Hi, I’m Nick Ortiz. I’m a board certified disability insurance attorney and today I’m here to talk to you about why it’s important to tell your story to the insurance company during the appeal process.
What do I mean by your story?
So when you’re going through the application process, and when you’re filing for long term disability, or we call it LTD for short, they will typically send you an application that has a few pages of questions for you. And one of the questions is, “What is it about your condition that keeps you from being able to work?” And there might be two lines for you to fill in why you can’t work. So that’s one place where the insurance company might ask you about your condition and how it impairs you.
The only other place that you might explain to them is during the interview process.
So during the application process the insurance company will typically ask to perform a phone interview or send you a written questionnaire. And they’ll ask you to identify some of the problems that you have as a result of your condition. That structure doesn’t really give you a good opportunity to tell your whole story. And if you think about it, how motivated is the insurance company to ask you a series of questions that’s designed to really outlay the types of problems that you’re having that keep you from being able to work? They’re really not. So you need to reclaim the power in terms of establishing your case and you need to tell your story in a way that the insurance company is able to recognize why it is you’re unable to work. And that’s why this is one of the most important components to an appeal, I believe, is your story.
Now how do you do that? We typically do it in our office in the form of an affidavit. And what we’ll do is we’ll send our clients a detailed questionnaire asking them about their daily life, and then what kind of problems they have in their daily life. How long they can do certain activities before they need to take a break. How long do they need to take a break before they can resume those activities. And so we go over a series of questions that are tailored towards our client’s particular medical condition as well that are meant to identify the types of problems that they have that keep them from working.
What you want to do is really lay it out for the insurance company in a way that they can understand why it is you can’t do work activity. And you do that by showing what kind of difficulties you have in your daily life.
Let me give you an example. Let’s say I have a client who has severe back pain disorder. They have multiple herniated discs, and it really impacts what they do. For example, they can’t lift more than five pounds to carry across the room. Due to extreme pain, they have to lie down several times a day, or several hours each time to relieve the pressure and pain in their back. That’s the kind of limitation that we want to set forth in the sworn statement.
Let me further explain why it’s so important that this type of what we call testimonial evidence is in your file. As you’ll learn from other videos that we’ve recorded, your ability to introduce evidence if your case needs to go to trial in an ERISA case is extremely limited.
In fact, you won’t be allowed to testify. Your friends and family won’t be allowed to testify. Your doctors won’t be allowed to testify. So the reality of the situation is this sworn statement is your way of testifying in your case. That’s why we even do these in a sworn statement or affidavit format where it’s under penalty of perjury that our clients are swearing as to their limitations because again this is a way for the judge, if your case needs to go to trial, is able to see how your conditions have impacted your daily life. And you can see how by putting it forth in a sworn statement document or an affidavit, it’s controlling the way that it’s set forth to the insurance company, and it’s going into a lot more detail than they may have asked you at the very beginning of the case.
You may do the same thing with co-workers, friends, family members, former supervisors or bosses. If you can get statements from them as well, that can be hugely influential in establishing additional evidence to support your case.
I can tell you that when people do write letters that kind of set forth limitations that they have to the insurance company, they tend to be very basic. They tend not to be very detailed. They don’t identify specific levels of impairment. They tend to just appeal more to the emotions saying, “Look, I’ve worked hard my whole life “and I just can’t do it any more.” But you can see how a statement like that, while it is designed to appeal to one’s sympathy or empathy, it doesn’t really get into the nitty gritty detail about, okay, well why. How long can you do work activity? Is it 10 minutes, 30 minutes, an hour? How long do you need to rest after 30 minutes of activity? So that type of identification of impairment is extremely different than saying, “I’d be working if I could.” So we help our clients identify the levels of impairment and set it forth in a way that the insurance company can use to properly evaluate your claim.
Another reason why we like sworn statements or affidavits is it also gives you an opportunity to address some comments that were maybe made by the insurance company in the denial letter, if you believe that there is factual inaccuracies. If the insurance company did surveillance on you and you can address some of what the surveillance video shows, it’s your chance to address that.
The next thing is as you can tell from some other videos that we’ve recorded, the insurance company has probably conducted a lot of surveillance, and they’ve also looked into your social media profile including Facebook, Twitter, and others. They will probably have a printout of some of your Facebook posts. If you have Twitter posts and things like that, this will be your opportunity to explain what you meant by some of your posts. Or if they don’t tell the whole story, you can give a little background as to why you were able to do certain things on certain days and address what’s in your file.
If you’d like to talk to us more about this, then I encourage you to give us a call at 850-898-9904. If you’d like additional information about the long term disability process, then I encourage you to download a free copy of a book that I wrote called “The Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim”. You can get a free copy of the book at www.freeltdbook.com. We look forward to hearing from you, and have a great day.