Hi, I’m Nick Ortiz, I’m a Board Certified Disability Attorney in Florida. Today I’m here to talk to you about what to do if your long term disability claim is denied. The first thing I want to get out of the way is that this primarily applies to ERISA governed plans, that is, plans that are part of a group employer plan, and is not meant to apply to individual disability plans.
The first thing that you must do is that you must act within the time limits required by the denial letter. What that means is the denial letter should set forth the amount of time that you have to bring an appeal. In most cases, that’s 180 days to file your appeal. However, in some instances, that amount of time may be less, so you must look at the denial letter to determine the time.
Second, you should request a copy of your entire claim file. This is all the evidence that the insurance company has on your case in their file. This may include their internal correspondence between each other, this includes their correspondence to their doctors and nurses, this includes all the correspondence to and from you. It includes all your medical records and other vocational evidence in your file. You need to have all this information so that you can know how to go about filing your appeal.
The next thing that you must do is evaluate the reasoning behind the denial. For example, they may have sent you for a compulsory medical examination, and their doctor wrote a report about what you can and can’t do. You want to have a copy of that report so that you can attack the reasoning behind their doctor’s assessment of your abilities.
Next, they may have conducted surveillance of you, video surveillance where they recorded your daily activities on one or more days. You wanna have a copy of the video so a) you could determine if that’s really you in the video, and b) so that you can explain what you were doing when they were recording you.
Next, you want to review their vocational assessment. What that means is, an insurance company will typically refer your file out to a job expert to determine what your job was and what your responsibilities were within that job. However, they may not have even identified the correct occupation, so you may need to have your own vocational professional provide an assessment of what your actual job title was, and what your individual responsibilities were.
Finally, what you want to do is attack the reasoning. The insurance company will set forth all the reasons why it’s denying your case, so you want to go step by step and attack the evidence and the reasoning behind their decision. One of the ways that you might do so is perhaps through an affidavit where you swear under penalty of perjury about certain facts that may directly refute some of the facts that they’ve put in their denial letter. I’ve even seen some individuals prepare a day-in-the-life video where they may have someone, a videographer, follow them around to really give insight into the problems that you have on a day-to-day basis, and again, the idea of this is to go against any surveillance video that they may have on you.
One of the most important pieces of evidence that you have is to provide updated medical evidence for your file. Often times, by the time the insurance company has made its decision, you may have been to the doctor numerous more times, and you wanna get any updated medical evidence on record in your claim as part of your appeal. And then if the insurance company is saying that there’s insufficient medical evidence to support your claim, then you may try to go out and get additional evidence, whether it be an MRI, maybe an additional x-ray to support your claim. These are objective medical findings that can really go far to support a physical disability claim. On the mental health side, you might have a neuropsych testing done. That will show any cognitive impairments you may have as a result of your condition.
So putting together all this evidence can take anywhere from two to three to the full six months, remember that’s why they give you 180 days, because sometimes it takes that entire amount of time to prepare a good appeal for your case. If you want some assistance in your case, then I wrote a book called the Top 10 Mistakes That Will Destroy Your Long Term Disability Claim. You can request a free download copy of this at www.freeltdbook.com or give my office a call at 850-898-9904 and we’d be glad to go over your legal options with you. We look forward to hearing from you. Thanks.