. You should carefully consider all the information you want to include with your disability appeal letter before sending it to the insurance company via certified mail, fax, or e-mail. You can find the contact information to which you must submit your appeal letter in your long term disability claim denial letter.
Medical Evidence to Support Your Long Term Disability Appeal
Your appeal should include updated medical evidence and physicians’ opinions as to your limitations, all of which should work to satisfy the disability policy and plan’s definition of disability. Review your long term disability claim file and determine if your medical records are missing. Missing records could be why your claim was denied in the first place, so you should identify and obtain any medical records not in your claim file.
You should not rely upon your claims handler to accurately conclude how your condition impairs your ability to work solely from the medical records alone. Instead, you should ask your doctor to thoroughly explain in writing how your medical conditions impair your ability to perform work activities or even routine activities of daily living. Your doctors’ opinions may be in a narrative statement, a Residual Functional Capacity form, or a Medical Source Statement. Submit this form with your long term disability appeal letter. It will create a clearer picture of the difficulties you are having and why you cannot sustain competitive employment.
You may also document the side effects of the medical treatment itself and how negative side effects impair your ability to work in your appeal. For example, you may be taking medications with a very heavy sedative effect, making it impossible to stay awake. What you do to treat your medical conditions can have just as much of an effect on your ability to perform work activities as the sickness or injury itself. As such, make sure you and your doctors identify any medications you are taking or treatments you are undergoing and the side effects.
Note: You should not limit yourself to written reports solely from your primary care physician. Although you will likely have one main family doctor who treats you for your overall health, you might also have had treatment from specialists for certain conditions. Ask for support for your disability claim from these specialists as well. The more medical evidence you have and the more doctors you have to identify your limitations and restrictions, the stronger your long term disability claim becomes.
Non-Medical Evidence to Support Your Long Term Disability Appeal
You can also get statements from people other than your medical doctor to support your disability claim. For example, if you suffer from a sickness (as opposed to an acute injury), your employer certainly should have some knowledge that something changed over time that caused you to be unable to work. You could, therefore, obtain written support from your employer about your dwindling performance. You should also request a copy of your personnel file. This type of information may show a history of good performance reviews, with the only negative reviews coming towards the end of your employment.
Who else can you think of? Brainstorm! Keep the evidentiary support going. Obtain written statements from friends and family in your personal life. While they may not be medical experts, a spouse, pastor, family member, close friend, or former co-worker can all provide excellent insight into your daily struggles. You can support your long term disability appeal with third-party statements regarding changes to your daily activities, social life, etc.
Vocational Assessment
You may also consider submitting a professional vocational assessment or an evaluation from a “job expert” stating why you cannot work with your medical impairments. This is one of several advanced appeal strategies. It can be especially helpful if the insurance company obtained a vocational assessment as part of its review that led to the denial of your claim. The expert hired by the insurance company is supposed to be an impartial expert, but that is rarely the case when they rely on the insurance company for a paycheck.
Legal Representation for Your Long Term Disability Appeal
Although based in Florida, the Ortiz Law Firm represents disability insurance claimants across the United States. If your long term disability claim has been wrongfully denied, delayed, or terminated, and you’d like to speak to an experienced long term disability attorney, call us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine how to proceed with the long term disability insurance appeal process.
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